Adjuvant therapy for bacterial keratitis, criteria for the use of steroids, surgical treatment methods (conjunctival flap, full thickness keratoplasty)

👁 “Adjunctive and Surgical Treatments for Bacterial Keratitis – A Complete Guide”

While topical antibiotics are the cornerstone of treatment,
adjunctive therapies, judicious use of corticosteroids, and in severe cases,
conjunctival flaps or full-thickness corneal grafts (PKP) may be necessary to save the eye.

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💊 Adjunctive Measures for Comfort & Healing

MeasurePurpose

Lid hygiene / discharge removal	Improves slit-lamp visibility
Cycloplegics (e.g., cyclopentolate, homatropine)
– Reduces ciliary spasm pain
– Prevents posterior synechiae
– Atropine/Phenylephrine for persistent adhesion
Vitamin A supplementation	If suspected deficiency
STD screening for gonococcal conjunctivitis
– Co-treat Chlamydia with doxycycline 100mg x 7 days
IOP monitoring	Start pressure-lowering agents if elevated

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⚠️ Corticosteroid Use in Bacterial Keratitis

ScenarioSafe?

Initial presentation	❌ Never (may worsen infection)
After 2–3 days of antibiotic improvement	✅ Possibly
After culture confirmation	✅ Ideally
If cornea is thinning/perforating	❌ Contraindicated

📝 Always apply antibiotics more frequently than steroids. Adjust steroid use if antibiotics are tapered.

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🔪 Surgical Interventions

Type of SurgeryIndication & Note

Conjunctival Flap
– After infection control only
– Enhances healing by bringing in vascular supply
– Used when visual prognosis is already poor
Penetrating Keratoplasty (PKP)
– For persistent ulcers, central involvement, elderly
– Emergently for perforation or scleritis
– Intensive pre-op antibiotics needed
– Incomplete excision risks reinfection, endophthalmitis

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✅ Clinical Tip
– Never use steroids in active bacterial ulcers
– Consider surgical options only after infection control

 

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