Emergency: requires immediate attention
Bacterial corneal ulcer - External and Internal Eye
Alerts and Notices
Synopsis
Risk factors that can lead to bacterial keratitis include contact lens wear, eye trauma, previous ocular surgery, dry eye, immunosuppression, and any other process that causes breakdown of the ocular surface.
Patients with a bacterial corneal ulcer will complain of eye pain, light sensitivity, red eyes, and possibly reduced vision. The rapidity of the onset and progression of symptoms depends on the virulence of the bacteria causing the infection.
History is very important in giving clues as to the most common organism causing the infection. Bacterial keratitis in a contact lens wearer is frequently caused by gram-negative organisms, such as Pseudomonas aeruginosa, whereas ulcers in patients with blepharitis are more commonly due to gram-positive organisms.
Note: Per January 20, 2023, the Centers for Disease Control and Prevention (CDC) is investigating a multistate cluster of carbapenem-resistant Pseudomonas aeruginosa with Verona integron-mediated metallo-β-lactamase and Guiana extended-spectrum-β-lactamase (VIM-GES-CRPA). As of March 14, 2023, the CDC identified 68 patients in 16 states with with VIM-GES-CRPA. At this time, CDC and FDA recommend clinicians and patients stop using EzriCare or Delsam Pharma's Artificial Tears products. The isolates have remained cefiderocol sensitive.
Codes
ICD10CM:H16.009 – Unspecified corneal ulcer, unspecified eye
SNOMEDCT:
231893002 – Bacterial corneal ulcer
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Fungal keratitis
- Acanthamoeba keratitis
- Herpes simplex virus (HSV) stromal keratitis
- Sterile ulcer
- Corneal foreign body
- Corneal scar
- Although rare, acute keratitis can be caused by a direct bee sting (see, eg, bumblebee sting, honeybee sting)
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:06/26/2019
Last Updated:04/09/2023
Last Updated:04/09/2023
Emergency: requires immediate attention
Bacterial corneal ulcer - External and Internal Eye