Management approach for bacterial and fungal corneal ulcers

Abstract

Infectious keratitis is an ocular medical emergency. Corneal infections remain a serious cause for concern regarding increasing ocular morbidity in developing nations. Trauma-induced bacterial and fungal keratitis are preventable entities. Contact lens-associated keratitis and postrefractive surgery keratitis are emerging in higher proportions in developed countries around the world. Noninvasive methods and molecular techniques have improved diagnosis of infectious keratitis. Fortified topical antibiotics and fluoroquinolones are still the mainstay of bacterial keratitis therapy. The fourth-generation fluoroquinolones, such as moxifloxacin and gatifloxacin, have enhanced activity against Gram-positive bacteria while retaining potent activity against most Gram-negative bacteria. These fourth-generation fluoroquinolones have improved penetration into the anterior chamber and better in vivo efficacy. Besides available commercial antifungal preparations, voriconazole and new routes of administration of conventional antifungals appear promising for fungal keratitis management. Improved modalities of diagnosis and treatment have enhanced the outcome of infectious keratitis; however, therapy of fungal and Pseudomonas aeruginosa keratitis still remains a challenge.