AAO Preferred Practice Pattern 2018 for Bacterial Keratitis
The American Academy of Ophthalmology (AAO) has updated its 2013 Preferred Practice Pattern (PPP) guidelines for Bacterial Keratitis.

Bacterial keratitis is an infection of the cornea caused by bacteria. Loss of vision can frequently occur due to corneal scarring or topographic irregularity. Untreated or severe bacterial keratitis may result in corneal perforation, and it has the potential to develop into endophthalmitis and result in loss of the eye.

Because this process of destruction can take place rapidly (within 24 hours when the infection is caused by a virulent organism), optimal management requires rapid recognition, timely institution of therapy, and appropriate follow-up.

Highlighted findings and recommendations for care include the following:-
• The majority of community-acquired cases of bacterial keratitis resolve with empiric therapy and are managed without smears or cultures. Smears and/or cultures are specifically indicated in the following circumstances: 1) a corneal infiltrate is central, large (>2 mm) and/or associated with significant stromal involvement or melting; 2) the infection is chronic in nature or unresponsive to broad-spectrum antibiotic therapy; 3) there is a history of corneal surgeries; 4) atypical clinical features are present that are suggestive of fungal, amoebic, or mycobacterial keratitis; or 5) infiltrates are in multiple locations on the cornea.

• Topical antibiotics should be prescribed to prevent acute bacterial keratitis in patients presenting with a contact lens-related corneal abrasion.

• Patching the eye in a patient who wears contact lenses and has a corneal abrasion is not advised because of the increased risk of bacterial keratitis. Bandage contact lens use in the management of these epithelial defects remains controversial.

• The use of a cycloplegic agent is an often-overlooked adjunctive treatment and may decrease pain as well as synechia formation in bacterial keratitis. It is indicated when substantial anterior chamber inflammation is present.

• Corticosteroids may be considered after 24 to 48 hours when the causative organism is identified and/or infection is responding to therapy. Corticosteroids should be avoided in cases of infection involving organisms like Acanthamoeba, Nocardia, and fungus.

• Awareness of the increased resistance of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa to topical fluoroquinolones is important.

About AAO
The American Academy of Ophthalmology (Academy) is a professional medical association of ophthalmologists. It is headquartered in San Francisco, California. The Academy's stated mission is "to protect sight and empower lives by serving as an advocate for patients and the public, leading ophthalmic education, and advancing the profession of ophthalmology."

Note: This list is a brief compilation of some of the key recommendations included in the Guidelines and is not exhaustive and does not constitute medical advice. Kindly refer to the original publication here: https://pxmd.co/OqYG5
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