corneal abscess

A corneal abscess, also known as a corneal ulcer or microbial keratitis, is a serious and potentially sight-threatening condition that affects the clear layer in front of the iris and pupil (cornea). It is characterized by an open sore or wound on the cornea, usually caused by an infection.

Causes and Symptoms

• A corneal abscess can be caused by bacterial, viral, or fungal infections.
• The symptoms include:
  • Severe eye pain
  • Redness and swelling of the eye
  • Discharge or pus from the eye
  • Blurry or hazy vision
  • Sensitivity to light (photophobia)
  • Very painful and watery eyes

Complications

If left untreated, a corneal abscess can lead to serious complications, including:

• Endophthalmitis: a severe inflammation of the inner eye that can cause blindness
• Corneal perforation: a hole in the cornea that can lead to vision loss or even blindness
• Blindness

Treatment and Prevention

A corneal abscess requires prompt medical attention. Treatment typically involves antibiotics, antiviral medications, or antifungal agents, depending on the cause of the infection. In some cases, surgery may be necessary to repair any damage to the cornea.

To prevent a corneal abscess, it is essential to:

• Practice good hygiene and eye care
• Avoid sharing makeup or contact lenses
• Get regular eye exams
• Wear protective eyewear when engaging in activities that could potentially harm the eyes

References

• [1] A corneal ulcer is an open sore on your cornea that can be caused by a virus or bacterial infection. Learn more about the causes, risk factors, symptoms, diagnosis, treatment, prevention, and outlook for a corneal ulcer.
• [3] Symptoms · Blurry or hazy vision · Eye that appears red or bloodshot · Itching and discharge · Sensitivity to light (photophobia) · Very painful and watery eyes ...
• [13] Bacterial keratitis or corneal ulcer is a common sight-threatening ocular corneal pathology. In some cases, there is rapidly progressive stromal inflammation. If untreated can lead to progressive tissue destruction, corneal perforation, or extension of infection to adjacent tissue.
• [15] Keratitis, also known as a corneal ulcer, is an inflammation or irritation of the cornea. Although treatable, this condition is the most common cause of corneal blindness through an infection in the United States.

Corneal Abscess Signs and Symptoms

A corneal abscess, also known as a corneal ulcer or keratitis, is an open sore on the cornea that can be caused by a bacterial, fungal, viral, or parasitic infection. The signs and symptoms of a corneal abscess can vary depending on the severity of the infection, but common symptoms include:

• Blurry or hazy vision: This is often one of the first symptoms of a corneal abscess, as the infection causes inflammation and damage to the cornea (1).
• Eye that appears red or bloodshot: The eye may appear red, pink, or even have a yellowish tint due to the presence of pus or other discharge (2-5).
• Itching and discharge: You may experience itching or irritation in your eye, accompanied by a thick, sticky, or watery discharge (4-6).
• Sensitivity to light (photophobia): The affected eye may be extremely sensitive to light, making it painful to look at bright lights or even everyday activities like reading or watching TV (5-7).
• Very painful and watery eyes: The eye may feel very painful, with a sensation of burning or stinging, accompanied by excessive tearing or watering (5-8).

Other symptoms

In addition to these common symptoms, you may also experience:

• Feeling of having something in your eye: You may feel like there's an object or debris stuck in your eye, even though nothing is actually present (6).
• Inflammation and soreness: The affected area around the eye may become inflamed and sore to the touch (6-8).
• Swollen eyelids: In some cases, the eyelid on the affected side may become swollen or puffy due to the infection (6).

Important note

If you suspect that you have a corneal abscess, it's essential to seek medical attention immediately. Untreated corneal abscesses can lead to serious complications, including vision loss and even blindness.

References:

(1) [Search result 1] (2-5) [Search results 2-5] (6) [Search results 6-8] (7) [Search result 7] (8) [Search results 8]

Diagnostic Tests for Corneal Abscess

To diagnose a corneal abscess, several diagnostic tests can be performed to confirm the presence and extent of the infection.

• Fluorescein stain: A special dye called fluorescein is used to light up any damage to the cornea, making it easier to visualize the abscess. [5]
• Cultures of scrapings from the ulcer: A sample of cells from the affected area is taken and sent for laboratory analysis to determine the type of bacteria causing the infection. [4], [14]
• Confocal microscopy: This non-invasive test uses a special microscope to examine the cornea in detail, helping to identify the presence and extent of the abscess. [2]
• High-definition (HD) photography: High-quality images are taken of the affected area to document the progression of the infection and monitor the effectiveness of treatment. [2]

Additional Tests

Other tests may also be performed to support the diagnosis, including:

• Keratometry: This test measures the curve of the cornea to ensure that it is not significantly affected by the abscess.
• Pupillary reflex response: The pupillary light reflex is tested to assess the function of the iris and pupil.

Laboratory Analysis

The sample taken from the affected area may also be sent for laboratory analysis, including:

• Sensitivity testing: This test helps guide the de-escalation of broad-spectrum antibiotics and ensures that the most effective treatment is used. [13]

These diagnostic tests are essential in confirming the presence and extent of a corneal abscess, allowing healthcare providers to develop an effective treatment plan.

Treatment Options for Corneal Abscess

Corneal abscess, also known as bacterial keratitis, requires prompt and effective treatment to prevent complications such as corneal perforation. The primary goal of drug treatment is to eliminate the infection and promote healing.

• Topical Antibiotics: Topical antibacterial drugs are the mainstay in managing corneal abscess cases [15]. Fluoroquinolones, aminoglycosides, and cephalosporines are commonly used antibiotics for treating bacterial keratitis. However, it's essential to note that these antibiotics may demonstrate reduced efficacy against certain bacterial isolates [12].
• Fluoroquinolone Monotherapy: Commercially available fluoroquinolone monotherapy is a viable treatment option for corneal infections [11]. This approach can be effective in eliminating the infection and promoting healing.
• Combination Therapy: A combination of fortified antibiotics, such as cefazolin 5% and tobramycin or gentamicin 1.4%, may also be used to treat bacterial keratitis [11].
• Steroidal Anti-Inflammatory Agents: Steroidal anti-inflammatory agents, like prednisolone acetate, are sometimes used in conjunction with antibiotics to reduce inflammation and promote healing [7].

Important Considerations

• Prompt Treatment: Empirical antibiotic therapy should be initiated promptly to prevent complications and promote healing.
• Microbiological Testing: Microbiological testing is essential to guide treatment decisions and ensure that the most effective antibiotics are used.
• Follow-up Care: Regular follow-up visits with an eye care provider are crucial to monitor the progression of the infection, adjust treatment as needed, and prevent complications.

References

[7] DH Dang · 2022 · Cited by 45 — Steroidal anti-inflammatory agents are frequently used as part of the therapeutic regimen. [11] Empirical antibiotic therapy should be promptly started and there are broadly two treatment options available [Table 1]. [12] With respect to corneal infections, the most commonly used antibiotics (fluoroquinolones, aminoglycosides, and cephalosporines) are demonstrating reduced efficacy against bacterial keratitis isolates. [15] Topical antibacterial drugs are the mainstay in management of these cases.

Differential Diagnosis of Corneal Abscess

A corneal abscess, also known as a suppurative corneal ulcer, is a serious eye condition that requires prompt attention. The differential diagnosis of a corneal abscess involves considering various causes of the condition, including infectious and non-infectious etiologies.

Infectious Causes:

• Bacterial keratitis (resulting from bacterial infections such as Staphylococcus aureus or Pseudomonas aeruginosa) [10]
• Fungal keratitis (caused by fungal infections like Fusarium or Aspergillus) [11]
• Viral keratitis (resulting from viral infections such as herpes simplex virus) [7]

Non-Infectious Causes:

• Corneal abrasion involving the corneal epithelium only [9]
• Dry eye disease (keratoconjunctivitis sicca) [4]
• Atopic keratoconjunctivitis (AKC) [3]
• Band keratopathy [3]

Other Considerations:

• Corneal ulcers can also be caused by trauma, chemical burns, or other forms of eye injury.
• Systemic conditions such as diabetes, autoimmune disorders, or nutritional deficiencies may contribute to the development of a corneal abscess.

It is essential to note that a detailed history and thorough clinical examination using the slit-lamp biomicroscope are crucial steps in diagnosing a corneal abscess. A break in the continuity of the corneal epithelium can be an indicator of infection, but clinical signs may not always confirm the presence of infection.

References:

[3] Atopic Keratoconjunctivitis (AKC) - Differential Diagnoses [4] Emergency Care of Corneal Abrasion [7] Symptoms of Corneal Ulcer [9] Cited by 15 - The differential diagnosis of corneal ulceration is corneal abrasion involving the corneal epithelium only. [10] Bacterial keratitis or corneal ulcer is an infection of the corneal tissue caused by varied bacterial species. [11] Filamentous fungi appear as hyperreflective, linear opacities with a diameter of 3-8 µm, 200-400 µm long, and irregular branching.