Bacterial Keratitis

Publication Date: October 30, 2018


The majority of community-acquired cases of bacterial keratitis resolve with empiric therapy and are managed without smears or cultures. Smears and/or cultures are specifically indicated in the following circumstances: 1) a corneal infiltrate is central, large (>2 mm) and/or associated with significant stromal involvement or melting; 2) the infection is chronic in nature or unresponsive to broad-spectrum antibiotic therapy; 3) there is a history of corneal surgeries; 4) atypical clinical features are present that are suggestive of fungal, amoebic, or mycobacterial keratitis; or 5) infiltrates are in multiple locations on the cornea.

Topical antibiotics should be prescribed to prevent acute bacterial keratitis in patients presenting with a contact lens-related corneal abrasion.

Patching the eye in a patient who wears contact lenses and has a corneal abrasion is not advised because of the increased risk of bacterial keratitis. Bandage contact lens use in the management of these epithelial defects remains controversial.

The use of a cycloplegic agent is an often-overlooked adjunctive treatment and may decrease pain as well as synechia formation in bacterial keratitis. It is indicated when substantial anterior chamber inflammation is present.

Corticosteroids may be considered after 24 to 48 hours when the causative organism is identified and/or infection is responding to therapy. Corticosteroids should be avoided in cases of infection involving organisms like Acanthamoeba, Nocardia, and fungus.

Awareness of the increased resistance of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa to topical fluoroquinolones is important.

Recommendation Grading




Bacterial Keratitis

Authoring Organization

Publication Month/Year

October 30, 2018

Document Type


External Publication Status


Country of Publication


Document Objectives

Recognize and reduce risk factors that predispose patients to bacterial infection of the cornea. Establish the diagnosis of bacterial keratitis and differentiate it from other causes of keratitis. Utilize appropriate diagnostic tests. Select appropriate therapy to resolve the keratitis. Relieve pain. Establish appropriate follow-up. Prevent complications such as medication toxicity, intraocular infection, cataract, corneal perforation, and loss of vision due to corneal scarring. Educate patients and their families about treatment and ways to reduce risk factors in the future.

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Emergency care, Operating and recovery room, Outpatient

Intended Users

Optometrist, nurse, nurse practitioner, physician, physician assistant


Diagnosis, Management

Diseases/Conditions (MeSH)

D003316 - Corneal Diseases, D007634 - Keratitis, D020795 - Photophobia


blurred vision, Bacterial Keratitis, Pseudomonas aeruginosa


Number of Source Documents
Literature Search Start Date
February 1, 2017
Literature Search End Date
June 1, 2018