CORNEAL ULCER ,DR M SAQUIB , OPHTHALMOLOGY
•Download as PPTX, PDF•
1 like•359 views
DR M SSAQUIB
Recommended
More Related Content
What's hot
What's hot (20)
Similar to CORNEAL ULCER ,DR M SAQUIB , OPHTHALMOLOGY
Similar to CORNEAL ULCER ,DR M SAQUIB , OPHTHALMOLOGY (20)
More from MEDICS india
More from MEDICS india (18)
Recently uploaded
Recently uploaded (20)
CORNEAL ULCER ,DR M SAQUIB , OPHTHALMOLOGY
- 1. CORNEAL ULCER 16th July 2020 DR M SAQUIB Vice Principal MBBS,MS , FSCEH DELHI,FHVDESAI PUNE, EX REGISTRARA JNMCH,AMU CONSULTANT OPHTHALMOLOGIST HOD D/O OPHTHALMOLOGY G.S .MEDICAL COLLEGE Founder sec: MEDICS India , Mail-dms2k5@gmail.com , 9634123800
- 2. Suppurative keratitis Purulent /Corneal Ulcer Non –Suppurative Keratitis Non Purulent Corneal ulcer : Refers to corneal tissue excavation associated with an epithelial defect, usually with infiltration and necrosis 2
- 4. “ 4
- 5. Corneal ulcers can be classified in three ways 1. On The Basis Of Aetiology 2. On The Basis Of Location Of Ulcer 3. On The Basis Of Involvement Of The Corneal Layers Superficial – superficial to Bowman’s layer Deep - Involve Stroma and other deep layer 4. Severity – Mild ( <2mm in size) Moderate ( 2-5 mm size ) Severe ( 5 mm in size ) 1
- 6. . On The Basis Of Aetiology Classification a. Infective: Bacterial Viral Fungal Protozoal b. Non-infective/sterile : Neuroparalytic Neurotrophic Corneal ulcer due to Vit A deficiency Mooren ulcer6
- 7. “On the basis of location of ulcer Central Paracentral Peripheral 7
- 9. Predisposing Factors Local Factors : ▸ Ocular trauma ▸ Dry eye ▸ Chronic dacryocystitis ▸ Exophthalmos ▸ Xerophthalmia ▸ Entropion ▸ Trichiasis ▸ Contact lens wear ▸ Prolong use of local steroids ▸ Extreme Age ▸ Immunocompromised Individuals ▸ Lagophthalmos( Facial paralysis ) 9
- 10. Predisposing Factors ▸ Systemic Factors : - Malnutrition - DM - Alcoholism - Drug addiction - Malignancy - Immunosuppressive drugs 10
- 11. Predisposing Factors ▸ Contact lens users are predisposed to corneal ulcer. ▸ Causes : ▸ Negligence ▸ Prolonged period of time ▸ Cleaning with tap water ▸ Contamination 11
- 12. Infective Corneal Ulcer ▸ Compromised ocular defense ▸ Sight threatening condition ▸ Ocular emergency 12
- 13. Ocular Defence Mechanism ▸ Corneal epithelium- mechanical barrier ▸ Conjunctiva- cellular & chemical components ▸ Tear film- biological protective system Major components of ocular defense system 13
- 14. Barriers Of Microbial Infection Anatomical ▸ Intact corneal and conjuctival epithelium ▸ Bony Orbital rim ,Eye lids Mechanical ▸ Tear Film – Mucus Layer ▸ Lacrimal System Antimicrobial ▸ Tear film constitutes IgA,compleme nt component ,Enzymes lysozymes,Lac toferin,Betalys ins ▸ CALT 14
- 15. Causative Organisms Bacterial ▸ Staphylococcus aureus ▸ Staph Epidermidis ▸ Strptococcus pnemoniae, ▸ Moraxella , Cornyebacterium diptheria, ▸ Pseudomonas aeruginosa ▸ Proteus ,Nocardia , Klebsiella ,Haemophilous influenza ▸ Fungal ▸ Filamentou Fusarium , Aspergillus ▸ Dermatacious – Curvularia species ▸ Yeast – Candida Albicans ▸ Viral ▸ Herpes simplex ▸ Varicella zoster ,Cytomegalovir us ,Adeno virus ▸ Protozoal – ▸ Acanthamoeba , Microsporidia ,Omchocerca, Leishmania 15
- 16. Pathogenesis Corneal abrasion- Microbes adhere , clone and invade to stromal lamellae,release toxins & lytic enzymes Host response PMNs at the site of defect from tears & limbal vessels, release of cytokines & interleukins , progressive invasion of cornea & increase in size of ulcer ▸ Phagocytosis Release of free radicals, proteolytic enzymes Necrosis & sloughing of epithelium, Bowman’s membrane & stroma A saucer shaped defect with projecting walls above the normal surface due to swelling of tissue resulting from fluid imbibitions by corneal stroma with grey zone of infiltration 16
- 17. Pathogenesis ▸ Stage of Ulceration ▸ Stage of Progression ▸ Stage of Regression ▸ Stage of Healing 17
- 18. Presenting Symptoms: Lacrimation Photophobia Blephrospasm pain congestion of eye Decrease visual acuity foreign body sensation ▸ Bacterial ▸ Purulent Discharge ▸ Fungal ▸ Dry looking ▸ Signs more than symptoms ▸ Trauma to vegetative matter ▸ Protozoal ▸ Contact lens user ▸ Swimming bathing in infected pool/water ▸ Viral ▸ Recurrence ▸ Fever ▸ Skin vesicles 18
- 20. 20
- 21. Fungal – Dry looking , Feathery margin , Satellite lesion ,Immune ring (wesseley),Hypopyon –Immobile ,thick 21
- 23. 23
- 24. 24
- 25. 25
- 26. 26
- 27. 27
- 30. 30
- 32. Protozoal Corneal Ulcer Causative organism : ▸ Acanthamoeba Definitive sign : ▸ Perineural infiltrates (radial keratoneuritis) ▸ Investigations : • Corneal scraping for – ▸ - Calcofluor white stain ▸ - Gram stain ▸ - Giemsa stain Culture and sentivity : - Non-nutrient agar seeded with dead E. coli32
- 33. Complication ▸ Complications of corneal ulcer can be described under two headings : ▸ 1.Before perforation ▸ 2.After perforation 33
- 34. Before Perforation : ▸ Anterior uveitis ▸ Hypopyon ▸ Secondary glaucoma ▸ Descemetocele ▸ Corneal scarring ▸ Nebula ▸ Macula ▸ Leucoma34
- 35. Pics 35
- 36. 36
- 37. After Perforation : Anterior Synaechiae Iris Prolapse Adherent Leucoma Complicated Cataract Sublaxation Of The Lens Anterior Staphyloma Endophthalmitis Phthisis Bulbi 37
- 38. 38
- 39. General measures ▸ Hospital Admission ▸ Discontinuation Of Contact Lens Wear ▸ Using Eye Shield/Dark Glass ▸ Improvement Of Nutrition (Vit–c ) 39
- 40. Local Therapy ▸ Antibiotic monotherapy Fluoroquinolone ▸ Antibiotic duotherapy : Combination of two fortified antibiotics : cephalosporin + aminoglycoside ▸ Cycloplegics : ▸ Cyclopentolate ,Homatropine , Atropine 40 Bacterial Corneal Ulcer
- 41. 41
- 42. 42
- 43. Want big impact? Use big image. 43
- 45. 45