This presentation describes all clinical aspects of infectious corneal ulcers
You can watch the illustrated presentation in this link :
https://www.youtube.com/watch?v=okWDPG3C34g&list=PLZ_mM13I_TrhwqZuGjB6M9Z3n7MntrURd
2. Corneal Ulcers
Def: Corneal ulcers are defects in the corneal epithelium
with or without stromal infiltration.
Types:
A) Infectious ulcerative keratitis
B) Non infectious ulcerative keratitis
3. Bacteria and
Fungi Viruses Acanthamoeba
Systemic
Autoimmune/
Inflammatory
Local Toxic
InfectiousNon infectious
Etiology
4. Non Infectious Ulcerative Keratitis
Causes:
Local causes:
Punctate marginal keratitis: Staphylococci, Streptococci, hypersensitivity to
medications
Peripheral keratitis associated with blepharitis:
Systemic causes:
Generally manifestation of systemic, immune-mediated disease
Most common: Rheumatoid arthritis, Wegener’s granulomatosis and
polyarteritis nodosa
9. Important Facts
A corneal ulcer is an ocular emergency that
raises high stakes of questions about diagnosis
and management.
When a large corneal ulcer is staring you in the
face time isn't in your side.
Despite varying etiologies and presentations,
as well as different treatment approaches ,
corneal ulcers have one thing in common : the
potential to cause devastating loss of vision.
10. PRINCIPLES OF MANAGEMENT OF CORNEAL
DISEASE
1- Control of infection
2- Control of inflammation
3- Promotion of re-epithelialization
– lubrication
– lid closure
– bandage soft contact lens
4- Prevention of perforation
Tissue adhesive glue
Conjunctival flap
Systemic immunosuppressive agents
Corneal grafting
12. Causative Organisms
80 % of cases >>>>Staphylococcus aurous, Streptococcus
pneumonia and Pseudomonas species
Pseudomonas aeruginosa
is the most frequent and the most pathogenic ocular
pathogen which can cause corneal perforation in just 72
hours
13. MICROBIAL KERATITIS ( Bacterial)
Pathogens which can produce corneal infection in intact
epithelium.
1.Neisseria gonorrhoeae
2.Corynebacterium diphtheriae
3.Listeria
4.Haemophilus
14. Staph. aureus and strep. pneumoniae
Oval, yellow-white, densely opaque stromal suppuration
surrounded by relatively clear cornea
19. Clinically
History of vegetable matter injury
Greyish-white ulcer with indistinct margins
Surrounded by feathery infiltrates
Ring infiltrate
Endothelial plaque
Hypopyon
20. Differentiators
Dull grey infiltrate.
Satellite lesions.
Awareness of those ulcers resembling
bacterial keratitis
Awareness of those caused by yeast better
defined borders
Real flags
22. Filamentous fungal keratitis
Firm elevated necrotic slough, “hyphate” lines that extend beyond the
edge of the ulcer into the normal cornea,
multifocal granular (or feathery) gray-white “satellite” infiltrates in the
corneal stroma
23. MANAGEMENT
Culture
Biopsy
Antifungal therapy
– Initially broad-spectrum econazole 1%, voriconazole 1% topically
– Then depending upon sensitivity Natamycin or imidazole for 6 weeks
Systemic ketoconazole
Therapeutic penetrating keratoplasty
27. MANAGEMENT
Corneal scrappings stained with calcoflour white
Corneal biopsy
Treatment with chlorhexidine,
polyhexamethylenebiguanide drops,
dipropamidine and propamidine.
Therapeutic penetrating keratoplasty
28. VIRAL KERATITIS
HERPES SIMPLEX VIRUS
Basically it is epitheliotropic and
may become neurotropic
Two types-HSV-1 & HSV-2
Primary HSV-1 infection occurs
most commonly in the mucocutaneous
distribution of the trigeminal nerve
31. Differentiators
Dentritic ulcer.
Loss of corneal sensation.
Photophobia.
Types of HSV keratitis:
Primary
Recurrent
Dentritic , Geographic , Metaherptica
Diabetic foot in the eye Neurotrophic
32. TREATMENT
Epithelial keratitis is treated with topical antivirals
Aciclovir ophthalmic ointment and Trifluridine eye drops
Herpetic stromal keratitis is treated initially with prednisolone
drops every 2 hours accompanied by a prophylactic antiviral drug
Metaherpetic ulcer treated by artificial tears and eye lubricants,
stopping toxic medications, performing punctal occlusion, bandage
contact lens and amniotic membrane transplant
34. Herpes Zoster Ophthalmicus
(HZO)
Unilateral painful skin rash in one or more dermatome distributions of
the fifth cranial nerve (trigeminal nerve)
HUTCHINSON’S sign:
Vesicles at the side or
tip of
the nose are potential
indicators of
ocular diseases
35. ACUTE EYE DISEASES
Acute epithelial keratitis:
Dendritic lesions with tapered ends without terminal bulbs
36. Nummular keratitis:
Fine granular subepithelial deposits
Episcleritis:
Scleritis and sclerokeratitis:
Stromal (interstitial) keratitis:
Anterior uveitis
39. Treatment
Oral acyclovir 800 mg five times daily for 7 to 10 days is the
standard treatment
Topical antiviral ttt
Topical steroids in uveitis
Pain should be treated with narcotics
Topical skin ointment