Strategies for the management of microbial keratitis.

Microbial keratitis results from a complex interaction between a protean array of pathogens and a diversity of host responses. The variability of these factors has hampered the development of simple management guidelines that will ensure an optimal outcome for most cases; a consequence of this has been the use of an extensive range of culture media in initial investigation, toxic levels of antibiotic treatment, and constant clinical review, all of which may be unnecessary. The simplified initial management strategies described here are designed to provide effective treatment for the majority of cases, and to identify the point of failure when referral for specialist management may be indicated. A systematic approach to the further management of cases in which initial therapy has failed is also given. These recommendations have been developed to be both practical and safe.