Documenting Corneal Keratitis Lesions

Essential Components of Lesion Description

The American Academy of Ophthalmology recommends documenting the location of the infiltrate, whether it is central, peripheral, inferior, perineural, or associated with surgical/traumatic wounds, in patients with corneal keratitis 1, 2
The size of the infiltrate should be measured and recorded in millimeters, with infiltrates ≥2 mm considered large and clinically significant, according to the American Academy of Ophthalmology 1, 3
The depth of the infiltrate should be specified, whether it is superficial, mid-stromal, or extends to the posterior one-third of the stroma, as deeper lesions carry a worse prognosis, as stated by the American Academy of Ophthalmology 1, 2
The density of the infiltrate should be characterized as light, moderate, or dense, and the shape should be noted, including any distinctive patterns such as ring-shaped or irregular configuration, as recommended by the American Academy of Ophthalmology 1, 2

The margin definition of the infiltrate should be documented, with bacterial keratitis typically presenting with indistinct, feathery edges, versus well-demarcated borders, according to the American Academy of Ophthalmology 1, 4
The presence of suppuration, necrosis, and crystalline appearance should be noted, as these may indicate active bacterial infection or chronic infection, as stated by the American Academy of Ophthalmology 1, 2

An epithelial defect is typically present in bacterial keratitis and should be documented with fluorescein staining, including the size and shape of the defect, as recommended by the American Academy of Ophthalmology 1, 2
The presence of punctate keratopathy, epithelial edema, and any surrounding punctate epithelial changes should be noted, as these may indicate corneal inflammation, according to the American Academy of Ophthalmology 1, 2

The presence of stromal edema, white cell infiltration, and stromal thinning should be documented, as these are characteristic features of bacterial keratitis, as stated by the American Academy of Ophthalmology 1, 2
The presence of stromal melting, perforation, and neovascularization should be noted, as these may indicate severe infection or tissue loss, according to the American Academy of Ophthalmology 1, 2

The presence of anterior chamber reaction, including cell and flare, should be documented, as this may indicate severe infection, as recommended by the American Academy of Ophthalmology 1, 2
The presence of hypopyon, fibrin, and hyphema should be noted, as these may indicate severe infection or bleeding, according to the American Academy of Ophthalmology 1, 3

Bacterial keratitis typically presents with suppurative stromal infiltrates, surrounding stromal edema, and white cell infiltration, an epithelial defect, and anterior chamber reaction, as stated by the American Academy of Ophthalmology 1, 4

Large central infiltrates (≥2 mm within 3 mm of corneal center) require cultures before initiating therapy, as recommended by the American Academy of Ophthalmology 1, 3
Multiple infiltrates, significant stromal involvement, and anterior chamber cells may indicate severe infection and require aggressive management, according to the American Academy of Ophthalmology 1, 3