Infectious Keratitis

Highland Ophthalmology

Mary Davidian, MD, is a cornea specialist and medical director at Highland Ophthalmology Associates in New Windsor, NY. DR. Davidian completed her residency at the New York Eye and Ear Infirmary and a cornea fellowship at UC Irvine. She is an active participant of multiple ophthalmology societies. She is a consultant and speaker for BIO‑TISSUE® and can be reached at (845) 562-0138.



Infectious keratitis is a serious sight-threatening ocular infection and one of the most significant complications of contact lens usage. Damage to the cornea can occur rapidly and early diagnosis and treatment are essential. The principal therapeutic goal is to eliminate the pathogens and to prevent irreversible corneal structural damage. After the pathogen is identified by microbiological workup, topical antimicrobial therapies take precedence to sterilize the corneal lesion. Despite the control of infection, corneal melting/damage/scarring may occur due to digestive enzymes released by inflammatory and immune reactions to microbes. Cryopreserved amniotic membrane is well known to have potent anti-inflammatory and anti-scarring properties that promote healing and prevent corneal melt and scar formation. In addition, due to its therapeutic effects, cryopreserved amniotic membrane may also facilitate reduced steroid usage.


  • History: Injury, contact lens usage, or surgery
  • Symptoms: Pain, photophobia, lacrimation, and loss of vision
  • Examination: Corneal epithelial defect with infiltrate or ulcer, corneal edema, and hypopyon

Treatment Strategy

  • Perform scraping and microbial culture
  • Treat infection with fortified broad-spectrum antibiotics, which will be modified according to culture results
  • Treat the inflammation and prevent corneal melting (PROKERA®)
  • Restore corneal integrity by promoting healing and reducing haze (PROKERA®)

Case Study

  • A 61-year-old LASIK and contact lens wearer presented with severe ocular pain and loss of vision
  • Examination revealed a central corneal ulcer, deep stromal infiltrate, hypopyon, and severe conjunctival inflammation (Fig. A, C)
  • Corneal scraping and culture were followed by fortified antibiotics. Microbiologic workup confirmed the diagnosis of staphylococcus aureus.
  • PROKERA® was placed and fortified antibiotics were tapered to QID
  • Two weeks later, inflammation was markedly reduced, the corneal epithelial defect completely healed, and the patient regained 20/25 vision (Fig. B, D)


Early intervention by PROKERA® promotes epithelialization and reduces pain, inflammation, and haze in severe bacterial keratitis.

Bonini S, Rama P, Olzi D, Lambiase A. Neurotrophic keratitis. Eye (Lond). 2003;17(8):989-995.
Touhami A, Grueterich M, Tseng SC. The role of NGF signaling in human limbal epithelium expanded by amniotic membrane culture. Invest Ophthalmol Vis Sci. 2002;43(4):987-994.
Pachigolla G, Prasher P, Di Pascuale MA, et al. Evaluation of the role of ProKera in the management of ocular surface and orbital disorders. Eye Contact Lens. 2009;35(4):172-175.
Kent HD, Cohen EJ, Laibson PR, Arentsen JJ. Microbial keratitis and corneal ulceration associated with therapeutic soft contact lenses. CLAO J. 1990;(16):49-52.
Sheha H, Liang L, Li J, Tseng SC. Sutureless amniotic membrane transplantation for severe bacterial keratitis: Cornea. 2009;28(10):1118-1123.
Tseng SC. A practical treatment algorithm for managing ocular surface and tear disorders. Cornea. 2011;30(suppl 1):S8-S14.
Chotikavanich S, de Paiva CS, Li de Q, et al. Production and activity of matrix metalloproteinase-9 on the ocular surface increase in dysfunctional tear syndrome. Invest Ophthalmol Vis Sci. 2009;50(7):3203-3209.
Reidy JJ, Paulus MP, Gona S. Recurrent erosions of the cornea: epidemiology and treatment. Cornea. 2000;19(6):767-771.
Chen YT, Huang CW, Huang FC, et al. The cleavage plane of corneal epithelial adhesion complex in traumatic recurrent corneal erosion. Mol Vis. 2006;12:196-204.
Fini ME, Cook JR, Mohan R. Proteolytic mechanisms in corneal ulceration and repair. Arch Dermatol Res. 1998;290(suppl):S12-23.
Heiligenhaus A, Li HF, Yang Y, et al. Transplantation of amniotic membrane in murine herpes stromal keratitis modulates matrix metalloproteinases in the cornea. Invest Ophthalmol Vis Sci. 2005;46(11):4079-4085.
Narayanan R, Gaster RN, Kenney MC. Pseudophakic corneal edema: a review of mechanisms and treatments. Cornea. 2006;25(9):993-1004.
Lee HK, Kim JK, Kim EK, et al. Phototherapeutic keratectomy with amniotic membrane for severe subepithelial fibrosis following excimer laser refractive surgery. J Cataract Refract Surg. 2003;29(7):1430-1435.