Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
CORNEAL ULCER
PRESENTED BY-
Captain Ayinun Nahar
Trainee in Ophthalmology
Armed Forces Medical Institute
Definition
Corneal ulcer : Refers to corneal tissue
excavation associated with an epithelial defect,
usually with infiltra...
Histology of Cornea
Classification
Corneal ulcers can be classified in three ways :
1. On the basis of aetiology
2. On the basis of location o...
Classification
a. Infective:
- Bacterial
- Viral
- Fungal
- Protozoal
b. Non-infective/sterile :
- Neuroparalytic
- Neurot...
Classification
2. On the basis of location of ulcer-
Central
Paracentral Peripheral
Classification
Deep
3. On the basis of involvement of the corneal layers-
Superficial
Predisposing Factors
• Ocular trauma
• Dry eye
• Chronic dacryocystitis
• Exophthalmos
• Xerophthalmia
• Entropion
• Trich...
Predisposing Factors
• Systemic Factors :
- Malnutrition
- DM
- Alcoholism
- Drug addiction
- Malignancy
- Immunosuppressi...
Predisposing Factors
Contact lens users are predisposed to corneal ulcer.
Causes :
• Negligence
• Prolonged period of time...
Infective Corneal Ulcer
• Compromised ocular defence
• Sight threatening condition
• Ocular emergency
Ocular defence mechanism
• Corneal epithelium- mechanical barrier
• Conjunctiva- cellular & chemical components
• Tear fil...
Barriers of microbial infection
Causative Organisms
Pathogenesis
Corneal abrasion Microbes adhere , clone and invade to stromal
lamellae,release toxins & lytic enzymes
Host ...
Presenting Symptoms
Sign
BACTERIAL ULCERS
A)Severe candidal keratitis;
here is a large epithelial defect, and folds in Descemet membrane
FUNGAL ULCERS
VIRAL ULCERS
VIRAL ULCERS
Investigations
Corneal Scraping
Culture Media
S. aureus grows on blood agar
N. Gonorrhoea grows on Chocolate Agar
Protozoal Corneal Ulcer
Protozoal Corneal Ulcer
Causative organism :
Acanthamoeba
Definitive sign :
Perineural infiltrates (radial keratoneuritis)...
Protozoal Corneal Ulcer
Complication
Complications of corneal ulcer can be described
under two headings :
1.Before perforation
2.After perforation
Before perforation :
• Anterior uveitis
• Hypopyon
• Secondary glaucoma
• Descemetocele
• Corneal scarring
- Nebula
- Macu...
After perforation :
• Anterior synaechiae
• Iris prolapse
• Adherent leucoma
• Complicated cataract
• Sublaxation of the l...
Treatment of Corneal Ulcer
General measures
• Hospital admission
• Discontinuation of contact lens wear
• Using eye shield/dark glass
• Improvement o...
Bacterial Corneal Ulcer
• Antibiotic monotherapy :
- Fluoroquinolone
• Antibiotic duotherapy :
- Combination of two fortif...
Systemic antibiotic therapy :
• Potential for systemic involvement
- Ceftriaxone
- Cefotaxime
- Ciprofloxacin
- Amoxycilli...
Fungal Corneal Ulcer
Local Therapy :
• Removal of the epithelium
• Topical antifungal
- Amphotericin B
- Econazole
- Natam...
• Cycloplegics
• Subconjunctival injection
• Anterior chamber washout
Systemic Therapy :
• Antifungals :
- Voriconazole 400 mg twice daily for 1 day
then, 200 mg twice daily
- Itraconazole 200...
Viral Corneal Ulcer
Topical Therapy :
• Antiviral :
- Aciclovir 3% ointment - five times daily
- Ganciclovir 0.15% gel - f...
Systemic Therapy :
• Oral antiviral
- Aciclovir
200–400 mg five times daily for 5–10 days
- Famciclovir
- Valaciclovir
• I...
Local care :
• Debridement of ulcer
• Care of skin lesions
- aciclovir cream five times daily
• IOP control
Protozoal Corneal Ulcer
• Debridement of involved epithelium
• Topical amoebicides
- Polyhexamethylene biguanide
- Hexamid...
Management of apparent treatment failure :
- Frequent instillation of fortified aminoglycosides
- Review of antibiotic reg...
Treatment of Complication
Management of perforation :
- Tissue adhesive glue with BCL
- Corneal patch graft
- Occlusive su...
• Management of endophthalmitis
• Visual rehabilitation :
- Keratoplasty
- Rigid contact lens
- Cataract surgery
Tissue adhesive glue
Keratoplasty
Gunderson Conjunctival flap
Conclusion
• Timely diagnosis and proper management of
corneal ulcer can save the valuable vision of the
patient
ANY
QUESTION
Corneal Ulcer
Corneal Ulcer
Corneal Ulcer
Corneal Ulcer
Upcoming SlideShare
Loading in …5
×

228

Share

Download to read offline

Corneal Ulcer

Download to read offline

A brief discussion on Corneal Ulcer

Related Books

Free with a 30 day trial from Scribd

See all

Related Audiobooks

Free with a 30 day trial from Scribd

See all

Corneal Ulcer

  1. 1. CORNEAL ULCER PRESENTED BY- Captain Ayinun Nahar Trainee in Ophthalmology Armed Forces Medical Institute
  2. 2. Definition Corneal ulcer : Refers to corneal tissue excavation associated with an epithelial defect, usually with infiltration and necrosis.
  3. 3. Histology of Cornea
  4. 4. Classification 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
  5. 5. Classification a. Infective: - Bacterial - Viral - Fungal - Protozoal b. Non-infective/sterile : - Neuroparalytic - Neurotrophic - Corneal ulcer due to Vit A deficiency - Mooren ulcer 1. On the basis of aetiology -
  6. 6. Classification 2. On the basis of location of ulcer- Central Paracentral Peripheral
  7. 7. Classification Deep 3. On the basis of involvement of the corneal layers- Superficial
  8. 8. Predisposing Factors • Ocular trauma • Dry eye • Chronic dacryocystitis • Exophthalmos • Xerophthalmia • Entropion • Trichiasis • Contact lens wear • Prolong use of local steroids Local Factors :
  9. 9. Predisposing Factors • Systemic Factors : - Malnutrition - DM - Alcoholism - Drug addiction - Malignancy - Immunosuppressive drugs
  10. 10. Predisposing Factors Contact lens users are predisposed to corneal ulcer. Causes : • Negligence • Prolonged period of time • Cleaning with tap water • Contamination
  11. 11. Infective Corneal Ulcer • Compromised ocular defence • Sight threatening condition • Ocular emergency
  12. 12. Ocular defence mechanism • Corneal epithelium- mechanical barrier • Conjunctiva- cellular & chemical components • Tear film- biological protective system Major components of ocular defence system
  13. 13. Barriers of microbial infection
  14. 14. Causative Organisms
  15. 15. 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 imbibition by corneal stroma with grey zone of infiltration
  16. 16. Presenting Symptoms
  17. 17. Sign
  18. 18. BACTERIAL ULCERS
  19. 19. A)Severe candidal keratitis; here is a large epithelial defect, and folds in Descemet membrane FUNGAL ULCERS
  20. 20. VIRAL ULCERS VIRAL ULCERS
  21. 21. Investigations
  22. 22. Corneal Scraping
  23. 23. Culture Media
  24. 24. S. aureus grows on blood agar
  25. 25. N. Gonorrhoea grows on Chocolate Agar
  26. 26. Protozoal Corneal Ulcer
  27. 27. 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. coli
  28. 28. Protozoal Corneal Ulcer
  29. 29. Complication Complications of corneal ulcer can be described under two headings : 1.Before perforation 2.After perforation
  30. 30. Before perforation : • Anterior uveitis • Hypopyon • Secondary glaucoma • Descemetocele • Corneal scarring - Nebula - Macula - Leucoma
  31. 31. After perforation : • Anterior synaechiae • Iris prolapse • Adherent leucoma • Complicated cataract • Sublaxation of the lens • Anterior staphyloma • Endophthalmitis • Phthisis bulbi
  32. 32. Treatment of Corneal Ulcer
  33. 33. General measures • Hospital admission • Discontinuation of contact lens wear • Using eye shield/dark glass • Improvement of nutrition (Vit–C )
  34. 34. Bacterial Corneal Ulcer • Antibiotic monotherapy : - Fluoroquinolone • Antibiotic duotherapy : - Combination of two fortified antibiotics : cephalosporin + aminoglycoside • Cycloplegics : - Cyclopentolate - Homatropine - Atropine Local Therapy :
  35. 35. Systemic antibiotic therapy : • Potential for systemic involvement - Ceftriaxone - Cefotaxime - Ciprofloxacin - Amoxycillin + Clavulinic acid • Severe corneal thinning - Ciprofloxacin - Tetracycline/ Doxicycline • Hypopyon • Scleral involvement Indication :
  36. 36. Fungal Corneal Ulcer Local Therapy : • Removal of the epithelium • Topical antifungal - Amphotericin B - Econazole - Natamycin - Fluconazole - Clotrimazole - Voriconazole
  37. 37. • Cycloplegics • Subconjunctival injection • Anterior chamber washout
  38. 38. Systemic Therapy : • Antifungals : - Voriconazole 400 mg twice daily for 1 day then, 200 mg twice daily - Itraconazole 200 mg once daily then reduced to 100 mg once daily - Fluconazole 200 mg twice daily • Tetracycline/ Doxicycline
  39. 39. Viral Corneal Ulcer Topical Therapy : • Antiviral : - Aciclovir 3% ointment - five times daily - Ganciclovir 0.15% gel - five times daily • Antibiotic prophylaxis • Topical steroids • Cycloplegics
  40. 40. Systemic Therapy : • Oral antiviral - Aciclovir 200–400 mg five times daily for 5–10 days - Famciclovir - Valaciclovir • Interferon monotherapy
  41. 41. Local care : • Debridement of ulcer • Care of skin lesions - aciclovir cream five times daily • IOP control
  42. 42. Protozoal Corneal Ulcer • Debridement of involved epithelium • Topical amoebicides - Polyhexamethylene biguanide - Hexamidine - Propamidine • Topical antibiotic • Topical steroid • Control of pain • Therapeutic Keratoplasty
  43. 43. Management of apparent treatment failure : - Frequent instillation of fortified aminoglycosides - Review of antibiotic regimen - Re-scraping and additional staining - Corneal biopsy
  44. 44. Treatment of Complication Management of perforation : - Tissue adhesive glue with BCL - Corneal patch graft - Occlusive surface repair techniques - Penetrating keratoplasty
  45. 45. • Management of endophthalmitis • Visual rehabilitation : - Keratoplasty - Rigid contact lens - Cataract surgery
  46. 46. Tissue adhesive glue
  47. 47. Keratoplasty
  48. 48. Gunderson Conjunctival flap
  49. 49. Conclusion • Timely diagnosis and proper management of corneal ulcer can save the valuable vision of the patient
  50. 50. ANY QUESTION
  • TrivikramMurugan

    Sep. 6, 2021
  • Aasma1998

    Sep. 6, 2021
  • Nishat18

    Aug. 29, 2021
  • PriyankaRao85

    Aug. 15, 2021
  • PadminiSahu5

    Aug. 5, 2021
  • swapnilbansod56

    Jul. 31, 2021
  • FoysalAhmad9

    Jul. 28, 2021
  • moujutha

    Jul. 26, 2021
  • AnilChauhan126

    Jul. 26, 2021
  • TimiyaRose

    Jul. 20, 2021
  • HimaniThukral1

    Jul. 18, 2021
  • ASHISHANAND166

    Jul. 16, 2021
  • AvijitMaity13

    Jul. 16, 2021
  • NiranjanSingh79

    Jul. 14, 2021
  • dmuhwichi12

    Jul. 13, 2021
  • IlakkyaPalanisamy

    Jul. 8, 2021
  • AhmedAissa4

    Jul. 6, 2021
  • AifaFathima1

    Jun. 26, 2021
  • PradipKharsan

    Jun. 23, 2021
  • DharshiniKrishnaraj1

    Jun. 22, 2021

A brief discussion on Corneal Ulcer

Views

Total views

53,441

On Slideshare

0

From embeds

0

Number of embeds

1,969

Actions

Downloads

1,626

Shares

0

Comments

0

Likes

228

×