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Bacterial KeratitisBacterial Keratitis is generally predisposed by trauma, but other local and even systemic conditions may compromise the host's natural and acquired defense against pathogenic organisms. Systemic factors include immune deficiency diseases, alcohol abuse, aging, and vitamin deficiency. Local factors include Keratoconjunctivitis Sicca (dry eye syndrome), poor epithelial adherence, contact lens wear, and chronic herpes simplex Keratitis.
Fungal KeratitisFungal infections of the cornea are almost always preceded by trauma. Filamentary infections are especially likely to occur in agricultural settings. Some examples of filamentary causative fungi, usually considered to be saprophytic, include organisms such as Fusarium, Aspergillus's, and Penicillium. Yeast infections occur most often in the structurally altered external eye, e.g., the dry eye or the immunologically incompetent individual.
Initial antibiotic therapy, the second step, should be determined by epidemiology, clinical characteristics, and early testing evaluations. For example, a rapidly progressing corneal ulcer in a patient with extended-wear lenses should suggest Pseudomonas (rod bacteria frequently found in solutions) as the responsible organism. Initial broad-spectrum coverage should include topical cefazolin or cefamandole and tobramycin or gentamicin. Bacterial keratitis caused by Neisseria species requires systemic antibiotics such as ceftriaxone or penicillin.
Although several promising antifungal agents are currently under investigation, the availability of approved drugs is severely limited. Only pimaricin is commercially available as an ophthalmic preparation. It is effective for a variety of fungal infections, however, it is expensive and may require extended use. Yeast infections can be treated by the addition or oral or topical Flucytosine. Only the oral form is available commercially.
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