Contribution of In Vivo Confocal Microscopy to the Diagnosis and Management of Infectious Keratitis

Infectious keratitis can lead to irreversible complications and even blindness. Identifying the infectious agent in this condition is a challenge for the ophthalmologist. Corneal cultures are considered to be the gold standard diagnostic tool for this condition. Nevertheless, routine culture and viral investigations may yield positive results in only half the cases. In vivo confocal microscopy (IVCM) is a noninvasive imaging technique that provides high-resolution images of all the corneal layers. Since accurate and rapid diagnosis is important for the management and outcome of infectious keratitis, this disease constitutes one of the most important clinical uses of IVCM. However, in this review, the efficacy of IVCM for infectious keratitis remains inconclusive. Although the value of IVCM has been demonstrated in the diagnosis and management of Acanthamoeba and filamentous fungal keratitis, the current resolution of this imaging technique limits its use in cases of bacterial and viral keratitis. By providing in vivo, repeated, and noninvasive analyses of the cornea, IVCM may also be used to evaluate the effectiveness of treatment and the healing of the cornea in the follow-up of infectious keratitis patients.