Keratitis is an inflammation of the cornea, the clear, dome-shaped surface that covers the front of the eye. It can be caused by infections (bacterial, viral, fungal, or parasitic) or non-infectious factors like injury or dry eyes. The treatments for keratitis vary widely depending on the cause, severity, and specific characteristics of the infection or inflammation.
**Bacterial Keratitis Treatment**
Bacterial keratitis is often treated aggressively because it can rapidly damage the cornea and threaten vision. The mainstay of treatment is antibiotic eye drops. Initially, broad-spectrum antibiotics are used to cover the most common bacteria, such as Staphylococcus aureus and Pseudomonas aeruginosa. Fortified antibiotic eye drops, such as vancomycin combined with tobramycin, are often prescribed for severe infections or when resistant bacteria are suspected. These fortified drops have higher concentrations than standard antibiotics and are prepared by compounding pharmacies.
Treatment usually begins with frequent administration—sometimes every hour around the clock—to quickly control the infection. As the infection improves, the frequency is gradually reduced. Daily follow-up with an eye specialist is essential to monitor healing, check for complications, and adjust treatment. If the infection worsens or does not respond, additional measures may include repeat cultures, adding or changing antibiotics, subconjunctival antibiotic injections, or even hospitalization for intensive treatment.
In cases where the cornea develops a small perforation (less than 2 mm), corneal gluing and bandage contact lenses may be used to promote healing. Larger or non-healing ulcers may require surgical intervention such as lamellar or penetrating keratoplasty (corneal transplant). Surgery is also considered if there is scleral extension of the infection or risk of vision loss. For patients with poor eyelid closure or nerve damage to the cornea (neurotrophic keratitis), procedures like tarsorrhaphy (partial eyelid closure) may be necessary to protect the eye and aid healing.
**Viral Keratitis Treatment**
Viral keratitis is most commonly caused by herpes simplex virus (HSV) or adenovirus. Herpetic keratitis is treated primarily with antiviral medications. Topical antiviral eye drops such as trifluridine, ganciclovir gel, or oral antivirals like acyclovir are used to reduce viral replication and speed healing. Early treatment is important to prevent deeper corneal involvement and scarring.
For epidemic keratoconjunctivitis (EKC), caused by adenovirus, there is no definitive cure. Treatment focuses on symptom relief using cold compresses, artificial tears, and sometimes topical cycloplegics to reduce pain and light sensitivity. Topical corticosteroids may be prescribed in severe cases to reduce inflammation, but they must be used cautiously because they can prolong viral shedding and worsen the infection if used improperly. Antiviral agents like ganciclovir gel have shown some promise in shortening the disease course and reducing complications, but more research is needed. Povidone-iodine eye drops have also been studied for their antiseptic properties to reduce viral load and inflammation.
**Fungal Keratitis Treatment**
Fungal keratitis requires antifungal medications, which are often more difficult to treat than bacterial infections. Common antifungal eye drops include natamycin, voriconazole, and amphotericin B. Treatment usually involves frequent application of these drops for several weeks to months, depending on the severity. Fungal infections tend to respond more slowly, and close monitoring is essential.
In some cases, adjunctive therapies such as corneal collagen cross-linking (a procedure that uses ultraviolet light and riboflavin to strengthen corneal tissue and reduce infection) or Rose Bengal photodynamic antimicrobial therapy may be used to help control fungal keratitis, especially when the infection i
