Bacterial and Fungal Keratitis
摘要
Infectious keratitis or corneal ulceration is a medical emergency with an incidence ranging from approximately 10 per 10,000 individuals in tropical and developing nations to 10 per 100,000 in more temperate climates in developed nations [1]. Corneal infection is normally prevented by the ocular adnexa; rapid tear turnover from blinking and antimicrobial properties in the tear film reduce pathogen exposure to the cornea surface [2]. However, risk factors such as trauma, contact lens wear, ocular surface disease, and corneal surgery can cause breakdown of the corneal epithelial barrier and promote adherence and penetration of an infectious pathogen [3]. Specifically for contact lenses, overnight wear, failing to wash and dry hands prior to handling lenses, and poor storage case hygiene can increase the risk of infection [4]. This results in an inflammatory cascade that produces inflammatory cells and cytokines such as interleukins and matrix metalloproteinases. While these have antimicrobial functions, they also degrade the corneal structural proteins and result in ulceration of the corneal stroma [5]. Progression of this process can cause corneal perforation and intraocular extension of infection that may result in loss of the eye from endophthalmitis. Even with appropriate treatment, there is a high incidence of visual loss due to the development of corneal scarring and irregularity. Thus, rapid diagnosis and aggressive management of infectious keratitis are needed to maintain the integrity of the eye. The estimated yearly incidence of blindness from corneal ulceration is 1.5 million worldwide, and over 840,000 in India alone [6]. In addition, the financial burden and time invested in treatment cannot be ignored. Microbial keratitis costs the US health care system an estimated $175 million in direct health expenditures [7].