Differential diagnosis and treatment of keratitis

The cornea is the protective layer of the eyeball and is an important membrane that is most exposed to foreign matter. The cornea is important but also fragile, so we need to pay great attention to protecting against keratitis in our daily lives. Keratitis can cause symptoms such as edema and red blood streaks. If you find similar problems with your cornea, you should go to the hospital in time to determine whether you have keratitis.

1. Differential diagnosis of keratitis

1. Check systemic and local pathogenic factors. For suppurative inflammation, smear examination, bacterial and fungal culture and drug sensitivity test should be performed; for dendritic and superficial punctate keratitis, immunological examination should be performed.

2. Pay attention to the location, size, shape, depth, surface depression or protrusion of the lesion to distinguish between ulcerative and non-ulcerative, the presence or absence of new blood vessels, and the condition of the posterior wall of the cornea. Use fluorescein staining to examine and make regular drawings to record the evolution in detail. Do not press on the eyeball during examination and treatment to avoid perforation.

3. Check for iritis, pay attention to pupil shape and size, degree of aqueous humor turbidity, and presence of anterior chamber abscess.

4. Check corneal sensation.

2. Treatment of keratitis

1. Hot compress: dilates blood vessels in the eyes, relieves congestion, and promotes blood flow, allowing ulcers to recover quickly.

2. Flushing: If there is a lot of secretion, you can use normal saline or 3% boric acid solution to flush the conjunctival sac 3 times or more a day to flush out the secretion, necrotic tissue, bacteria and toxins produced by bacteria. In this way, not only the factors that spread the infection are reduced, but also the concentration of the local medicine is ensured not to decrease.

3. Mydriasis: Atropine is the main and commonly used drug, with a concentration of 0.25-2% solution or ointment, which is dripped or applied 1-2 times a day (be sure to press the lacrimal sac after dripping the medicine to prevent the solution from being excessively absorbed by the mucous membrane and causing poisoning).

4. Bacteriostatic agents:

(1) Sulfonamide chemical preparations, such as 10%-30% sodium sulfacetamide and 4% sulfisoxazole eye drops.

(2) For Gram-positive coccal infections, topical application of 0.1% rifampicin eye drops, 0.5% erythromycin, or 0.5% bacitracin eye drops 4 to 6 times a day is sufficient to control the infection. Some broad-spectrum antibiotics such as 0.5% chloramphenicol, 0.25% chloramphenicol and 0.5% tetracycline (0.5%) are more effective in antibacterial effects.

(3) For infections caused by Gram-negative bacteria, you can choose 1%-5% streptomycin, 0.3%-0.5% gentamicin, polymyxin B (20,000 units/ml), 0.25-0.5% neomycin, 0.5% kanamycin, etc.

5. Stimulation therapy: When the ulcer has completely healed and started to scar, efforts should be made to make the scar as thin as possible. For small, dense, and centrally located leukoplakia, iridectomy may be performed to improve vision. For larger white spots, a corneal transplant may be done. Sometimes corneal leukoplakia is unsightly and can be treated with corneal ink acupuncture using coal soot or Chinese ink.

3. What to eat for keratitis

If you suffer from keratitis, you should eat more vegetables and fruits rich in vitamins and fiber, such as tomatoes, apples, etc. Eat more high-calorie, high-protein foods such as beans, soy products, lean meat, eggs, etc. to help corneal repair. Avoid eating fried, spicy, greasy and high-sugar foods on a daily basis. It is advisable to eat light food and eat more vegetables and fruits.