**5. Complications of infectious keratitis**

Despite timely and appropriate topical antibiotic treatment, surgical interventions such as tectonic or therapeutic keratoplasty may be required to preserve the eye and vision [91]. However, performing keratoplasty in a "hot eye" is associated with

**17**

*Infectious Keratitis: The Great Enemy*

primary care level is needed [93].

**6. Prevention of infectious keratitis**

development of infectious keratitis [24].

**7.1 Steroids for Corneal Ulcers Trial (SCUT)**

**7. Update of major clinical trials about common pathogens**

The large, randomized, placebo-controlled, double-masked multicenter clinical trial that compared 12 months clinical outcomes in patients receiving adjunctive topical 1.0% prednisolone sodium phosphate or topical placebo in the treatment of bacterial keratitis found that adjunctive topical corticosteroid therapy may improve

best spectacle-corrected visual acuity (BSCVA) in bacterial corneal keratitis

*DOI: http://dx.doi.org/10.5772/intechopen.89798*

an increased risk of recurrence of the disease and graft rejection/failure [91]. The visual outcomes of infectious keratitis may be poor from various complications such as corneal scarring or perforation, irregular astigmatism, development of glaucoma, cataracts, endophthalmitis, and vision loss [92]. Moreover, the advanced infectious keratitis that required therapeutic keratoplasty had decreased quality of life. The characteristics associated with corneal perforation in infectious keratitis were the lack of corneal vascularization, delay in starting initial treatment, and failure to start fortified antibiotics [42, 93]. Inappropriate use of traditional medicines or topical steroids abuse and delay in referral to an ophthalmologist for diagnosis and treatment are all responsible for unnecessary visual loss [24]. The primary care provider should be aware about complication of infectious keratitis. The standardized referral and treatment guideline for patients with infectious keratitis on their first contact at

Due to the magnitude of the problem, limited access to treatment, inadequate well-trained medical personnel, costs of treatments, and the often poor visual outcomes, prevention may be one of the feasible public health strategies available [5, 34]. Avoiding or correcting predisposing factors may reduce the risk of keratitis [44]. Patients with risk factors for keratitis should be educated about their risk, made familiar with the signs and symptoms of keratitis, and informed that they have to consult an ophthalmologist promptly if they encounter such warning signs or symptoms to minimize permanent visual loss [44, 94]. In the developed countries, infectious keratitis is usually associated with contact lens wear, but in developing countries, it is commonly caused by trauma during agricultural work [8–10, 13]. Interestingly, data from the recent trial reported that "Up to 50% of contact lens wearer are not compliant with hand washing procedures" [95]. Poor hand hygiene is a risk factor of developing infectious keratitis in contact lens wearers [95]. Developing effective prevention strategy that is circulated to contact lens users is crucial to reduce the incidence of infectious keratitis [40]. Although the use of protective eyewear in industrial and agricultural work can prevent ocular injury, the actual utilization of such protective eyewear has been found to be consistently low, even in industrialized countries with robust workplace safety regulations [34]. The protective eyewear during these works should be compelled. The outcome of corneal injury with secondary infection can be improved by early diagnosis and prompt treatment with appropriate antibiotics at the primary level of eye care [24]. Because most cases of infectious keratitis are the result of corneal trauma, the use of 0.5–1% chloramphenicol eye ointment three times per day for 3 successive days for superficial corneal trauma in primary care is recommended by WHO to prevent the

#### *Infectious Keratitis: The Great Enemy DOI: http://dx.doi.org/10.5772/intechopen.89798*

*Visual Impairment and Blindness - What We Know and What We Have to Know*

cataract, chorioretinitis, and retinal vasculitis [89].

tion and after corneal laser refractive surgery [36, 43, 90].

1.Diamidines (propamidine and hexamidine)

and itraconazole)

interval to avoid the late recurrence [62].

**5. Complications of infectious keratitis**

3.Aminoglycosides (neomycin and paromomycin)

2.Biguanides (polyhexamethylene biguanide and chlorhexidine)

4.Imidazole/triazoles (voriconazole, miconazole, clotrimazole, ketoconazole,

Unfortunately, only the biguanides have been proven to be effective against both the cysts and trophozoite forms of Acanthamoeba [43]. The combination therapy may be of benefit [89]. The earlier the diagnosis, the better the chances of having a good visual prognosis [43]. In the early stage, epithelial debridement and 3 to 4 months of anti-amoebic therapy are enough [45]. Confocal microscopy is the most suitable tool to monitor the keratitis during the course of treatment [62]. However, after a prolonged and maximal medical treatment, recurrence can occur. Topical corticosteroids may mask clinical signs of Acanthamoeba keratitis, encystment, and an increase in number of trophozoites [89]. However, a patient with Acanthamoeba keratitis and severe inflammation may also benefit from this drug [89]. Optical keratoplasty may be considered after 3 to 6 months disease-free

Despite timely and appropriate topical antibiotic treatment, surgical interventions such as tectonic or therapeutic keratoplasty may be required to preserve the eye and vision [91]. However, performing keratoplasty in a "hot eye" is associated with

*4.4.3 Risk factors*

*4.4.4 Treatment*

[36]. Limbitis is a common feature in both early and advance disease [36]. If not managed properly, the disease can progress and late stage findings can develop such as scleritis, iris atrophy, anterior synechiae, secondary glaucoma, mature

The majority of cases are found in contact lens wearers [43]. Infections related to contact lens are often associated with improper wear such as poor cleaning, overuse, and sleeping or swimming with them [36]. Other risk factors for Acanthamoeba keratitis are cornea trauma or exposure to contaminated fresh water, soil, or vegeta-

There are two principal issues that lead to severe visual outcomes that are misdiagnosis or late diagnosis, and lack of a fully effective therapy for highly resistant cyst stage of Acanthamoeba [36]. The current diagnostic techniques are insensitive and poor turn around time. Moreover, the better yields and rapid test such as PCR or IVCM are not widely available [62]. This keratitis should be treated as soon as possible to prevent loss of visual acuity or even blindness [36]. Thus, ophthalmologists should be familiar with varied clinical pictures of Acanthamoeba keratitis. Currently, there are n0 FDA-approved medications for Acanthamoeba keratitis [62]. Treatment for Acanthamoeba keratitis includes the following medications [62]:

**16**

an increased risk of recurrence of the disease and graft rejection/failure [91]. The visual outcomes of infectious keratitis may be poor from various complications such as corneal scarring or perforation, irregular astigmatism, development of glaucoma, cataracts, endophthalmitis, and vision loss [92]. Moreover, the advanced infectious keratitis that required therapeutic keratoplasty had decreased quality of life. The characteristics associated with corneal perforation in infectious keratitis were the lack of corneal vascularization, delay in starting initial treatment, and failure to start fortified antibiotics [42, 93]. Inappropriate use of traditional medicines or topical steroids abuse and delay in referral to an ophthalmologist for diagnosis and treatment are all responsible for unnecessary visual loss [24]. The primary care provider should be aware about complication of infectious keratitis. The standardized referral and treatment guideline for patients with infectious keratitis on their first contact at primary care level is needed [93].
