Ophtho On Call Case 3: Testing…

Ophtho On Call Case 3 Index

Answer: The exam is most concerning for a bacterial keratitis. HSV keratitis would demonstrate a dendrite and fungal keratitis are less purulent and more indolent in nature.

Obtaining corneal scrapings for culture is important before initiating empiric  antimicrobial therapy. Gram stain and giemsa stain of the corneal smear should also be performed to determine if the ulcer is bacterial or fungal. Contact lens cases and solutions can also be cultured if available.

Smears and cultures are indicated in the following cases of bacterial keratitis:

    • Sight-threatening or severe keratitis
    • Large infiltrates
    • Central infiltrates
    • No response to broad spectrum antibiotics
    • Atypical clinical features indicative of fungus or acanthamoeba
    • Multiple infiltrates in different location of the cornea

 

What is the most likely causative organism? Pick 1 before moving on.
Acanthamoeba
Pseudomonas aeruginosa 
 
Aspergillus
Staph aureus
Strep pneumo

Click here to move on!

Ophtho On Call Case 3 Index
Ophtho On Call Case 3: Introduction
Ophtho On Call Case 3: Additional History & Physical Exam
Ophtho On Call Case 3: Case Continued…