The clinical differentiation of bacterial and fungal keratitis: A photographic survey

Cyril Dalmon, Travis C. Porco, Thomas M. Lietman, N. Venkatesh Prajna, Lalitha Prajna, Mano Ranjan Das, J. Arun Kumar, Jeena Mascarenhas, Todd P. Margolis, John P. Whitcher, Bennie H. Jeng, Jeremy D. Keenan, Matilda F. Chan, Stephen D. McLeod, Nisha R. Acharya

Research output: Contribution to journalArticlepeer-review

109 Scopus citations


PURPOSE. The purpose of this study was to determine whether clinical signs of infectious keratitis can be used to identify the causative organism. METHODS. Eighty photographs of eyes with culture-proven bacterial keratitis or smear-proven fungal keratitis were randomly selected from 2 clinical trials. Fifteen cornea specialists from the F. I. Proctor Foundation and the Aravind Eye Care System assessed the photographs for prespecified clinical signs of keratitis, and they identified the most likely causative organism. RESULTS. Clinicians were able to correctly distinguish bacterial from fungal etiology 66% of the time (P < 0.001). The Gram stain, genus, and species were accurately predicted 46%, 25%, and 10% of the time, respectively. The presence of an irregular/ feathery border was associated with fungal keratitis, whereas a wreath infiltrate or an epithelial plaque was associated with bacterial keratitis. CONCLUSIONS. Cornea specialists correctly differentiated bacterial from fungal keratitis more often than chance, but in fewer than 70% of cases. More specific categorization led to less successful clinical distinction. Although certain clinical signs of infectious keratitis may be associated with a bacterial or fungal etiology, this study highlights the importance of obtaining appropriate microbiological testing during the initial clinical encounter.

Original languageEnglish
Pages (from-to)1787-1791
Number of pages5
JournalInvestigative Ophthalmology and Visual Science
Issue number4
StatePublished - Apr 2012


Dive into the research topics of 'The clinical differentiation of bacterial and fungal keratitis: A photographic survey'. Together they form a unique fingerprint.

Cite this