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Keratitis
 

Keratitis

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    Keratitis Keratitis Presentation Transcript

    • DR. ALI RAZA Associate ProfessorHead of Department Ophthalmology Holy Family Hospital Rawalpindi
    • MICROBIAL KERATITIS
    • BACTERIAL KERATITISCOMMON PATHOGENS:Neisseria gonorrhoeaeCorynebacterium diphtheriaeListeria sp.Haemophilus sp.
    • BACTERIAL KERATITISOTHER PAHTOGENS: Produce keratitis only after loss of corneal epithelial integrity as in:Contact lens wear: Pseudomonas aeruginosa
    • BACTERIAL KERATITISOcular surface diseaseChronic dacryocistitisTopical steroidsSystemic immunosuppressive agents
    • BACTERIAL KERATITISCLINICAL FEATURES: Certain bacteria produce characteristic corneal response.1- Staph. aureus and Strep. pneumoniae:Oval, yellow-white, densely opaque stromal suppurationclear cornea
    • Large Corneal infiltration in bacterial keratitis
    • Severe staphylococcal keratitis
    • Staphylococcal keratitis
    • CLINICAL FEATURES:2- Pseudomonas:Mucopurulent exudate,liquefactive necrosisground-glass adjacent stroma
    • Pseudomonas keratitis withhypopyon
    • Advanced pseudomonas keratitis
    • CLINICAL FEATURES:3- Enterobacteriaeceae:Shallow ulcerationGrey-white pleomorphic suppurationStromal opalescenceCorneal rings
    • BACTERIAL KERATITISMANAGEMENT: Bacterial corneal ulcer is a sight- threatening condition demandingIdentification of causative organismEradicationHospitalization
    • MANAGEMENT: Therapy is divided into:Sterilization phaseHealing phase
    • MANAGEMENT:1- CHOICE OF ANTIBIOTICS:Standard combined therapy with aminoglycosides and cephalosporins.Monotherapy with fluoroquinolone
    • MANAGEMENT:2- PREPARATION OF FORTIFIED ANTIBIOTICS: by combination with a compatible vehicle
    • MANAGEMENT:3- INSTILLATION OF TOPICAL ANTIBIOTICS:hourly intervals for first five days2 hourly if favourable responseGradually taper and discontinue
    • MANAGEMENT:4- SYSTEMIC CIPROFLOXACIN: When ulcer is close to limbus5- WHEN TO CHANGE ANTIBIOTICS: If resistant pathogen
    • MANAGEMENT:6- CYCLOPLEGICS: to prevent Posterior synechiae Pain7- STEROID THERAPY: Controversial
    • Deposits of ciprofloxacin
    • MANAGEMENT:8- CAUSES OF FAILURE TO RESPOND:Wrong diagnosis by inappropriate culturesWrong treatment by inappropriate antibioticsDrug toxicity preventing corneal healing
    • FUNGAL KERATITISKeratomycosisCLINICAL FEATURES:1- Filamentuous fungal keratitisAspergillus sp.Fusarium sp.2- Candida keratitis
    • Fungal keratitis with hypopyon
    • filamentous fungal keratitis
    • Advanced filamentous fungalkeratitis
    • MANAGEMENT:Re-culture and corneal biopsyAntifungal therapyTherapeutic penetrating keratoplasty
    • OTHER TYPES OF KERATITISAcanthamoeba keratitisInterstitial keratitis - luetic interstitial keratitis - cogan syndromeInfectious crystalline keratopathy
    • Acanthamoeba keratitis
    • Interstitial keratitis
    • Infectious crystalline keratopathy
    • COMPLICATIONS OF KERATITIS
    • HERPES SIMPLEX KERATITISPRIMARY OCULAR INFECTION Occurs in children b/w ages of 6 months and 5 yrs 1- Blepharoconjunctivitis 2- Keratitis
    • HERPES SIMPLEX KERATITISDENDRITIC ULCER Signs in chronological order: - opaque cells in punctate or stellate pattern - linear branching ulcer stains with fluorescein - anterior stromal infiltrates - large epithelial defect (amoeboid configuration) - pseudodendrites in healing phase
    • DENDRITIC ULCERAntiviral Therapy - Acycloguanosine - Trifluorothymidine - Adenine arabinosideDebridement
    • OTHER VIRAL KERATITISStromal Necrotic KeratitisDisciform Keratitis
    • HERPES ZOSTER OPHTHALMICUSRash on eye lidsConjunctivitisEpiscleritisScleritisKeratitisAnterior Uveitis
    • CORNEAL ECTASIAS1- KERATOCONUS - conical cornea - central or paracentral stromal thinning - apical protrusion - irregular astigmatism - presents with impaired vision - oil droplet reflex - Munson sign
    • 2- KERATOGLOBUS - rare condition - oval keatoconus early on - later protrusion and thinning of entire cornea3- PELLUCID MARGINAL DEGENERATION
    • Thanks