Older Age, Comorbidities Potential Risk Factors for Pneumococcal Keratitis

Pneumococcal keratitis is associated with older age, high number of comorbidities and severe outcomes.

Patients who were older and had more comorbidities were more likely to present with pneumococcal keratitis than conjunctivitis, according to research presented at the Association for Research in Vision and Ophthalmology (ARVO) 2023 Annual Meeting, held in New Orleans from April 23 to April 27, 2023.

The leading cause of ocular surface infection is Streptococcus pneumoniae. Patients who present with pneumococcal keratitis often present with severe symptoms. Most scientific reporting about pneumococcal keratitis comes from Southern India where it is most common, but overall, there is a lack of sufficient data about the clinical profile, risks, and outcomes of pneumococcal keratitis.

Clinical records from 63 patients who presented at the Massachusetts Eye and Ear clinic between 2014 and 2019 with pneumococcal ocular surface disease were retrospectively reviewed in this study. Trends were compared between patients with keratitis (n=41) and conjunctivitis (n=22).

The patients with keratitis were significantly older (median, 66 y) than the patients with conjunctivitis (median, 43 y; P =.006). More patients who presented with keratitis had a history of organ transplant (P =.006), alcoholism (P =.006), cardiovascular disease (P =.011), liver disease (P =.012), and chronic obstructive pulmonary disease (P =.023) compared with the conjunctivitis group.

The development of keratitis was associated with ocular surface disease (29.2%), eye trauma history (29.2%), and corneal transplantation (21.9%). Most of the patients with keratitis had corneal ulcer (80.5%) and hypopyon (53.6%) and few wore contact lenses (12.2%).

At baseline, most patients with keratitis had a visual acuity of greater than 20/150 (78%) and most (73.7%) did not improve after treatment. Visual outcomes did not differ significantly between the patients who were managed surgically or medically (P =.711583).

This study was limited by its small sample size and retrospective design.

The study author concluded, “[P]neumococcal keratitis was associated with older patients with a high number of comorbidities and severe outcomes. Surgical and medical interventions both lead to similar outcomes and were not associated with significant visual acuity improvements.”


Perera DC. Streptococcus pneumoniae keratitis: analysis of clinical risk factors and differences in treatment-based visual acuity outcomes. Poster presented at: The Association for Research in Vision and Ophthalmology (ARVO) 2023 Annual Meeting; April 23-27; Abstract 2330 – C0367.