Infectious crystalline keratopathy

Crystalline deposits developed in the anterior third of the stroma in a 60-year-old woman. The deposits resolved only after aggressive treatment with intravenously given penicillin and topical erythromycin and vancomycin hydrochloride. Review of reported cases indicated that infectious crystalline keratopathy is caused by chronic colonization of the stroma by bacteria, usually streptococci of the viridans group. Local tissue trauma, concomitant use of topical corticosteroids, an intact overlying epithelium and use of a bandage-type soft contact lens are factors in the development of the infection. Patients with crystalline formations in this setting should undergo early lamellar biopsy for histologic examination, culture and sensitivity testing, followed by aggressive therapy with appropriate antibiotics.