Pain, Blurry Vision from Microbial Keratitis Patients Associated with Worse VA

Asking specifically about symptoms and severity of blurry vision, redness, light sensitivity/glare and pain can guide non-eye clinicians to screen for vision-threatening MK, and determining severity of pain or blurry vision can guide clinicians to triage patients with worse presenting VA, authors of this recent study suggest. Photo: Christine Sindt, OD. Click image to enlarge. Microbial keratitis (MK) is a vision-threatening infection that can lead to a worse prognosis if diagnosis is delayed. In a recent study, researchers aimed to quantify severity of symptoms of MK at presentation and investigate their association with visual acuity (VA) in patients self-reporting their symptoms; they found that pain and blurry vision was associated with worse baseline acuity. The findings were reported in Cornea.A total of 703 MK patients from the University of Michigan (UM) as well as hospital clinics in India were enrolled in this prospective study from July 2020 to November 2022. Best-corrected VA was recorded at presentation, and patients were surveyed on severity of symptoms on a five-point scale for pain or a four-point scale for redness, light sensitivity/glare and blurry vision. The association between symptom severity and VA was tested with Spearman correlations (r) and Kruskal-Wallis tests.The majority of patients (96.7%) reported some degree of the four symptoms. For those who reported pain and blurry vision, VA worsened with increasing symptom severity. Indian participants reporting very severe pain had presenting vision that was 0.85 logMAR units (approximately 8.5 lines of Snellen vision) worse than those who reported mild pain. The authors noted that a similar difference was also observed in the UM group but it did not reach statistical significance likely due to sample size.Both the groups reported very high rates of symptoms, with the participants from India reporting less severity in those symptoms. “While this may be in part due to the UM participants having more central ulcers and longer delays to presentation,”  the authors wrote in their paper, “this may also be due to population differences.” Previous studies of non-ocular conditions have shown Asian populations reporting lower severity of pain compared to Caucasians with the same condition.Querying patients about symptoms in an objective questionnaire has its own merit in different clinical settings, the authors explained. “Asking specifically about symptoms and severity of blurry vision, redness, light sensitivity/glare and pain can guide non-eye clinicians to screen for vision-threatening MK,” they wrote. “Importantly, determining severity of pain or blurry vision can guide clinicians to triage patients with worse presenting VA.”They added that future studies are necessary to determine how presenting symptomatology correlates with MK infection types and visual outcomes. “Patient-reported symptoms at MK presentation may indicate disease severity and can aid clinicians in deciding on disease treatment and symptom management,” they concluded in their paper.Click here for the journal source. Ballouz D, Niziol LM, Prajna NV, et al. Symptoms as an indicator of microbial keratitis severity and its association with visual acuity. Eye & Contact Lens. April 12, 2025. [Epub ahead of print.]