While many bacteria may invade a damaged cornea, only a small number can involve an intact cornea. Invasion of an intact cornea requires pathogenic factors such as toxins or enzymes.
Bacteria that can cause a keratitis with an intact cornea:
(1) Shigella species
(2) Neisseria gonorrhoeae
(3) Corynebacterium diphtheriae
Complications:
(1) corneal perforation
(2) central scarring with vision loss
Differential diagnosis:
(1) other causes of keratitis (chemical, amebic, viral)
Management:
(1) topical therapy with broad-spectrum antibiotics
(2) systemic therapy if part of a generalized infection
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