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2003 OMIG, Abstract 7

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Psedomonas Radial Keratoneuritis
Juliana F Freitas, Stephanie A Baxter, Christopher J Rapuano, Peter R Laibson, Elisabeth J Cohen

Purpose: We will describe three cases of radial keratoneuritis associated with Pseudomonas corneal ulcers.
Methods: Retrospective, case series.
Results: Three patients with acute, central, purulent, corneal ulcers were referred to Wills Eye Hospital. All patients were soft contact lens wearers. Corneal scrapings were performed in all cases. Each patient received intensive, initial treatment with topical fortified tobramycin (50mg/ml) and cefazolin (15mg/ml). Two of the three cultures grew Pseudomonas. The third case was suspected to be Pseudomonas, given its clinical appearance. A radial keratoneuritis developed in all patients three to five days after their presentation to our center.
Discussion: Radial keratoneuritis has traditionally been felt to be pathognomonic for Acanthamoeba keratitis. We report three cases of radial keratoneuritis not associated with Acanthamoeba. Although both Pseudomonas and Acanthamoeba can occur in contact lens wearer and cause a radial keratoneuritis, they can often be distinguished clinically: Pseudomonas related corneal ulcers have a rapid onset and tend to be associated with adherent mucopurulent discharge. Thus, acute keratitis in contact lens wearers should be suspected and treated as Pseudomonas ulcers, even if they should develop radial keratoneuritis early in their course.

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