Neobook — clinical reference

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KERATITIS, HERPES SIMPLEX
B00.5 † + (H19.1*)

DESCRIPTION

Acute unilateral painful red eye with visual blurring and decreased corneal sensation.
Characteristic dendritic corneal ulcer seen on staining with fluorescein.

MEDICINE TREATMENT

Acyclovir, oral, 400 mg five times daily for 10–14 days.

Note: Topical corticosteroids are contraindicated for treating dendritic ulcers.

LoE:Ib^xiv

Note

Topical corticosteroids are contraindicated for treating dendritic ulcers.

KERATITIS, SUPPURATIVE
H16.8

DESCRIPTION

Painful red eye with corneal lesion that stains with fluorescein and has creamy white appearance.
Contact lenses are a major risk factor, especially for bacterial infections.
Have a high index of suspicion for fungal infection in PLHIV, or there is a history of injury to eye with plant matter.

MEDICINE TREATMENT

Empiric therapy until culture results become available:

Bacterial infection:

Fluoroquinolone ophthalmic drops, e.g.:
- Ciprofloxacin 0.3%, ophthalmic drops, instil 1 drop hourly for 3 days.
  - Then reduce frequency to 1 drop 3–4 hourly until the ulcer is completely healed.
  - Patients requiring treatment for longer than 2 weeks should be on the advice of an ophthalmologist.

LoE: IVb^xv

Fungal infection:

Natamycin 5%, ophthalmic drops, instil 1 drop 1–2 hourly for 3–4 days. (Specialist prescribed).
- Then reduce frequency to 1 drop 3–4 hourly.
- Continue for 14–21 days until resolution of infection.

LoE: Ib^xvi

REFERRAL

All patients to be managed in consultation with an ophthalmologist.

Click here to access the pdf.

Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.0_30 September 2024

Chapter 18 Eye Disorders_18.5 Keratitis

Keratitis

Drugs mentioned

ICD-10 codes