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Cornea specialists identify key clinical signs linked to microbial keratitis subtypes

Ophthalmology 360

Key Takeaways

  1. US cornea specialists identified 20 clinical factors most strongly associated with specific microbial keratitis organism groups.
  2. Agreement among specialists was limited, underscoring the difficulty of differentiating microbial keratitis organisms based on clinical presentation alone.

United States cornea specialists identified a limited set of clinical features they believe reliably distinguish microbial keratitis (MK) organism groups, according to a study.

The survey included 67 US cornea specialists and evaluated whether 61 clinical factors helped differentiate gram-positive bacterial keratitis, gram-negative bacterial keratitis, mold fungal keratitis, yeast fungal keratitis, parasitic keratitis, and viral keratitis.

Overall, 20 of the 61 evaluated clinical factors (32.8%) were identified by more than 75% of respondents as distinguishing a specific MK organism group. Commonly recognized features included the following:

  • Bacterial keratitis: 9 distinguishing factors, including copious ocular discharge and loose ocular sutures
  • Fungal keratitis: 3 distinguishing factors, including feathery infiltrate and ocular trauma involving organic matter
  • Parasitic keratitis: 5 distinguishing factors, including pain out of proportion to clinical findings and perineuritis
  • Viral keratitis: 3 distinguishing factors, including reduced or absent corneal sensation and prodromal symptoms

The remaining 41 clinical factors were identified by 75% or fewer specialists as distinguishing between organism groups.
The authors noted that specialist agreement was limited to roughly one-third of the evaluated clinical features, consistent with prior studies showing the challenges of differentiating MK organisms clinically. They concluded that the 20 factors with higher agreement may help support initial diagnosis, although additional validation is needed.

Reference
Vogt EL, Lu MC, Niziol LM, et al. Distinguishing Factors for Microbial Keratitis Groups: A Cross-Sectional Survey of US Cornea Specialists. Cornea. 2026;doi: 10.1097/ICO.0000000000004162. Epub ahead of print. PMID: 42133664.

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