Background: Herpetic stromal keratitis (HSK) is an immune-mediated disease due to primary infection with herpes simplex virus (HSV). It is now known about Cyclosporine A (CSA) that it selectively inhibits T-helper cell production of growth factors essential for B cell and cytotoxic T-cell differentiation and proliferation, so that the immune response which is considered the main cause of stromal lesion and opacity will be formed masking the transparent cornea affecting vision of the patients. The aim of our study was to compare between topical CSA ED versus Prednisolone ED in the treatment of HSK. Methods: The study is prospective, randomized, non-invasive and comparative on 30 eyes with HSK. Participants were divided randomly in numeric manner into 2 groups, each group included 15 eyes: Group (A): treated by topical CSA ED 0.4% and Group (B): treated by topical prednisolone acetate 1%. Comparison between both groups regarding effect on visual acuity, stromal haze, corneal edema, duration of healing, complications, HSV recurrence, vascularization and opacity was done. Results: There was no statistically significant difference between both groups in VA before treatment however, it was statistically significant lower in group B after treatment. There was no statistically significant difference between both groups in grade of stromal infiltration before treatment but there was a statistically significant difference after treatment. Duration of healing was statistically significant lower in group B compared to group A Conclusions: According to our study, CSA ED (0.4%) is effective and comparable to corticosteroid in management of HSK. It may be less tolerable and take longer duration of action but it is superior to steroids as regard the effect on corneal opacity. It has the advantage to decrease corneal vascularization as well. Using corticosteroids is associated with complications especially in more complicated cases like thin cornea and epithelial defects. It causes disease recurrence and IOP elevation so CSA ED is recommended to be used in these cases.

Background: Microbial keratitis (MK) is caused by bacteria, fungi, and protozoa. It is very important to differentiate between these three causative microorganisms very early as they differ in their treatment, and some of these microorganisms, like Pseudomonas aeurogenosa, may result in eye perforation within 72 hours .The purpose of this study was to evaluate impression cytology smear to be used as a guide for early accurate treatment of cases. This study was conducted on 80 patients suspected of having MK. A corneal smear was taken with impression cytology paper (a non-invasive technique) and transported to the microbiology laboratory for examination. Results: The IC smear examination results were as follows: 30 (37.5%) were Aspergillus fungus, 14 (17.5%) were Acanthamoeba, 15 (18.75%) were Gram-negative bacilli, 4 (5%) were Staphylococci, 1 (1.25%) was Streptococci, 14 (17.5%) were both Gram-negative bacilli and Aspergillus fungus, and 2 (2.5%) were both Staphylococci and Aspergillus fungus. There was no significant difference between the diagnosis of MK by the culture method and the IC smear method. Conclusion: The impression cytology smear can be used as guide for early treatment of MK.