Cornea class 2
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Cornea class 2

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Cornea class 2 Cornea class 2 Presentation Transcript

  • Corneal ulcer
  • Cornea
    • Classification
    • Location -superficial /deep
    • Etiology – infectious,immune mediated, degenerative, neoplastic, traumatic
    • Infectious/ non infectious
    • Ulcerative/ non ulcerative
    • A 65year old sweeper comes with history of
    • Decreased vision
    • Pain, foreign body sensation
    • Photophobia
    • Whiteness of the cornea
    • Watering and discharge
    • h/o ? Dust entering his eye
    • Signs
    • Lid swelling
    • Diffuse Conjunctival congestion
    • Ciliary congestion
    • Ulcer with raised edges,
    • Poorly defined margin,
    • Slough in the floor,
    • Hypopyon
    Hypopyon Diff Conj Congest infiltrate Epithelial defect
  • HYPOPYON
    • Bacterial ulcer – sterile hypopyon
    • Iritis
    • Outpouring of leucocytes which gravitate to the bottom of the ant chamber
    • Mobile
    • Depends on
    • Virulence of organisms –
    • Pneumococcus, Pseudomonas
    • Resistance of host
  • Hypopyon corneal ulcer
    • Organism- pseudomonas pyocyanea, pneumococci
    • Ulcus serpens- creep over the cornea in a serpiginous fashion
    • One end there is cicatrization and other end active infiltration.
    • Perforation likely.
  • Stages of corneal ulcer
    • Progressive
    • Regressive
    Cicatrization Leucocytic infiltration PMN leucocytic infiltration vascularisation
  • Management
    • Investigations
    • Ocular:
    • Corneal scraping-
    • Staining-Grams, Giemsa, KOH,
    • C/S-blood agar, chocolate agar, SDA
    • Syringing
    • Digital tonometry *
    • Systemic-
    • Blood sugars, BP, r/o use of steroids
    • Treatment
    • Specific:
    • Broad spectrum topical antibiotics hourly
    • (quinolones and fortified aminoglycocides)
    • Non specific :
    • Cycloplegics eye drops- Atropine 1%eye drops
    • Antiglaucoma- Timolol maleate eye drops, Acetazolamide tablets
    • Hygiene , heat and protection
  •  
  • Complications
    • Descematocele
    • Perforation
    • Iris prolapse
    • Adherent leucoma
    • Anterior staphyloma
    • Corneal fistula
    • Pseudocornea
    • Secondary glaucoma
    • Severe Anterior uveitis
    • Anterior capsularCataract
    • Intraocular haemorrhage
    • Panophthalmitis ,
    • Phthisis bulbi
    Iris prolapse
  •  
  • Treatment of perforation
    • Impending perforation-
    • Pressure bandage +anti glaucoma medications
    • Small perforation- Cyanoacrylate glue+contact lens
    • Conjunctival graft
    • Large perforation- Penetrating keratoplasty
    • If no cornea available- Evisceration of the eye ball
  • Causes of non healing corneal ulcer
    • Ocular
    • Secondary glaucoma
    • Associated dacryocystitis
    • Presence of Foreign body, trichiasis
    • Dry eye, corneal anaesthesia
    • Lagophthalmos,lid abnormalities
    • Use of topical steroids
    • Wrong diagnosis, wrong treatment, poor compliance with medications.
    • Systemic
    • Diabetes mellitus
    • Immunoc ompromised state
    • On systemic steroids or immuno suppresants .
  • Fungal corneal ulcer
    • History :
    • Injury with vegetable matter Aspergillus, Fusarium, Candida
    • Symptoms
    • Pain
    • Redness
    • Tearing
    • Photophobia
    • Defective vision
    • Blepherospasm
  • signs
    • Signs out of proportion to symptoms
    • Dry
    • Feathery margins
    • Immune ring
    • Satellite lesions
    • Endothelial plaque
    • Hypopyon
      • immobile
      • Convex
  • Diagnosis
    • History
    • Microbiological investigations
      • KOH, Calcofluor white, Giemsa
      • Sabouraud’s dextrose agar
  • Treatment
    • Specific treatment
    • Topical
      • Natamycin
      • Amphotericin B
    • Systemic
      • Ketoconazole
    • NO CORTICOSTEROID
    • Therapeutic Keratoplasty
    • Non specific treatment
  • Acanthamoeba Keratitis
    • Free living amoeboid protozoan
    • Trophozoites and cysts
    • Ubiquitous in nature
    • Found in air, soil & all water sources.
  • Acanthamoeba Keratitis
    • Symptoms out of proportion to signs
    • More in contact lens wearers , sand contamination
    • Epithelium initially intact
    • Stromal infiltrate
    • Ring infiltrate
    • Radial keratoneuritis
    • Limbitis
  •  
  • Management
    • Calcofluor white – cysts
    • Culture –
    • non nutrient agar
    • enriched with E coli
    • Specific
    • Propamidine isothionate 0.1 %
      • ( Brolene )
    • Polyhexamethylene biguanide (PHMB)
    • Neomycin
    • Fluconazole, Micanazole
    • NO CORTICOSTEROIDS
    • Therapeutic Keratoplasty
    • Non specific treatment