Differential_Diagnosis_Infective_Keratitis_with_Images.pptx

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1. Differential Diagnosis of Infective Keratitis Prepared by: [Your Name] [Institution]

2. Introduction • Corneal infection leading to keratitis • Importance: rapid progression, risk of vision loss • Need for correct diagnosis

3. Major Etiologies • Bacterial keratitis • Fungal keratitis • Viral keratitis (esp. HSV, VZV) • Parasitic keratitis (Acanthamoeba)

4. Bacterial Keratitis • Common organisms: Pseudomonas, Staphylococcus, Streptococcus • Clinical features: - Rapid onset pain, redness, purulent discharge - Dense suppurative stromal infiltrate - Hypopyon common • Risk factors: trauma, contact lens use Dense suppurative infiltrate with hypopyon – bacterial keratitis.

5. Fungal Keratitis • Organisms: Fusarium, Aspergillus, Candida • Clinical features: - Feathery-edged infiltrates - Satellite lesions - Dry, rough surface - Hypopyon less mobile • History: vegetative trauma, agricultural workers Feathery-edged stromal infiltrates – fungal keratitis (Fusarium).

6. Viral Keratitis • HSV keratitis: dendritic ulcers, reduced corneal sensation • VZV keratitis: pseudodendrites, skin involvement (Hutchinson’s sign) • Adenovirus: epidemic keratoconjunctivitis with subepithelial infiltrates Comparative panel showing viral keratitis (VK).

7. Acanthamoeba Keratitis • Associated with contact lens wear, contaminated water • Symptoms: disproportionate pain compared to signs • Signs: ring-shaped stromal infiltrate, perineural infiltrates • Often misdiagnosed early as HSV or bacterial keratitis Ring-shaped stromal infiltrate – Acanthamoeba keratitis.

8. Key Differentiating Features Feature Bacterial Fungal Viral Acanthamoeba Onset Rapid Subacute/Chronic Recurrent Subacute Pain Severe Moderate Variable Severe (out of proportion) Infiltrate Dense, suppurative Feathery, satellite Dendritic/pseudodendritic Ring infiltrate Hypopyon Common, mobile Less mobile Rare Rare Risk factor Trauma, CL Vegetative trauma Immunosuppression Contact lenses, water exposure

9. Diagnostic Aids • Corneal scraping & smear (Gram, KOH, Giemsa) • Culture (bacterial, fungal, viral) • Confocal microscopy (Acanthamoeba, fungi) • PCR for viruses

10. Conclusion • Infective keratitis has multiple etiologies with overlapping features • Careful history, slit-lamp exam, and lab investigations are crucial • Early, correct diagnosis prevents vision-threatening complications