[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
January 1996

Empirical or Culture-Guided Therapy for Microbial Keratitis?A Plea for Data

Author Affiliations

From the Department of Ophthalmology, Doheny Eye Institute, Los Angeles, Calif.

Arch Ophthalmol. 1996;114(1):84-87. doi:10.1001/archopht.1996.01100130080013

In the United States, about 30 000 bacterial corneal ulcers are treated annually.1 Compared with 100, or even 20, years ago ophthalmologists today have available to them many diagnostic tools (including special media and bacterial identification techniques), and an impressive assortment of antibiotics.2-4 Many reviews and book chapters describe the uses of microbiologic studies—from Gram and Giemsa staining to media inoculation to immunofluorescence and even molecular genetics—to identify causative organisms. This literature also describes the formulas for preparation of highly concentrated, "fortified" antibiotics for initial treatment of bacterial keratitis, until culture and sensitivity results are available to guide modifications in therapy. It would seem, therefore, that "experts" in the field of corneal and external diseases have reached consensus on an appropriate initial microbiologic evaluation and treatment of suspected microbial keratitis, and the large body of literature on this topic might be considered to represent practice guidelines. It comes as a surprise to many that these published "guidelines" apparently are routinely ignored in current clinical practice.

Pepose JS, Wilhelmus KR.  Divergent approaches to the management of corneal ulcers . Am J Ophthalmol . 1992;114:630-631.
Hyndiuk RA, Snyder RW.  Bacterial keratitis . In: Smolin G, Thoft RA, eds. The Cornea: Scientific Foundations and Clinical Practice . 2nd ed. Boston, Mass: Little Brown & Co Inc; 1987:193.
Liesegang T.  Bacterial and fungal keratitis . In: Kaufman HE, Barron BA, eds. The Cornea . New York, NY: Churchill Livingstone Inc; 1988:217.
Jones DB.  New horizons in antibacterial antibiotics . Int Ophthalmol Clin . 1993;33:179-186.Article
Schein OD, Glynn RJ, Poggio EC, Seddon JM, Kenyon KR, Microbial Keratitis Study Group.  The relative risk of ulcerative keratitis among users of daily wear and extended wear soft contact lenses: a case-control study . N Engl J Med . 1989;321:773-778.Article
Galentine PG, Cohen EJ, Laibson PR, Adams CP, Michaud R, Arentsen JJ.  Corneal ulcers associated with contact lens wear . Arch Ophthalmol . 1984;102:891-894.Article
Ormerod LD, Smith RE.  Contact lens-associated microbial keratitis . Arch Ophthalmol . 1986;104:79-83.Article
Alfonso E, Mandelbaum S, Fox M, Forster RK.  Ulcerative keratitis associated with contact lens wear . Am J Ophthalmol . 1986;101:429-433.
Mondino BJ, Weissman BA, Farb MD, Pettit TH.  Corneal ulcers associated with daily-wear and extended-wear contact lenses . Am J Ophthalmol . 1986;102:58-65.
McDonnell PJ, Nobe J, Gauderman WJ, Lee P, Aiello A, Trousdale M.  Community care of corneal ulcers . Am J Ophthalmol . 1992;114:531-538.
Poggio EC, Glynn RJ, Schein OD, et al.  The incidence of ulcerative keratitis among users of daily-wear and extended-wear soft contact lenses . N Engl J Med . 1989;321:779-783.Article
Leibowitz HM.  Clinical evaluation of ciprofloxacin 0.3% ophthalmic solution for treatment of bacterial keratitis . Am J Ophthalmol . 1991;112 ( (suppl) ):34-47.
Parks DJ, Abrams DA, Sarfarazi FA, Katz HR.  Comparison of topical ciprofloxacin to conventional antibiotic therapy in the treatment of ulcerative keratitis . Am J Ophthalmol . 1993;115:471-477.
O'Brien TP, Maguire MG, Fink NE, Alfonso E, McDonnell P, the Bacterial Keratitis Study Research Group.  Efficacy of ofloxacin vs cefazolin and tobramycin in the therapy for bacterial keratitis: report from the Bacterial Keratitis Study Research Group . Arch Ophthalmol . 1995;113:1257-1265.Article
Ormerod LD, Heseltine PNR, Alfonso E, et al.  Gentamicin-resistant Pseudomonas infection . Cornea . 1989;8:195-199.Article
Gelender H, Rettich C.  Gentamicin-resistant Pseudomonas aeruginosa corneal ulcers . Cornea . 1984;3:21-26.Article
Kowal VO, Mead MD.  Community acquired corneal ulcers: the impact of cultures on management . Invest Ophthalmol Vis Sci . 1992;33:1210.
American Academy of Ophthalmology. Conjunctivitis: Preferred Practice Pattern . San Francisco, Calif: American Academy of Ophthalmology; 1991.