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BACTERIAL CORNEAL
ULCER
Labeeb Pc
Corneal epithelial damage
Prolonged use of steroids
Wearing contact lenses
Poor local hygiene
Corneal Epithelial Damage
 Corneal Abrasion
 Epithelial drying
 Necrosis - keratomalacia
 Desquamation – bullous kerat...
TRICHIASIS
ENTROPION
LAGOPHTHALMOS
Sources Of Infection
Exogenous
Ocular tissue
Causative organisms
 Invade normal epithelium –
N.gonorrhoeae & C. diphtheriae
Stage of progressive
infiltration & ulceration
 Saucer shaped ulcer
 Walls project above normal surface
 Grey zone of i...
Stage of regression
A line of demarcation.
Necrotic material shed off
Begins to heal
Vascularisation
Stage of cicatrisation
 If epithelium only – no scar
 Nebular – Bowman’s membrane &
superficial stroma
 Macular – upto ...
Corneal Opacities
Nebular Macular Leucomat
ous
Adherent
Leucoma
Nebular
Macular
Leucomatous
Adherent Leucoma
 Pain & fb sensation
 Lacrimation
 Photophobia
 Blurred vision
 Blepharospasm
 Redness of eyes
Circum corneal
congestion
 Swelling of lids
 Conjunctiva – chemosis, CCC
 Corneal ulcer –
 Margins – swollen, over hanging
 Floor - necrotic ma...
 AC – hypopion - mobile
 Iris – slightly muddy
 Pupil – small
Ectatic
Cicatrix
Descemetocele
 Ectatic cicatrix
 Descemetocele
 Toxic Iridocyclitis
 Inflammatory glaucoma
Corneal perforation
 Prolapse of iris
 Adherent Leucoma
Pseudocornea
Anterior Staphyloma
Anterior Subcapsular
cataract
Anterior
Synechia
 Corneal fistula
 Secondary glaucoma
 Spontaneous expulsion of lens & vitreous
 Intraocular hemorrhage , Expulsive
Hem...
 Routine blood examination
 Lid & Adnexa Examination
 Corneal Scraping – kimura spatula
 Corneal biopsy
 Culture of c...

TREATMENT
Treatment of Uncomplicated Ulcers
1. Antibiotics
Fortified Cephazolin 5%, fortified Tobramycin
1.3%
Fortified Vancomycin 0...
4. Cauterisation – carbolic acid, trichloroacetic a
5. Rigid gas permeable contact lenses
6. Dense corneal scars with visu...
8. Analgesics
9. Hot Fomentation
10. Dark Goggles
11. Rest, good diet, fresh air
Perforated ulcer
1. Avoid straining
2. Tissue adhesive –
 N-butyl 2-ethyl cyanoacrylate
3. Bandage soft contact lenses
4....
Marginal Catarrhal Ulcer
 Near limbus
 Old pupil
 Hypersnsitivity to staphylococcal toxins

HYPOPION ULCER
 Pneumococcus – Ulcus Serpens
 Pseudomonas, Staphylococcus, Gonococci,
Streptococcus, Moraxella
 C/c Dacrocystitis
 St...
Ulcus serpens
 Greyish white or
yellowish disc like.
 Opacity greater at the edges
 One edge – infiltration , other - c...
Bacterial corneal ulcer
Bacterial corneal ulcer
Bacterial corneal ulcer
Bacterial corneal ulcer
Bacterial corneal ulcer
Bacterial corneal ulcer
Bacterial corneal ulcer
Bacterial corneal ulcer
Bacterial corneal ulcer
Bacterial corneal ulcer
Bacterial corneal ulcer
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Bacterial corneal ulcer

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Bacterial Corneal Ulcer

An Ophthalmology topic for MBBS

Published in: Education
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Bacterial corneal ulcer

  1. 1. BACTERIAL CORNEAL ULCER Labeeb Pc
  2. 2. Corneal epithelial damage Prolonged use of steroids Wearing contact lenses Poor local hygiene
  3. 3. Corneal Epithelial Damage  Corneal Abrasion  Epithelial drying  Necrosis - keratomalacia  Desquamation – bullous keratopathy  Trophic changes – neurotrophic keratitis
  4. 4. TRICHIASIS
  5. 5. ENTROPION
  6. 6. LAGOPHTHALMOS
  7. 7. Sources Of Infection Exogenous Ocular tissue
  8. 8. Causative organisms  Invade normal epithelium – N.gonorrhoeae & C. diphtheriae
  9. 9. Stage of progressive infiltration & ulceration  Saucer shaped ulcer  Walls project above normal surface  Grey zone of infiltration  Hypopion  Progress laterally or deeper
  10. 10. Stage of regression A line of demarcation. Necrotic material shed off Begins to heal Vascularisation
  11. 11. Stage of cicatrisation  If epithelium only – no scar  Nebular – Bowman’s membrane & superficial stroma  Macular – upto half of stroma  Leucomatous – more than half of stroma  Corneal Facets
  12. 12. Corneal Opacities Nebular Macular Leucomat ous Adherent Leucoma
  13. 13. Nebular Macular
  14. 14. Leucomatous
  15. 15. Adherent Leucoma
  16. 16.  Pain & fb sensation  Lacrimation  Photophobia  Blurred vision  Blepharospasm  Redness of eyes
  17. 17. Circum corneal congestion
  18. 18.  Swelling of lids  Conjunctiva – chemosis, CCC  Corneal ulcer –  Margins – swollen, over hanging  Floor - necrotic material  Stromal edema around
  19. 19.  AC – hypopion - mobile  Iris – slightly muddy  Pupil – small
  20. 20. Ectatic Cicatrix
  21. 21. Descemetocele
  22. 22.  Ectatic cicatrix  Descemetocele  Toxic Iridocyclitis  Inflammatory glaucoma
  23. 23. Corneal perforation  Prolapse of iris  Adherent Leucoma
  24. 24. Pseudocornea
  25. 25. Anterior Staphyloma
  26. 26. Anterior Subcapsular cataract Anterior Synechia
  27. 27.  Corneal fistula  Secondary glaucoma  Spontaneous expulsion of lens & vitreous  Intraocular hemorrhage , Expulsive Hemorrhage  Endophthalmitis or Panophthalmitis
  28. 28.  Routine blood examination  Lid & Adnexa Examination  Corneal Scraping – kimura spatula  Corneal biopsy  Culture of contact lens & solution
  29. 29.  TREATMENT
  30. 30. Treatment of Uncomplicated Ulcers 1. Antibiotics Fortified Cephazolin 5%, fortified Tobramycin 1.3% Fortified Vancomycin 0.3%, Fluroquinolones 2. Atropine 3. Steroids
  31. 31. 4. Cauterisation – carbolic acid, trichloroacetic a 5. Rigid gas permeable contact lenses 6. Dense corneal scars with visual potential- Lamellar keratoplasty, full thickness graft 7. Without visual potential – Cosmetic contact lenses, tattooing.
  32. 32. 8. Analgesics 9. Hot Fomentation 10. Dark Goggles 11. Rest, good diet, fresh air
  33. 33. Perforated ulcer 1. Avoid straining 2. Tissue adhesive –  N-butyl 2-ethyl cyanoacrylate 3. Bandage soft contact lenses 4. Therapeutic keratoplasty , Dacrocystorhinostomy 5. Conjuctival flap, amniotic membr transplant 6. Antiglaucoma
  34. 34. Marginal Catarrhal Ulcer  Near limbus  Old pupil  Hypersnsitivity to staphylococcal toxins
  35. 35.  HYPOPION ULCER
  36. 36.  Pneumococcus – Ulcus Serpens  Pseudomonas, Staphylococcus, Gonococci, Streptococcus, Moraxella  C/c Dacrocystitis  Sterile , mobile, rapidly absorbed
  37. 37. Ulcus serpens  Greyish white or yellowish disc like.  Opacity greater at the edges  One edge – infiltration , other - cicatrization  Cornea – lustreless  Violent iritis and aqueous is cloudy

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