Treatment of Corneal Ulcer in Suppurative Keratitis When No Fungal Hyphae Are Seen on Smear

Clinical Scenario

This protocol covers patients presenting with suppurative keratitis (corneal ulcer) in whom corneal smear examination has found no fungal hyphae, directing management toward the appropriate antibacterial pathway.

Key Finding

No fungal hyphae are identified on corneal smear. This finding distinguishes the presentation from fungal keratitis and determines the class of antimicrobial therapy used.

Treatment Approach

Management centres on intensive topical antibacterial therapy; an alternative agent may substitute one component, and when continuous instillation is not feasible, a periocular injection route may be considered. The specific agents, selection criteria, and adjunctive measures are detailed in the full protocol.

Treatment Goals

Ulcer begins improving on daily examination
Refer if there is no improvement after 3 days of treatment

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References

No fungal hyphae seen on smear
Cefazolin 5% and Gentamycin 1.4% drops hourly
Ciprofloxacin may be used instead of gentamycin.
If hourly drops is not possible then a sub-conjunctival injection can be considered.
Adjunctive therapy includes cycloplegics; analgesics; anti-glaucoma medication, if indicated.
Do not use any preparation containing steroids.
Daily examination until the ulcer is improving
Not improving after 3 days treatment

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