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Microbial keratitis
  1. B H Jeng1,
  2. S D McLeod1
  1. The Francis I Proctor Foundation and the Department of Ophthalmology, University of California San Francisco Medical Center, San Francisco, CA, USA
  1. Correspondence to: Stephen D McLeod, MD, Cornea and Refractive Surgery Service, Department of Ophthalmology, 10 Kirkham Street, K-301, University of California, San Francisco, San Francisco, CA 94143, USA; smcleod{at}

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Shifting trends in the epidemiology of infectious keratitis demand that we approach all cases thoughtfully

Microbial keratitis is a potentially vision threatening condition that requires prompt diagnosis and treatment to prevent untoward outcomes. The incidence of this condition varies from 11.0 per 100 000 person years in the United States1 to 799 per 100 000 person years the developing nation of Nepal.2 Microbial keratitis is thus a significant public health problem, and numerous studies have been performed describing the microbiology of corneal infection. As would be expected, there are regional differences in the organisms that are cultured from infected corneas, but for the most part, in the United States, Staphylococcus species seem to predominate.

On a global level, predisposing risk factors for microbial keratitis vary tremendously with geographical location. Although non-surgical trauma to the eye accounted for 48.6–65.4% of all corneal ulcers in the developing countries of Nepal and India,2–3 at a large county trauma referral centre in the United States, non-surgical eye trauma accounted for only 27% of all cases.4 In the United States it is contact lens wear that has emerged as a major risk factor for microbial keratitis. The reported percentage of corneal ulcers associated with contact lens wear has increased in the general population from 0% in the 1950s and 1960s, to 31% in the 1970s, and to 52% in the 1980s.1 In our own community based population study during the late 1990s, we found a continuation of this upward trend with 55% of corneal ulcers associated with contact lens wear (unpublished data).

Similarly, in academic referral institutions in the United States, there was a well documented upward trend in the incidence of contact lens related corneal ulcers from 9% …

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