This document discusses bacterial corneal ulcers, including their definition, causative agents, pathogenesis, symptoms, signs, investigations, differential diagnosis, risk factors, complications, and treatment. The main points are: Bacterial corneal ulcers are discontinuations of the normal corneal epithelium caused by bacterial organisms and surrounding corneal tissue necrosis. Pseudomonas aeruginosa is a common causative agent and can cause rapidly progressive stromal necrosis. Investigation involves a detailed history, slit lamp exam, gram stain, and culture/sensitivity testing. Treatment aims to eliminate bacteria and control infection to prevent complications like perforation, and involves topical antibiotics, cycloplegics, steroids, and occasionally periocular antibiotics.

1. Mahir Faiyaz
B.Optom 7thBatch
ICO

2. Definition
Bacterial corneal ulcer may be defined as a
discontinuation of normal epithelium surface of
cornea caused by various bacterial organisms
associated with necrosis of the surrounding corneal
tissue.
It’s a sight threatening condition and should be
considered as ocular emergency.

3. Causative Agent
Pseudomonas aeruginosa
-Rapidly Progressive;Stromal necrosis with shaggy
surface
-Excavated paracentral corneal ulcer with an immune
ring & hypopyon

5. CONTINUE….
Pneumococcus
-Greenish white disc shaped ulcer
-Iridocyclitis is often associated with it.
Streptococcus viridans
-Needle like opacities in stroma
-Not associated with infiltration & inflammation

8. Moraxella
-In debiliating diseases: DM,Malnutrition,Alcoholic
Staphylococcus aureus
-Central,Oval Corneal ulcer.
-Mild oedema of the remaining cornea.
-Affects compromised cornea,Bullous keratopathy,Dry
eyes.

10. Pathogenesis
Stage of progressive infiltration
Stage of active ulceration
Stage of regression
Stage of Cicatrization

11. Stage of progressive infiltration &
ulceration
o Saucer shaped ulcer
o Walls project above normal surface
o Grey zone of infiltration
o Hypopyon
o Progress laterally or deeper

12. Stage of Regression
o A line of demarcation
o Digestion of Necrotic material
o Vascularization
o Begins to heal

13. STAGE OF CICATRIZATION
o If epithelium only – no scar
o Progressive epithelization
o Nebula
o Macula
o Leucoma

15. SYMPTOMS
o Pain
o Foreign body sensation
o Redness
o Photophobia
o Discharge
o Lacrimation
o Blepharospasm
o Reduced Vision

16. SIGNS
 Lid – edema,narrow palpebral fissure
 Conjunctiva - ciliary congestion
 Cornea-
Location of the ulcer – central, para central,
peripheral, total.
Size, shape, depth, margins and floor – depends on
stage of ulcer.
Density and extent of stromal infiltration.

17. Anterior chamber
 Cells/ flare, mobile hypopyon.
Iris - muddy
Pupil – miotic

19. INVESTIGATION
A detailed history
Review of related medical problems, current ocular
medications & history of systemic steroids.
Slit lamp examination
Gram staining
Corneal scraping
Culture media and antibiotic sensitivity

20. DIFFERENTIAL DIAGNOSIS
Bacterial endophthalmitis
Fungal corneal ulcer
Band keratopathy
Peripheral corneal ulcer
Exposure keratopathy
Epithelial keratitis
Herpes simplex virus

21. Risk Factors
Local factors
 Trauma
 Eyelid & Adnexal disease
 Contact lens use
 Local immune suppression
 Ocular surgery

22. Systemic Factors
 Malnutrition
 Vitamin A deficiency
 DM
 Immunosuppressions
 Chronic alcoholism

23. COMPLICATIONS
 Before perforation
 Perforation
 After perforation

24. Before perforation
Corneal opacity
-Nebula
-Macula
-Leucoma
Iritis
Descemetocele
Complicated Cataract

25. Perforation
Rupture
PAS
Very shallow AC
Eyeball becomes soft
Iris prolapse

26. After Perforation
Iris prolapse
Adherent leucoma
Pseudocornea
PAS
Endophthalmitis
Panophthalmitis
Anterior Staphylloma
Pthisis bulbi
Secondary Glaucoma

28. Treatment
Aims of Rx:
a) Eliminate viable bacteria from the cornea
b) Suppression of inflammatory response
 Principle
 Symptomatic relief
 Control of infection
 Prevention of Complication(perforation)

29. Treatment of uncomplicated ulcer
Topical antibiotic
 When confronted with a severe ulcer,antibiotic
instillation at 1minute intervals for 5doses each hour
for the first 6 to 8 hours is recommended,followed by
hourly instillation.
 With additional signs of healing , frequency is
decreased to 2 hours then to 3 hours intervals & so
forth.
 Gentamicin(1.5%) Cephazolin 50mg/ml Moxifloxacin
0.5%

30. Cycloplegic drugs
-Atropine 1%
-Homatropine 2%
-Cyclopentolate1%
Steroid
-1 % Prednisolone

31. PERIOCULAR ANTIBIOTICS
 Can be used when
Confronted with a gram negative extensive corneal
ulcer not responding to topical therapy
Infiltrates extending beyond limbus involving sclera

32. Analgesics & anti inflammatory drugs
Hot fomentation
Dark Goggles
Rest,Good diet,Fresh air

33. Complicated ulcer
Rest in bed is advised
Atropine & antibiotic ointment are applied
Avoid straining
Pressure Pad & Bandage
Tissue adhesives
RGP CLs
Conjunctival flap
Therapeutic penetrating keratoplasty

34. Thank you
For
Your Attention