The patient should be referred the same day for emergency ophthalmological management.
Cultures and scrapings from the infected area should be obtained (by a suitably experienced clinician) before antibiotic therapy is commenced. In this way pathogenic organisms and their sensitivity may be determined.
Intensive topical antibiotics (e.g. chloramphenicol drops, topical fluoroquinolones), are given in combination with a mydriatic e.g. atropine.
In severe keratitis fortified ophthalmic combination solutions may be used e.g. ticarcillin + gentamicin + vancomycin (1).
Low dose steroids may be administered but should be tapered off slowly (2)
Oral antibiotics are usually not indicated except in cases of corneal perforation or gonococcal infection
Reference:
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