What is the recommended management for suspected bacterial keratitis requiring urgent care?

• A. Home treatment with artificial tears
• B. Urgent ophthalmology evaluation and empiric broad-spectrum topical antibiotics, followed by cultures
• C. Oral antibiotics only
• D. Steroid-only therapy

Answer: (B)

Suspected bacterial keratitis is an ocular emergency that can rapidly threaten vision, so the most important step is urgent ophthalmology evaluation. The cornerstone of management is to start broad-spectrum topical antibiotics right away to cover the most common bacteria and to obtain corneal cultures to identify the organism and tailor therapy as results come back. This approach helps prevent progression to a larger corneal ulcer, perforation, scarring, or substantial vision loss.

Starting empiric therapy promptly is essential because waiting for a culture result can allow the infection to worsen. Broad-spectrum topical antibiotics are used around the clock initially to ensure constant antimicrobial exposure of the inflamed cornea. Cultures are gathered to pinpoint the causative organism and guide adjustments, especially if the patient does not improve or if the culture identifies a resistant organism.

Steroid-only therapy would not treat the infection and can worsen it, so steroids are not used as frontline treatment in active bacterial keratitis. Oral antibiotics alone do not adequately address a corneal ulcer, and home treatment with artificial tears may provide comfort but does not control the infection.