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Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
Cornea class 3
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Cornea class 3

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  • 1. Fungal corneal ulcer <ul><li>History : </li></ul><ul><li>Injury with vegetable matter Aspergillus, Fusarium, Candida </li></ul><ul><li>Symptoms </li></ul><ul><li>Pain </li></ul><ul><li>Redness </li></ul><ul><li>Tearing </li></ul><ul><li>Photophobia </li></ul><ul><li>Defective vision </li></ul><ul><li>Blepherospasm </li></ul>
  • 2. signs <ul><li>Signs out of proportion to symptoms </li></ul><ul><li>Dry, raised </li></ul><ul><li>Feathery margins </li></ul><ul><li>Immune ring </li></ul><ul><li>Satellite lesions </li></ul><ul><li>Endothelial plaque </li></ul><ul><li>Hypopyon </li></ul><ul><ul><li>Fixed </li></ul></ul><ul><ul><li>Convex </li></ul></ul><ul><ul><li>Non sterile </li></ul></ul>
  • 3. Management <ul><li>Diagnosis </li></ul><ul><li>Treatment </li></ul><ul><li>History </li></ul><ul><li>Microbiological investigations </li></ul><ul><ul><li>KOH, Calcofluor white, Giemsa </li></ul></ul><ul><ul><li>Sabouraud’s dextrose agar </li></ul></ul><ul><li>Specific treatment </li></ul><ul><li>Topical </li></ul><ul><ul><li>Natamycin </li></ul></ul><ul><ul><li>Amphotericin B </li></ul></ul><ul><li>Systemic </li></ul><ul><ul><li>Ketoconazole </li></ul></ul><ul><li>NO CORTICOSTEROID </li></ul><ul><li>Therapeutic Keratoplasty </li></ul><ul><li>Non specific treatment </li></ul>
  • 4. Acanthamoeba Keratitis <ul><li>Free living amoeboid protozoan </li></ul><ul><li>Trophozoites and cysts </li></ul><ul><li>Ubiquitous in nature </li></ul><ul><li>Found in air, soil &amp; all water sources. </li></ul>
  • 5. Acanthamoeba Keratitis <ul><li>Symptoms out of proportion to signs </li></ul><ul><li>More in contact lens wearers , swimming pool, soil contamination </li></ul><ul><li>Epithelium initially intact </li></ul><ul><li>Stromal infiltrate, dendrite like infiltrate. </li></ul><ul><li>Ring infiltrate </li></ul><ul><li>Radial keratoneuritis </li></ul><ul><li>Limbitis </li></ul>
  • 6. &nbsp;
  • 7. Management <ul><li>Calcofluor white – cysts </li></ul><ul><li>Culture – </li></ul><ul><li>non nutrient agar </li></ul><ul><li>enriched with E coli </li></ul><ul><li>Specific </li></ul><ul><li>Propamidine isothionate 0.1 % </li></ul><ul><ul><li>( Brolene ) </li></ul></ul><ul><li>Polyhexamethylene biguanide (PHMB) </li></ul><ul><li>Neomycin </li></ul><ul><li>Fluconazole, Micanazole </li></ul><ul><li>NO CORTICOSTEROIDS </li></ul><ul><li>Therapeutic Keratoplasty </li></ul><ul><li>Non specific treatment </li></ul>
  • 8. Herpetic Keratitis <ul><li>Herpes Simplex – 1 : above the waist </li></ul><ul><li>Primary HSV - 6 months to 5years </li></ul><ul><li>- and self limiting </li></ul><ul><li>Acute follicular keratoconjunctivitis </li></ul><ul><li>Blepharitis </li></ul><ul><li>Corneal lesions </li></ul>
  • 9. Herpetic Keratitis <ul><li>Corneal lesions </li></ul><ul><li>Epithelial lesions Dendritic ulcer Amoeboid ulcer geographic ulcer </li></ul><ul><li>Stromal (necrotising and non necrotising) </li></ul><ul><li>Endothelial </li></ul>
  • 10. &nbsp;
  • 11. Dendritic ulcer <ul><li>Superficial punctate erosions </li></ul><ul><li>Infiltrates spread in all direction- coalesce </li></ul><ul><li>Large shallow ulcers with crenated edges. </li></ul><ul><li>Increase in length ,send out lateral branches and are knobbed at the ends </li></ul><ul><li>Giving rise to dendritic form configuration </li></ul>Linear bran ching Ulcer stains with Fluorescein Reduced corneal sensation
  • 12. Rose bengal stain
  • 13. Management <ul><li>Investigations </li></ul><ul><li>Treatment </li></ul><ul><li>Immunoflurescence and culture of epithelial scrapings. </li></ul><ul><li>Antivirals </li></ul><ul><li>Acyclovir 3% 5 times/ day Triflurothymidine </li></ul><ul><li>IDU 0.1% drops </li></ul><ul><li>Antibiotic eye drops </li></ul><ul><li>Debridement </li></ul><ul><li>Cycloplegics </li></ul>
  • 14. <ul><li>Stromal keratitis </li></ul><ul><li>Disciform keratitis </li></ul><ul><li>Necrotising ulcerative keratitis Interstitial keratitis </li></ul><ul><li>Sclerokeratitis </li></ul><ul><li>Endotheleitis </li></ul><ul><li>Indolent &amp; trophic ulceration </li></ul><ul><li>Uveitis </li></ul>
  • 15. Reactivated infection of the endothelium and keratocytes Past history of dendritic ulcer Disc shaped corneal dedep lesion Oedema Immune ring KPS Anterior uveitis IOP may be high Old lesions – faint opacities
  • 16. Treatment of disciform keratitis <ul><li>Topical Antivirals e.g acyclovir </li></ul><ul><li>Steroids under the cover of anti viral drops. </li></ul><ul><li>Tapered over weeks eg. 4x to 6x a day over 2weeks and then to taper. </li></ul>
  • 17. Herpes Zoster <ul><li>Chicken pox- Varicella </li></ul><ul><li>Zoster virus </li></ul><ul><li>Virus dormant in Gasserian ganglion </li></ul><ul><li>Immunity depressed </li></ul><ul><li>Infection activates and virus travels down the branches of ophthalmic division of trigeminal nerve (supra orbital aupre and infra trochlear) </li></ul>
  • 18. Herpes zoster ophthalmicus <ul><li>Ophthalmic division of the trigeminal nerve </li></ul><ul><li>Acute phase Prodromal phase- Influenza like illness Neuralgia </li></ul><ul><li>Ocular lesions – vesicles over the lids </li></ul><ul><li>eyelids ,conjunctivitis, episcleritis, scleritis, keratitis,anterior uveitis,retinal vasculitis,optic neuritis, cranial nerve palsy. </li></ul><ul><li>Hutchinson&apos;s sign –involvement of the tip of the nose is associated with ocular involvement. </li></ul>
  • 19. Rash Maculapapular rash Vesicles Pustules Crust Oedema Along distr. Of nerve Does not cross midline Ocular Complications Iridocyclitis Keratitis Sec. Glaucoma
  • 20. Treatment <ul><li>Oral Acyclovir 800mg </li></ul><ul><li>5 times/day for 10 days </li></ul><ul><li>Topical acyclovir ointment </li></ul><ul><li>Topical antibiotics </li></ul><ul><li>In case of iridocyclitis add topical steroids and cycloplegics </li></ul>

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