OM VERMA ASSOCIATE PROFESSOR GRACIOUS COLLEGE OF NURSING ABHANPUR RAIPUR C.G

1. GRACIOUS COLLEGE OF NURSING
RAIPUR C.G.
CORNEA- INFLAMMATION AND
INFECTION
PRESENTED BY
OM VERMA
ASSISTANT PROFESSOR

2. KERATITIS

3. INTRODUCTION
The transparent part of the eye that covers
the iris and the pupil and allows light to
enter the inside. Inflammation of the clear
tissue on the front of the eye (cornea).
Keratitis is caused by infection, injury,
disease or wearing contact lenses too long.
Eye redness, pain and blurred or decreased
vision are symptoms.

4. Keratitis is the inflammation of the
cornea and is characterized by
corneal edema, infiltration of
inflammatory cells, and ciliary
congestion it is called keratitis .
According lippen cott

5. Keratitis is a define
as Infection of one or many
layers of the cornea
According to luckmans

6. Keratitis is painful inflammation
of the eye’s clear top layer, the
cornea. It can stem from an
infection or injury, and it makes
vision blurry and the eyes
sensitive to light.
According to ANA
.

7. Keratitis Infection or inflammation of
the cornea caused by a variety of
microorganism or by. Etiology •
Bacterial infection • Viral infection
,fungal infection it is called keratitis
According to levis

8. TYPES
Inflammations of the cornea
may be divided into Four
types:

9. Ulcerative Keratitis: A corneal ulcer is a
condition in which there is destruction of
some portion of both the epithelium and the
underlying stroma of the cornea.
Non-ulcerative keratitis: is a condition in
which the stroma of the cornea is only
affected by the keratitis describes an
inflammatory process in the cornea.

10. 3. Infectious keratitis - can be caused by
bacteria, viruses, fungi and parasites.
4. Noninfectious keratitis
can be caused by a relatively minor injury,
such as from wearing your contact lenses
too long or getting a foreign body in the
eye.

11. Risk factors
Factors that may increase your risk of keratitis include:
Contact lenses.
Wearing contact lenses — especially sleeping in the
lenses —increases your risk of both infectious and
noninfectious keratitis. The risk typically stems from
wearing them longer than recommended, improper
disinfection or wearing contact lenses while swimming.

12. Reduced immunity.
If your immune system is weakened due to
disease or medications, you're at higher
risk of developing keratitis.
Corticosteroids.
Use of corticosteroid eye drops to treat an
eye disorder can increase your risk of
developing infectious keratitis or make
existing keratitis worse.
Eye injury.
If one of your corneas has been damaged

13. ETIOLOGY

14. Injury.
If any object scratches or injures the
surface of your cornea, noninfectious
keratitis may result. In addition, an
injury may allow microorganisms to
gain access to the damaged cornea,
causing infectious keratitis.

15. Bacteria, fungi or parasites.
These organisms may live on the surface
of a contact lens or contact lens carrying
case. The cornea may become
contaminated when the lens is in your eye,
resulting in infectious keratitis. Poor
contact lens hygiene or contact lens
overwear can cause both noninfectious and
infectious keratitis.

16. Bacteria.
Staphylococcus,
streptococcus and
pseudomonas are common
bacteria involved in
keratitis.

17. Fungal infections:
This type of keratitis infection is
not common. It can be caused
by scratching your eye with a
branch or plant material. It can
also be caused by the improper
use of contact lenses or steroid
eye drops.

18. Contaminated water.
Bacteria, fungi and parasites in water —
particularly in, rivers, lakes can enter eyes
when you're swimming and result in
keratitis. However, even if you're exposed
to these organisms, a healthy cornea is
unlikely to become infected unless there
has been some previous breakdown of the
corneal surface — for example, from
wearing a contact lens too long.

19. Exposure to intense ultraviolet (UV)
light (photokeratitis):
Photokeratitis is caused by damage to
the cornea by UV light. It can be
caused by the reflection of UV light

20. Exogenous Infections:
The cornea is exposed throughout life to
miner trauma, virulent micro-organisms
present in the conjunctival sac may gain
access to the corneal tissue.
Endogenous Agents:
The inflammation is typically a cell-mediated
immune response to a foreign antigen and
often occurs in the periphery of the
cornea,.

21. Chemical Agents:
Acids, alkali, tincture of iodine or lime
produce corneal ulceration by
destroying the epithelium and the
superficial layers of the stroma.

22. .
Loss of corneal sensation: Corneal
anesthesia, caused by trigeminal nerve
paralysis, leads to trophic changes in the
corneal epithelium resulting in degeneration
and ulceration. This condition is called
neuroparalytic keratitis.
Vitamin A Deficiency: This leads to
degenerative changes in the corneal
epithelium leading to ulceration, it also
induces lack of resistance of the cornea to
micro-organisms of low virulence.

25. Due to etiological factors infection and non
infection
Keratitis is a clinical entity wherein inflammatory
cells infiltrate different corneal layers in response
to noxious stimuli,
either infectious exogenous agents or self-
antigens. The inflammatory reaction
may result in the suppurative melting ( all stages
of inflammation ) of corneal epithelium and
stroma, resulting in the formation of ulcers then
lead the Keratitis

26. Symptoms
Symptoms of keratitis include:
Eye redness
Eye pain
Excess tears or other discharge from eye
Difficulty opening eyelid because of pain or
irritation
Blurred vision
Decreased vision
Sensitivity to light, called photophobia
A feeling that something is in your eye

27. DIAGNOSTIC TEST

28. History: The eye doctor will take a medical
history, identify any illness, and ask you about
your symptoms before examining your eye. •
Visual acuity: This test will show how well you
can see.
Penlight exam: The eye doctor may examine
your eye using a penlight, to check your pupil’s
reaction, size, and other factors The main
purpose of a penlight is to assess pupil
response, or how fast the pupils constrict when
suddenly exposed to a bright light..

29. Slit-lamp:
The eye doctor uses a special
microscope called a slit lamp. It shines
a light into one eye at a time so the
doctor can look closely at the outside
and inside of the eye. eye doctor may
apply a stain (fluorescein) to the
surface of eye, to light up any damage
to cornea.

30. Laboratory analysis: The eye doctor may
swab under eyelid to get a sample of tears
or some cells from cornea for laboratory
analysis. The doctor might also swab
contact lens case as a separate sample for
analysis. This will help to determine the
cause of keratitis and develop a treatment
plan for your condition.

31. Medical management
 To identify the causative agents
1. Antibiotic to control infection.
2. Atropine to Relieve Uveal Irritation.
3. Application of heat to increase blood flow.
4. Wash out of conjunctival discharge.
5. Protection of the eye.
6. Promotion of re-epithelialization
7.Mild, noninfectious keratitis tends to heal
on its own. The doctor may suggest
artificial tears, eye ointments, cold
compresses, .

32. Pharmacological management
Treatment of Herpes Simplex Keratitis:
Medical lines of Treatment:
Antiviral agents are usually the first line of
treatment in addition to the usual routine
treatment of corneal ulcers,
1. Atropine drops,
2. Antibiotic against secondary bacterial
infection,
3. Pad and bandage.

33. MILD BACTERIAL INFECTION,
The doctor may recommend antibacterial
eye drops. For more serious cases, they
may prescribe oral antibiotics. And adding
steroid eye drops to the treatment plan
can reduce swelling if the keratitis is
severe. bacterial keratitis is fortified
antibiotics, tobramycin (14 mg/mL) 1 drop every hour
alternating with fortified cefazolin (50 mg/mL) or
vancomycin (50mg/mL) 1 drop every hour. In cases of
severe ulcers, this is still the recommended initial
therapy.

34. viral keratitis,
A doctor prescribes antiviral eye drops or
oral medications.
Treatment of herpes simplex keratitis should be
started as soon as possible. The doctor may
prescribe an antiviral drug, such as trifluridine
eye drop or ganciclovir eye gel. Acyclovir,
another antiviral drug, can be taken by mouth or
by vein (intravenously). The antiviral drug
valacyclovir can also be taken by mouth.

35. fungal keratitis
involves using oral and eye drop antifungal
medication Natamycin is a topical
(meaning it's given in the form of eye
drops) antifungal medication that works
well for fungal infections involving the
outer layer of the eye, particularly those
caused by fungi such as Aspergillus and
Fusarium.

36. SURGICAL MANAGEMENT
Corneal transplantation
Penetrating keratoplasty (PKP) is the
most common procedure done for
infectious keratitis. The goal of the
surgery is to removal all the infected
corneal tissue and replace it with
healthy cornea.

37. Keratotomy
('cutting the cornea') involves
making a partial thickness
incision into the cornea to
change its radius of
curvature and refractive
power

38. Debridement:
removal of virus-containing cells is
indicated in recurrent dendrite
ulcers.

39. COMPLICATIONS OF KERATITIS
INCLUDE:
Chronic corneal inflammation and
scarring.
Chronic or recurrent viral infections of
cornea.
Open sores on cornea, called corneal
ulcers.
Temporary or permanent reduction in
vision.
Blindness.