Keratitis Treatment Guidelines

Standard Treatment Approach

For bacterial keratitis, topical antibiotics remain the mainstay of treatment, with consideration of topical corticosteroids only after 2-3 days of antibiotic therapy showing improvement, as recommended by the American Academy of Ophthalmology 1, 2
For inflammatory or allergic keratitis, topical corticosteroids, cyclosporine, tacrolimus, or other immunomodulators are the recommended treatments, according to the American Academy of Ophthalmology 3
For viral keratitis, antiviral medications with careful consideration of corticosteroids are indicated, as suggested by the American Academy of Ophthalmology 4

Topical corticosteroids remain the standard treatment for non-infectious keratitis, with careful monitoring of IOP and potential complications, as recommended by the American Academy of Ophthalmology 5, 6
For cases refractory to topical steroids, the American Academy of Ophthalmology recommends topical cyclosporine 0.05% to 2% for severe cases 3
For cases refractory to topical steroids, the American Academy of Ophthalmology also recommends topical tacrolimus 0.03% or 0.1% as an alternative immunomodulator 3
For severe cases that don't respond to topical therapy, the American Academy of Ophthalmology recommends systemic immunosuppressants 3

Before considering non-standard treatments, the American Academy of Ophthalmology recommends confirming the specific type of keratitis through comprehensive corneal evaluation and testing to guide appropriate therapy 5, 2
For non-infectious keratitis refractory to standard topical steroids, the American Academy of Ophthalmology recommends a trial of topical cyclosporine 0.05% to 2% 3
For non-infectious keratitis refractory to standard topical steroids, the American Academy of Ophthalmology also recommends considering topical tacrolimus 0.03% or 0.1% as an alternative immunomodulator 3

Failing to identify the specific type of keratitis before determining treatment, as warned by the American Academy of Ophthalmology 5
Inadequate trial of standard therapies before moving to non-standard treatments, as cautioned by the American Academy of Ophthalmology 3
Prolonged use of topical corticosteroids without monitoring for complications such as increased IOP, cataract formation, or infectious crystalline keratopathy, as advised by the American Academy of Ophthalmology 2, 7
Overlooking the importance of treating associated conditions such as dry eye or blepharitis that may contribute to keratitis, as emphasized by the American Academy of Ophthalmology 8

Brief courses of topical corticosteroids are helpful for eyelid or ocular surface inflammation, including marginal keratitis, with the minimal effective dose to avoid long-term adverse effects, according to the American Academy of Ophthalmology 9
Site-specific corticosteroids such as loteprednol etabonate and corticosteroids with limited ocular penetration like fluorometholone phosphate may minimize adverse effects, as recommended by ophthalmology guidelines 9
Artificial tears, especially those containing oil or lipid-based products, can be helpful for posterior blepharitis and associated keratitis, as suggested by the American Academy of Ophthalmology 9

For bacterial keratitis, topical antibiotics remain the mainstay of treatment, with consideration of topical corticosteroids only after 2-3 days of antibiotic therapy showing improvement, according to the American Academy of Ophthalmology 10
For preservative-induced keratoconjunctivitis, discontinuation of the agent responsible usually results in resolution over weeks to months, with brief courses of topical corticosteroids indicated for severe inflammation, as recommended by ophthalmology guidelines 11

Long-term corticosteroid therapy (including Acthar Gel which has steroidogenic effects) carries risks of increased intraocular pressure and cataract formation, as reported by the American Academy of Ophthalmology 10