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DR. ALI RAZA
         Associate Professor
Head of Department Ophthalmology
 Holy Family Hospital Rawalpindi
MICROBIAL KERATITIS
BACTERIAL KERATITIS
COMMON PATHOGENS:

Neisseria gonorrhoeae
Corynebacterium diphtheriae
Listeria sp.
Haemophilus sp.
BACTERIAL KERATITIS
OTHER PAHTOGENS:
 Produce keratitis only after loss of corneal epithelial
 integrity as in:

Contact ...
BACTERIAL KERATITIS
Ocular surface disease


Chronic dacryocistitis


Topical steroids


Systemic immunosuppressive ag...
BACTERIAL KERATITIS
CLINICAL FEATURES:
 Certain bacteria produce characteristic corneal
 response.

1- Staph. aureus and S...
Large Corneal infiltration in
 bacterial keratitis
Severe staphylococcal keratitis
Staphylococcal keratitis
CLINICAL FEATURES:

2- Pseudomonas:
Mucopurulent exudate,
liquefactive necrosis
ground-glass adjacent stroma
Pseudomonas keratitis with
hypopyon
Advanced pseudomonas keratitis
CLINICAL FEATURES:

3- Enterobacteriaeceae:

Shallow ulceration
Grey-white pleomorphic suppuration
Stromal opalescence
...
BACTERIAL KERATITIS
MANAGEMENT:
                 Bacterial corneal ulcer is a sight-
 threatening condition demanding

Id...
MANAGEMENT:
                  Therapy is divided into:

Sterilization phase
Healing phase
MANAGEMENT:

1- CHOICE OF ANTIBIOTICS:

Standard combined therapy with aminoglycosides
 and cephalosporins.
Monotherapy ...
MANAGEMENT:

2- PREPARATION OF FORTIFIED ANTIBIOTICS:

 by combination with a compatible vehicle
MANAGEMENT:

3- INSTILLATION OF TOPICAL ANTIBIOTICS:

hourly intervals for first five days
2 hourly if favourable respon...
MANAGEMENT:

4- SYSTEMIC CIPROFLOXACIN:
          When ulcer is close to limbus

5- WHEN TO CHANGE ANTIBIOTICS:
         I...
MANAGEMENT:

6- CYCLOPLEGICS:
      to prevent
  Posterior synechiae
  Pain


7- STEROID THERAPY:
      Controversial
Deposits of ciprofloxacin
MANAGEMENT:

8- CAUSES OF FAILURE TO RESPOND:

Wrong diagnosis by inappropriate cultures
Wrong treatment by inappropriat...
FUNGAL KERATITIS
Keratomycosis
CLINICAL FEATURES:

1- Filamentuous fungal keratitis
Aspergillus sp.
Fusarium sp.


2- Ca...
Fungal keratitis with hypopyon
filamentous fungal keratitis
Advanced filamentous fungal
keratitis
MANAGEMENT:

Re-culture and corneal biopsy
Antifungal therapy
Therapeutic penetrating keratoplasty
OTHER TYPES OF KERATITIS
Acanthamoeba keratitis
Interstitial keratitis
     - luetic interstitial keratitis
     - cogan...
Acanthamoeba keratitis
Interstitial keratitis
Infectious crystalline keratopathy
COMPLICATIONS OF KERATITIS
HERPES SIMPLEX KERATITIS
PRIMARY OCULAR INFECTION
                    Occurs in children b/w ages of 6
 months and 5 yrs
...
HERPES SIMPLEX KERATITIS
DENDRITIC ULCER
          Signs in chronological order:

    - opaque cells in punctate or stell...
DENDRITIC ULCER

Antiviral Therapy
     - Acycloguanosine
     - Trifluorothymidine
     - Adenine arabinoside

Debridem...
OTHER VIRAL KERATITIS
Stromal Necrotic Keratitis
Disciform Keratitis
HERPES ZOSTER OPHTHALMICUS
Rash on eye lids
Conjunctivitis
Episcleritis
Scleritis
Keratitis
Anterior Uveitis
CORNEAL ECTASIAS
1- KERATOCONUS

    - conical cornea
    - central or paracentral stromal thinning
    - apical protrusio...
2- KERATOGLOBUS
      - rare condition
      - oval keatoconus early on
      - later protrusion and thinning of entire co...
Thanks
Keratitis
Keratitis
Keratitis
Keratitis
Keratitis
Keratitis
Keratitis
Keratitis
Keratitis
Keratitis
Keratitis
Keratitis
Keratitis
Keratitis
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Keratitis

  1. 1. DR. ALI RAZA Associate Professor Head of Department Ophthalmology Holy Family Hospital Rawalpindi
  2. 2. MICROBIAL KERATITIS
  3. 3. BACTERIAL KERATITIS COMMON PATHOGENS: Neisseria gonorrhoeae Corynebacterium diphtheriae Listeria sp. Haemophilus sp.
  4. 4. BACTERIAL KERATITIS OTHER PAHTOGENS: Produce keratitis only after loss of corneal epithelial integrity as in: Contact lens wear: Pseudomonas aeruginosa
  5. 5. BACTERIAL KERATITIS Ocular surface disease Chronic dacryocistitis Topical steroids Systemic immunosuppressive agents
  6. 6. BACTERIAL KERATITIS CLINICAL FEATURES: Certain bacteria produce characteristic corneal response. 1- Staph. aureus and Strep. pneumoniae: Oval, yellow-white, densely opaque stromal suppuration clear cornea
  7. 7. Large Corneal infiltration in bacterial keratitis
  8. 8. Severe staphylococcal keratitis
  9. 9. Staphylococcal keratitis
  10. 10. CLINICAL FEATURES: 2- Pseudomonas: Mucopurulent exudate, liquefactive necrosis ground-glass adjacent stroma
  11. 11. Pseudomonas keratitis with hypopyon
  12. 12. Advanced pseudomonas keratitis
  13. 13. CLINICAL FEATURES: 3- Enterobacteriaeceae: Shallow ulceration Grey-white pleomorphic suppuration Stromal opalescence Corneal rings
  14. 14. BACTERIAL KERATITIS MANAGEMENT: Bacterial corneal ulcer is a sight- threatening condition demanding Identification of causative organism Eradication Hospitalization
  15. 15. MANAGEMENT: Therapy is divided into: Sterilization phase Healing phase
  16. 16. MANAGEMENT: 1- CHOICE OF ANTIBIOTICS: Standard combined therapy with aminoglycosides and cephalosporins. Monotherapy with fluoroquinolone
  17. 17. MANAGEMENT: 2- PREPARATION OF FORTIFIED ANTIBIOTICS: by combination with a compatible vehicle
  18. 18. MANAGEMENT: 3- INSTILLATION OF TOPICAL ANTIBIOTICS: hourly intervals for first five days 2 hourly if favourable response Gradually taper and discontinue
  19. 19. MANAGEMENT: 4- SYSTEMIC CIPROFLOXACIN: When ulcer is close to limbus 5- WHEN TO CHANGE ANTIBIOTICS: If resistant pathogen
  20. 20. MANAGEMENT: 6- CYCLOPLEGICS: to prevent Posterior synechiae Pain 7- STEROID THERAPY: Controversial
  21. 21. Deposits of ciprofloxacin
  22. 22. MANAGEMENT: 8- CAUSES OF FAILURE TO RESPOND: Wrong diagnosis by inappropriate cultures Wrong treatment by inappropriate antibiotics Drug toxicity preventing corneal healing
  23. 23. FUNGAL KERATITIS Keratomycosis CLINICAL FEATURES: 1- Filamentuous fungal keratitis Aspergillus sp. Fusarium sp. 2- Candida keratitis
  24. 24. Fungal keratitis with hypopyon
  25. 25. filamentous fungal keratitis
  26. 26. Advanced filamentous fungal keratitis
  27. 27. MANAGEMENT: Re-culture and corneal biopsy Antifungal therapy Therapeutic penetrating keratoplasty
  28. 28. OTHER TYPES OF KERATITIS Acanthamoeba keratitis Interstitial keratitis - luetic interstitial keratitis - cogan syndrome Infectious crystalline keratopathy
  29. 29. Acanthamoeba keratitis
  30. 30. Interstitial keratitis
  31. 31. Infectious crystalline keratopathy
  32. 32. COMPLICATIONS OF KERATITIS
  33. 33. HERPES SIMPLEX KERATITIS PRIMARY OCULAR INFECTION Occurs in children b/w ages of 6 months and 5 yrs 1- Blepharoconjunctivitis 2- Keratitis
  34. 34. HERPES SIMPLEX KERATITIS DENDRITIC ULCER Signs in chronological order: - opaque cells in punctate or stellate pattern - linear branching ulcer stains with fluorescein - anterior stromal infiltrates - large epithelial defect (amoeboid configuration) - pseudodendrites in healing phase
  35. 35. DENDRITIC ULCER Antiviral Therapy - Acycloguanosine - Trifluorothymidine - Adenine arabinoside Debridement
  36. 36. OTHER VIRAL KERATITIS Stromal Necrotic Keratitis Disciform Keratitis
  37. 37. HERPES ZOSTER OPHTHALMICUS Rash on eye lids Conjunctivitis Episcleritis Scleritis Keratitis Anterior Uveitis
  38. 38. CORNEAL ECTASIAS 1- KERATOCONUS - conical cornea - central or paracentral stromal thinning - apical protrusion - irregular astigmatism - presents with impaired vision - oil droplet reflex - Munson sign
  39. 39. 2- KERATOGLOBUS - rare condition - oval keatoconus early on - later protrusion and thinning of entire cornea 3- PELLUCID MARGINAL DEGENERATION
  40. 40. Thanks
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