Microbiological spectrum of microbial keratitis in patients presenting with nasolacrimal duct obstruction

Purpose: To study the type of bacteria and their antibiotic susceptibility pattern from corneal scrapings of patients with infectious keratitis presenting with concurrent nasolacrimal duct obstruction. Methods: A retrospective analysis was carried out of patients with microbial keratitis and co-existing nasolacrimal duct obstruction during a 5-year period (January 2012 to December 2016). Antibiotic susceptibility profile data was collected from the microbiology records. Results: The study included 56 (M:F = 33:23; OD:OS = 34:22) eyes. The mean age of patients was 60.2 +/- 12.3 years. Microscopic examination of corneal scrapings showed 52% of gram-positive (n = 29/55) and 2% of multiple (>1;n = 1/55) bacteria.Streptococcus pneumoniae(32%,n = 18/56), coagulase-negativeStaphylococcus(25%,n = 14/56), andStaphylococcus aureus(11%,n = 6/56) were the most common bacteria.Streptococcus pneumoniae was found to be susceptible to ciprofloxacin (72.2%), ofloxacin (94.4%), gatifloxacin (61.1%), and moxifloxacin (83.3%). Conclusion: Corneal infection associated with nasolacrimal duct obstruction is commonly caused by gram-positive-bacteria. Irrigation of nasolacrimal duct should be mandatory test in microbial keratitis. The gram-positive bacteria isolated showed maximum susceptibility to vancomycin and cefazolin. Early treatment by surgery and appropriate medical management is recommended for its control.