DIFFERENTIAL CARE OF CORNEAL ULCERS IN THE COMMUNITY-BASED ON APPARENT SEVERITY

Purpose: To describe current practice patterns in treating infectious keratitis. Methods: A questionnaire was designed that asked ophthalmol ogists to describe the diagnostic equipment accessible to their practi ce for performing smears and obtaining scrapings for microbial culture and sensitivity testing. The questionnaire also presented two hypothe tical cases of patients with infectious keratitis. Bacterial keratitis was relatively early and less severe in the first patient, and it was more advanced and more severe in the second patient. Recipients were asked about their diagnostic and therapeutic approach. The survey was mailed to 300 ophthalmologists in Florida, Illinois, and New York. Res ults: One hundred twenty-four completed surveys (45%) were returned. S ix surveys were from cornea specialists, who were excluded from the an alysis. Only 18 practices (15%) maintained access to Gram stain suppli es, and 58 (50%) maintained culture supplies. Whereas 56% of responden ts would treat the patient with the less severe bacterial keratitis wi thout obtaining samples for cultures, only 13% would treat the patient with the more severe condition in this manner (P < 0.00001). Of the r espondents, 82% would treat the patient with the less severe bacterial keratitis with a fluoroquinolone, compared with 62% for the patient w ith the more severe infection (P = 0.002). The mean frequency of fluor oquinolone administration for the patient with more-severe bacterial k eratitis was one drop every 0.88 hours, compared with one drop every 1 .48 hours for the patient with the less severe infection. Conclusions: Ophthalmologists appear to treat suspected infectious keratitis diffe rently, depending on perceived severity; they choose different antibio tic regimens; and are more likely to forgo scrapings for Gram staining and cultures for ulcers that appear less severe. The justification fo r this approach should be established.