Real-World Management and Patterns of Antibiotic Use in Patients with Keratitis and Ocular Surface Injuries: A Nationwide Survey Study in Spain

Background/Objectives: Infectious keratitis and eye injuries, despite being well-recognized ophthalmological diseases, continue to pose diagnostic and therapeutic challenges in clinical practice; therefore, this study was conducted to assess the salient features of care provided by Spanish ophthalmologists working in emergency and ocular surface consultations to patients presenting with keratitis and ocular trauma. Methods: Nationwide cross-sectional survey with the participation of 100 ophthalmologists, including 50 ophthalmologists in emergency care and 50 ocular surface specialists. The study questionnaire assessed diagnostic approaches, treatment strategies, and factors influencing therapeutic decision making. Results: The mean age of participants (51% women) was 37.9 years, with 10.2 years of professional activity. External eye examination, slit lamp examination, fluorescein staining, computed tomography (CT) in penetrating injuries, and microbiological cultures in corneal ulcers were rated as important diagnostic methods. Topical antibiotics were especially recommended for keratitis in general (mean 80.6%) and for contact lens-related keratitis (85.6%). The use of antiseptics was limited. Topical corticosteroids were most commonly selected for viral keratitis with stromal and endothelial involvement (between 24.3% and 50.4%); chlorhexidine (52.0%) and propamidine (26.8%) for Acanthamoeba keratitis; re-epithelizing compounds (20.4%) and artificial tears (29.1%) for actinic keratitis; and topical antifungals for fungal keratitis (77%). Conclusions: This study highlights a limited availability of some specific diagnostic methods and an extensive use of topical antibiotics in the management of keratitis and ocular surface injuries, with relatively limited use of antiseptics. Areas of improvement in therapeutic approach would be awareness of a potential overuse of topical antibiotics with the consequences of increase in antimicrobial resistance.