Scribd Logo
Upload

Welcome to Scribd!

  • 812 views

    Corneal Ulcer

    Uploaded by

    drrahulv
    This document discusses bacterial keratitis and corneal ulcers. It describes the natural defenses of the eye, risk factors for infection, and the pathophysiology by which interruptions in the corneal epithelium allow bacterial entry and proliferation, potentially causing ulceration, inflammation, necrosis and perforation. Common causative organisms are listed. Clinical features include pain, photophobia, discharge and ulceration visible on slit lamp exam. Diagnosis involves clinical exam, fluorescein staining, and corneal scrapings for smear and culture. Treatment involves topical broad-spectrum antibiotics tailored to culture results, with cycloplegics and pain medications as needed. Complications include descematocele, perforation, glaucoma and need

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd

    Corneal Ulcer

    Uploaded by

    drrahulv
    812 views29 pages
    This document discusses bacterial keratitis and corneal ulcers. It describes the natural defenses of the eye, risk factors for infection, and the pathophysiology by which interruptions in the corneal epithelium allow bacterial entry and proliferation, potentially causing ulceration, inflammation, necrosis and perforation. Common causative organisms are listed. Clinical features include pain, photophobia, discharge and ulceration visible on slit lamp exam. Diagnosis involves clinical exam, fluorescein staining, and corneal scrapings for smear and culture. Treatment involves topical broad-spectrum antibiotics tailored to culture results, with cycloplegics and pain medications as needed. Complications include descematocele, perforation, glaucoma and need

    Original Description:

    Dr. Rahul Verma Assistant Professor Chhattisgarh Institute of Medical Sciences, Bilaspur (C.G.)

    Original Title

    Corneal ulcer

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses bacterial keratitis and corneal ulcers. It describes the natural defenses of the eye, risk factors for infection, and the pathophysiology by which interruptions in the corneal epithelium allow bacterial entry and proliferation, potentially causing ulceration, inflammation, necrosis and perforation. Common causative organisms are listed. Clinical features include pain, photophobia, discharge and ulceration visible on slit lamp exam. Diagnosis involves clinical exam, fluorescein staining, and corneal scrapings for smear and culture. Treatment involves topical broad-spectrum antibiotics tailored to culture results, with cycloplegics and pain medications as needed. Complications include descematocele, perforation, glaucoma and need

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    812 views29 pages

    Corneal Ulcer

    Uploaded by

    drrahulv
    This document discusses bacterial keratitis and corneal ulcers. It describes the natural defenses of the eye, risk factors for infection, and the pathophysiology by which interruptions in the corneal epithelium allow bacterial entry and proliferation, potentially causing ulceration, inflammation, necrosis and perforation. Common causative organisms are listed. Clinical features include pain, photophobia, discharge and ulceration visible on slit lamp exam. Diagnosis involves clinical exam, fluorescein staining, and corneal scrapings for smear and culture. Treatment involves topical broad-spectrum antibiotics tailored to culture results, with cycloplegics and pain medications as needed. Complications include descematocele, perforation, glaucoma and need

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    You are on page 1of 29

    Corneal Ulcer

    Bacterial Keratitis
     Natural defenses
     Eyelids
     Epithelial barrier
     Tears
     Risk factors
     Lid abnormalities; Dry eye; Steroids ;
     prior herpetic infection; Contact lens user;
     LASIK; Immune compromise
     Trauma
     lagophthalmos; neurotrophic keratitis
    Pathophysiology
     Interruption of an intact corneal
    epithelium -> entrance of
    microorganisms into the corneal
    stroma -> proliferate and cause
    ulceration -> inflammation, necrosis
    -> corneal perforation/ scar tissue
    Pathophysiology
     Organisms –
     staphylococcus
     streptococcus,

     pseudomonas,

     Enterobacteriaceae (including Klebsiella,


    Enterobacter, Serratia, and Proteus)
     Moraxella

    .
    Clinical Features
     Rapid onset of pain, photophobia
     Decreased vision.
     Lid erythema, edema;
     Conjunctival congestion; chemosis; lacrimation;
     Mucopurulent discharge
     Ulceration of the epithelium;
     Corneal infiltrate
     Dense, suppurative stromal inflammation and
    surrounding stromal edema
     Stromal tissue loss;
    Small ulcer with active area towards the center.
    The central cornea is hazy and shows Descemet's
    Clinical Features
     Anterior chamber – inflammation;
    hypopyon
     Esp. with pseudomonas pyocyanea and
    pneumococci -> called hypopyon ulcers
     Regressive stage -> vascularization
    -> cicatrization -> opaque scar
    Diagnosis
     Clinical history & examination
     Slit lamp examination – size/depth/
    location/ AC reaction
     Fluorescein stain
     Confirmation – corneal scraping for smear
    and culture
     Scrapings including the edges -> plated in blood,
    chocolate, and Sabouraud agar plates
     Stained smears with gram, Giemsa,KOH
    Treatment
     Initial therapy – broad spectrum topical
    Antibiotics, (no organisms in slide smear)
     Fluoroquinolones include ciprofloxacin,
    ofloxacin, moxifloxacin or gatifloxacin.
     Fortified Tobramycin 1 drop every hour
    alternating with.
     Fortified Cefazolin 1 drop every hour.
     Fortified Vancomycin eye drops – reserved
    drug
    Treatment
     The frequency of antibiotic administration
    should be tapered off parameters:
     Decreased density of infiltrate
     Decreased anterior chamber inflammation
     Reepithelialization of the corneal epithelial
     Improvement in pain
    Corneal Ulcer, Bacterial, Under Treatment No
    longer hypopyon, thus indicating effective
    Treatment
     Cycloplegic agents – atropine,
    Homatropine, Cyclopentolate
     Relieve ciliary spasm
     Prevent synechiae

     Oral pain medications


     Oral antibiotics – scleral expansion
     Repeated scraping
    Complications
     Descematocele
     Perforation – iris prolapse
     Pseudocornea
     Secondary glaucoma
     Anterior capsular cataract
     Spontaneous expulsion of lens and vitreous
     Endophthalmitis
    Descemetcele, Old
    nter the tissue has melted away and a Descemetocele has d
    Treatment of complicated
    ulcers
     Perforated ulcers –
     Firmly applied bandage; Bandage contact lenses
     forced expiration avoided
     Tissue adhesives
     antiglaucomas
     Corneal transplant
     Secondary glaucoma – iv mannitol/
    Acetazolamide; Topical antiglaucomas
     Late management – Corneal grafts;
    Cosmetic CL; Tattoing
    Perforated Corneal Ulcer, Keratoplasty

    You might also like