Corneal Ulcer.pptx

No when it happens

1. Corneal Ulcer ZERA 1

2. Corneal ulcer/Ulcerative keratitis Definition Inflammation of the cornea associated with some destruction of a portion of the epithelium. Purulent (Bacterial & fungal) Non-purulent (Viral, Chlamydial,allergic ) ZERA 2

3. Cornea Transparent, avascular watch glass – like structure Forms anterior 1/6 of the outer fibrous coat ZERA 3

4. Bacterial Corneal ulcer Etiology Staph Aureus Pseudomonas pyocyanea Strep. Pneumoniae Klebsiella E. coli ZERA 4

5. C. Dipthiriae H. Influenza N. Menengitidis N. Gonorrhea Listeria Monocytogens ZERA 5

6. Symptoms Photophobia Pain Watery discharge Redness of eyes Defective vision ZERA 6

7. Signs Swollen lids Blepharospasm chemosed & hyperaemic conjunctiva Corneal ulcer – yellowish white pit (Green for + ve fluorescein dye test) - +/- hypopyon in AC ZERA 7

8. Tx Topical Abx Topical cycloplegic drugs – 1% atropine Systemic analgesics Vitamins A, B - complex, C Hot fomentation ZERA 8

9. Fungal corneal ulcer Etiology Aspergillus Candida Fusarium Mode of infection – trauma by leaf of crop, branch of tree, straw, hay, decaying matter ZERA 9

10. Symptoms As in bacterial corneal ulcer but less marked Signs Generally as in BCU Dry with thick greyish white slough at the base Satelite lesions around ulcer Marked hypopyon ZERA 10

11. Investigations Examination of wet KOH Gram’s & Giemsa staining Sabouraud agar medium ZERA 11

12. Tx Topical antifungal drugs – Natamycin , Fluconazole, Nystatin, Silver sulphadiazine Other measures as in BCU ZERA 12

13. Viral corneal ulcers Herpes simplex keratitis Two forms – primary & recurrent Primary Occurs in a non-immune person Children 6/12 – 5 years of age, teenagers ZERA 13

14. Clinical features Vesicular skin lesions – lids & periorbital region Acute follicular conjunctivitis Epithelial keratitis Usually self-limiting but virus establishes latent infection in trigeminal ganglion ZERA 14

15. Recurrent ocular herpes Due to periodic activation of the virus in the trigeminal ganglion Triggers – fever, malaria, flu, UV rays, ill health, emotional & physical exhaustion, mild trauma ZERA 15

16. Clinical features Epithelial keratitis; punctate, dendritic, geographic, Pain Photophobia Lacrimation Blurred vision ZERA 16

17. Stromal keratitis – disciform Due to delayed hypersensitive to HSV antigen Steroid eye drops Antiviral cover 3% Acyclovir ZERA 17

18. Herpes Zoster ophthalmicus Acute infection of the trigeminal ganglion by VZV Contracted in childhood, manifests as chicken pox ZERA 18

19. Clinical features Fever Malaise Severe neuralgia Cutaneous lesions; vesicles in the areas of distribution of trigeminal n. Ocular lesions – conjunctivitis, keratitis, episcleritis , iridocyclitis ZERA 19

20. TX Analgesics Systemic acyclovir Abx steroid ointment for scar lesions Systemic steroids if other cranial n are involved Topical acyclovir eye ointments, cyclopentolate & steroid drops for zoster keratitis ZERA 20

21. Exposure Keratitis Etiology Develops when the eyeball is insufficiently covered by eyelids Loss of protective mechanism of blinking Extreme ptosis Facial n palsy Severe ectropion Inadequate lid closure in deep coma ZERA 21

22. Clinical features Desiccation in inter-palpebral area Punctate keratitis Necrosis Frank ulceration vascularization ZERA 22

23. Tx Artificial tears & ointments Corneal should be kept covered Tx causative condition ZERA 23

24. Mooren’s ulcer Severe inflammatory peripheral ulcerative keratitis Unkown etiology ZERA 24

25. Clinical features Chronic, painful, indolent ulcer Usually seen in the elderly Tx Immunosuppressive drugs - cyclosporine ZERA 25