January 16, 2012 | POSTED BY | Clinical Pearls

Clinical Pearl by: Yuliya Bababekova, SUNY 2013

In order to differentiate between sterile versus infectious keratitis, look for several important distinctions.

  • Sterile infiltrates are located in the periphery.
  • These are typically small, grey lesions that are separated from the limbus by about 1 mm of clear space.
  • Immune cells are thought to be more readily available because of the location of capillaries in the peripheral cornea.
  • Infectious infiltrates are located in the central region of the cornea.
  • Clinical signs of infectious infiltrates include fluorescein staining, and raised appearance with a surrounding haze.

Symptoms are also very different: 

  • Pts with sterile infiltrates are mildly symptomatic
  • Those with infectious keratitis are often photophobic and in pain.

Note: When examining these patients, it’s important to consider that sub-epithelial infiltrates are a distinguishing feature of EKC (epidemic keratoconjunctivitis).

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