Researchers in Thailand have found a high incidence of elevated intraocular pressure (IOP) in moderate or severe infectious ulcerative keratitis. Moderate to severe infectious keratitis was associated with a high incidence of secondary ocular hypertension (OHT), which the study defined as IOP greater than 21mm Hg or a consistent demonstration of higher IOP in the affected eye of 8 mm Hg or greater, at any time before resolution of the ulcer.

A retrospective chart review of 202 eyes revealed a 45.5% incidence of secondary OHT. Severe keratitis and severe anterior chamber cells reaction were the risk factors for IOP elevation during active keratitis. In the long-term data available, a third of OHT patients developed persistent elevated IOP after keratitis healed. Older age and hyperosmotic agents used during active keratitis were significantly associated with persistent elevated IOP. While the study was able to find an association between older age with poorer visual outcome, it did not find one between persistent elevated IOP after resolved infectious keratitis and poorer visual outcome.

The researchers concluded that most of the eyes could control their persistent elevated IOP with one to two medications. Understanding the risk of OHT development along with an accurate diagnosis and appropriate treatment will improve patient outcomes in moderate and high levels of infection.

Sakiyalak D, Chattagoon Y. Incidence of and risk factors for secondary ocular hypertension in moderate to severe infectious ulcerative keratitis. Clin Ophthalmol. 2018;12:2121-8.