The annual incidence of infectious keratitis has been increasing due to higher rates of contact lens use, and is now 2.5 to 800 per 100,000 per year.[3]Ting DSJ, Ho CS, Deshmukh R, et al. Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance. Eye (Lond). 2021 Apr;35(4):1084-101.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102486
http://www.ncbi.nlm.nih.gov/pubmed/33414529?tool=bestpractice.com
Patients affected by contact lens-related infectious keratitis are usually between 25 and 40 years old, reflecting the age distribution of contact lens users, although contact lens-related infections are also encountered in younger and older patients. No clear sex differences are borne out in epidemiological studies.[3]Ting DSJ, Ho CS, Deshmukh R, et al. Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance. Eye (Lond). 2021 Apr;35(4):1084-101.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102486
http://www.ncbi.nlm.nih.gov/pubmed/33414529?tool=bestpractice.com
The most common causes of bacterial keratitis include Pseudomonas aeruginosa, Staphylococcus aureus, coagulase negative staphylococci, and Streptococcus pneumoniae.[3]Ting DSJ, Ho CS, Deshmukh R, et al. Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance. Eye (Lond). 2021 Apr;35(4):1084-101.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102486
http://www.ncbi.nlm.nih.gov/pubmed/33414529?tool=bestpractice.com
[4]Rhee MK, Ahmad S, Amescua G, et al. Bacterial keratitis preferred practice pattern®. Ophthalmology. 2024 Apr;131(4):P87-133.
https://www.aaojournal.org/article/S0161-6420(24)00007-1/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/38349295?tool=bestpractice.com
[5]Cabrera-Aguas M, Khoo P, Watson SL. Infectious keratitis: a review. Clin Exp Ophthalmol. 2022 Jul;50(5):543-62.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542356
http://www.ncbi.nlm.nih.gov/pubmed/35610943?tool=bestpractice.com
[6]Stapleton F. The epidemiology of infectious keratitis. Ocul Surf. 2023 Apr;28:351-63.
http://www.ncbi.nlm.nih.gov/pubmed/34419639?tool=bestpractice.com
Herpes simplex keratitis is an important cause of corneal blindness in the developed world.[5]Cabrera-Aguas M, Khoo P, Watson SL. Infectious keratitis: a review. Clin Exp Ophthalmol. 2022 Jul;50(5):543-62.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542356
http://www.ncbi.nlm.nih.gov/pubmed/35610943?tool=bestpractice.com
[7]Guess S, Stone DU, Chodosh J, et al. Evidence-based treatment of herpes simplex virus keratitis: a systematic review. Ocul Surf. 2007 Jul;5(3):240-50.
http://www.ncbi.nlm.nih.gov/pubmed/17660897?tool=bestpractice.com
The annual incidence of fungal keratitis has been estimated to be 1 to 1.4 million cases; it is most prevalent in tropical and subtropical regions. In temperate regions, fungal keratitis is uncommon and mostly occurs in people with a history of corneal transplantation or ocular surface disease (e.g., blepharitis).[3]Ting DSJ, Ho CS, Deshmukh R, et al. Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance. Eye (Lond). 2021 Apr;35(4):1084-101.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102486
http://www.ncbi.nlm.nih.gov/pubmed/33414529?tool=bestpractice.com
[8]Brown L, Leck AK, Gichangi M, et al. The global incidence and diagnosis of fungal keratitis. Lancet Infect Dis. 2021 Mar;21(3):e49-57.
http://www.ncbi.nlm.nih.gov/pubmed/33645500?tool=bestpractice.com
Acanthamoeba keratitis accounts for up to 5% of all cases with contact lens use a major risk factor.[3]Ting DSJ, Ho CS, Deshmukh R, et al. Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance. Eye (Lond). 2021 Apr;35(4):1084-101.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102486
http://www.ncbi.nlm.nih.gov/pubmed/33414529?tool=bestpractice.com
[9]Kinota S, Wong KW, Biswas J, et al. Changing patterns of infectious keratitis: overview of clinical and histopathologic features of keratitis due to Acanthamoeba or atypical Mycobacteria, and of infectious crystalline keratopathy. Indian J Ophthalmol. 1993 Apr;41(1):3-14.
http://www.ncbi.nlm.nih.gov/pubmed/8225521?tool=bestpractice.com
[10]Toshida H, Kogure N, Inoue N, et al. Trends in microbial keratitis in Japan. Eye Contact Lens. 2007 Mar;33(2):70-3.
http://www.ncbi.nlm.nih.gov/pubmed/17496698?tool=bestpractice.com
Non-infectious keratitides
Heterogeneous, and their incidence depends on the underlying aetiology. Peripheral ulcerative keratitis (a type of autoimmune keratitis) associated with systemic autoimmune diseases is of special concern to primary care physicians. Peripheral ulcerative keratitis has an incidence of 3 cases per million per year according to one study from England.[11]Gomes BF, Santhiago MR. Biology of peripheral ulcerative keratitis. Exp Eye Res. 2021 Mar;204:108458.
http://www.ncbi.nlm.nih.gov/pubmed/33493475?tool=bestpractice.com