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.
-SOLANKI RIDDHI
2ND YEAR (B.OPTOM)
 INFECTIVE KERATITIS:
I. BACTERIAL CORNEAL ULCERS
i. Hypopyon corneal ulcer
ii. Marginal catarrhal ulcer
iii. Mycotic cor...
 ALLERGIC KERATITIS:
I. PHLYCTENULAR KERATITIS
II. VERNAL KERATITIS
III. ATOPIC KERATITIS
 TROPHIC:
I. NEUROPARALYTIC KE...
 KERATITIS ASSOCIATED WITH SYSTEMIC
COLLAGEN VASCULAR DISEASES
 IDIOPATHIC KERATITIS:
I. MOOREN’S ULCER
I. BACTERIAL CORNEAL ULCER:
 Being the most ant. part of eyeball, the
cornea is exposed to atmosphere & hence
prone to ge...
ETIOLOGY:
 Following 3 pathogens can invade the intact
corneal epithelium & produce ulceration:
i. Neisseria gonorrhoeae
...
2. Source of infection include:
i. Exogenous infection
ii. From the ocular tissue
iii. Endogenous infection
3. Causative o...
1. Stage of progressive infiltration:
 It is characterised by the infiltration of
polymorphonuclear &/or lymphocytes into...
2. Stage of active ulceration:
 Active ulceration results from necrosis &
sloughing of the epithelium, bowman’s
membrane ...
3. Stage of regression:
 Regression is induced by the natural host
defence mechanisms.
 A line of demarcation develops a...
4. Stage of cicatrization:
 In this stage, healing continues by progressive
epithelization which forms a permanent
coveri...
 Perforation of corneal ulcer occurs when the
ulcerative process deepens & reaches up to
descemet’s membrane.
 This memb...
i. HYPOPYON CORNEAL ULCER
 Causative Organisms:
i. Staphylococci
ii. Streptococci
iii. Gonococci
iv. Moraxella
v. Pseudom...
Clinical features:
 Symptoms:
i. Pain
ii. Foreign body sensation
iii. Watering
iv. Photophobia
v. Blurred vision
vi. Redn...
 Complications Of Corneal Ulcer:
1. Toxic iridocyclitis: usually associated with
cases of purulent corneal ulcer.
2. Seco...
TREATMENT:
i. Topical antibiotics: Ciprofloxacin or
Ofloxacin or Gatifloxacin (0.3%) eye drops,
ii. Cycloplegic drugs
iii....
ii. MARGINAL CATARRHAL ULCER
 These superficial ulcers situated near limbus
are frequently seen especially in old people....
Clinical Features:
i. Patient usually presents with mild ocular
irritation, pain, photophobia & watering.
ii. The ulcer is...
iii. MYCOTIC CORNEAL ULCER
 The incidence of suppurative corneal ulcers
caused by fungi has increased in the recent
years...
CLINICAL FEATURES:
Symptoms:
i. Pain
ii. Foreign body sensation
iii. Watering
iv. Photophobia
v. Blurred vision
vi. Rednes...
TREATMENT:
i. Antifungal drugs
ii. Natamycin, Fluconazol, Nystatin
iii. Therapeutic penetrating keratoplasty
i. HERPES SIMPLEX KERATITIS
 Ocular infections with herpes simplex virus
(HSV) are extremely common & constitute
herpetic...
Mode Of Infection:
1. HSV-I infection: It is acquired by kissing or
coming in close contact with a patient
suffering from ...
[B] Recurrent herpes:
1. Epithelial keratitis:
i. Punctuate epithelial keratitis
ii. Dendritic ulcer
iii. Geographical ulc...
[A] Primary Ocular Herpes
 Primary infection (first attack) involves a
nonimmune person.
 It typically occurs in childre...
[B] Recurrent Ocular Herpes
 The virus which lies dormant in the trigeminal
ganglion, periodically reactivates & causes
r...
iii. Geographical ulcer:
 Sometimes, the branches of dendritic ulcer
enlarge & coalesce to form a large epithelial
ulcer ...
2. Stromal Keratitis:
i. Disciform keratitis:
 Endothelium damage results in corneal
oedema due to imbibation of aqueous ...
ii. Diffuse Stromal Necrotic Keratitis:
 It is a type of interstitial keratitis caused by
active viral invasion & tissue ...
3. Metaherpetic Keratitis:
 It is not an active viral disease, but is a
mechanical healing problem which occurs at
the si...
ii. HERPES ZOSTER OPHTHALMICUS
 Herpes zoster ophthalmicus is an acute
infection of Gasserian ganglion of the Vth
cranial...
Clinical Features
i. Frontal nerve is more frequently affected
than the lacrimal & nasociliary nerves.
ii. About 50% cases...
Clinical Phases of H. zoster ophthalmicus
are:
i. Acute, which may totally resolve.
ii. Chronic, which may persist for yea...
i. ACANTHAMOEBA KERATITIS
 Acanthamoeba keratitis has recently gained
importance because of its increasing
incidence, dif...
CLINICAL FEATURES
Symptoms :
i. Very severe pain
ii. Watering
iii. Photophobia
iv. Blepharospasm
v. Blurred vision.
Signs ...
Treatment :
It is usually unsatisfactory:
i. Non-specific treatment is on the general
lines for corneal ulcer.
ii. Specifi...
I. PHLYCTENULAR KERATITIS
 Corneal involvement may occur secondarily
from extension of conjunctival phlycten; or
rarely a...
A. Ulcerative Phlyctenular Keratitis
May occur in the following 3 forms:
1. Sacrofulous ulcer:
• Is a shallow marginal ulc...
B. Diffuse Infiltrative Phlyctenular
Keratitis
 It may appear in the form of central
infiltration of cornea with characte...
II. VERNAL KERATITIS
 Corneal involvement in VKC may be primary
or secondary due to extension of limbal
lesions.
 Vernal...
1. Punctuate epithelial keratitis
• Involving upper cornea is usually associated with
palpebral form of disease.
2. Ulcera...
Treatment
i. Topical steroids
ii. Mast cell stabilizers
iii. Topical antihistaminics
iv. Acetyl cysteine
v. Topical cyclos...
III. ATOPIC KERATITIS
 It is an adult equivalent of vernal keratitis & is
often associated with atopic dermatitis.
 Most...
Treatment is often frustrating
i. Treat facial eczema & lid margin disease.
ii. Sodium cromoglycate drops, steroids & tear...
 Trophic corneal ulcers develop due to
disturbance in metabolic activity of
epithelial cells.
 This group includes:
I. N...
I. NEUROPARALYTIC KERATITIS
 Neuroparalytic keratitis occurs due to paralysis
of the sensory nerve supply of the cornea.
...
ii. A neoplasm pressing on Gasserian ganglion.
iii. Gasserian ganglion destruction due to
acute infection in herpes zoster...
Clinical Features
i. Characteristics features are no pain, no
lacrimation, & complete loss of corneal
sensations.
ii. Cili...
Treatment
i. Initial treatment with antibiotic & atropine
eye ointment.
ii. Topical nerve growth factor drops &
amniotic m...
II. EXPOSURE KERATITIS
 Normally cornea is covered by eyelids during
sleep & is constantly kept moist by blinking
movemen...
Clinical Features
i. Initial dessication occurs in the
interpalpebral area leading to fine
punctuate epithelial.
ii. Bacte...
I. ROSACEA KERATITIS
Clinical Features
i. The condition typically occurs in elderly
women in the form of facial eruptions
...
 Peripheral corneal ulceration &/or melting of
corneal tissue is not infrequent occurrence in
patients suffering from sys...
I. MOOREN’S ULCER
The Mooren’s ulcer (chronic serpiginous or
rodent ulcer) is a severe inflammatory
peripheral ulcerative ...
Clinical Features
Two clinical varieties of Mooren’ ulcer have
been recognised.
1. Benign form which is usually unilateral...
Symptoms
i. Severe pain
ii. Photophobia
iii. Lacrimation
iv. Defective vision.
Signs
i. Patches of grey infiltrates which ...
Treatment
i. Topical corticosteroids
ii. Immunosuppressive therapy
iii. Soft contact lenses
iv. Lamellar or full thickness...
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Corneal ulcers
Upcoming SlideShare
Loading in …5
×

182

Share

Download to read offline

Corneal ulcers

Download to read offline

Corneal Ulcers, description & classification of almost all types of corneal ulcers, pathology of corneal ulcers & much more

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 ulcers

  1. 1. -SOLANKI RIDDHI 2ND YEAR (B.OPTOM)
  2. 2.  INFECTIVE KERATITIS: I. BACTERIAL CORNEAL ULCERS i. Hypopyon corneal ulcer ii. Marginal catarrhal ulcer iii. Mycotic corneal ulcer II. VIRAL CORNEAL ULCERS i. Herpes simplex keratitis ii. Herpes zoster ophthalmicus III. PROTOZOAL KERATITIS i. Acanthamoeba keratitis
  3. 3.  ALLERGIC KERATITIS: I. PHLYCTENULAR KERATITIS II. VERNAL KERATITIS III. ATOPIC KERATITIS  TROPHIC: I. NEUROPARALYTIC KERATITIS II. EXPOSURE KERATITIS  KERATITIS ASSOCIATED WITH DISEASES OF SKIN & MUCOUS MEMBRANE: I. ROSACEA KERATITIS
  4. 4.  KERATITIS ASSOCIATED WITH SYSTEMIC COLLAGEN VASCULAR DISEASES  IDIOPATHIC KERATITIS: I. MOOREN’S ULCER
  5. 5. I. BACTERIAL CORNEAL ULCER:  Being the most ant. part of eyeball, the cornea is exposed to atmosphere & hence prone to get infected easily.  At the same time cornea is protected from the defence mechanisms present in tears in the form of lysozyme, betalysin, & other protective proteins.  Infective corneal ulcer may develop when:  Either the local ocular defence mechanism is jeopardised, or  The causative organism is very virulent.
  6. 6. ETIOLOGY:  Following 3 pathogens can invade the intact corneal epithelium & produce ulceration: i. Neisseria gonorrhoeae ii. Corynebacterium diphtheriae iii. Neisseria meningitidis. 1. Corneal epithelial damage: It may occur in following conditions: i. Corneal abrasion ii. Epithelial drying iii. Necrosis of epithelium iv. Desquamation of epithelial cells v. Epithelial damage due to trophic changes
  7. 7. 2. Source of infection include: i. Exogenous infection ii. From the ocular tissue iii. Endogenous infection 3. Causative organism: common bacterias associated with corneal ulceration are: i. Staphylococcus aureus ii. Pseudomonas pyocyanea iii. Streptococcus pneumoniae iv. E. coli v. N. gonorrhoea vi. N. meningitidis vii. C. diphtheriae.
  8. 8. 1. Stage of progressive infiltration:  It is characterised by the infiltration of polymorphonuclear &/or lymphocytes into the epithelium from the peripheral circulation supplemented by similar cells from the underlying stroma if this tissue is also affected.  Subsequently necrosis of the involved tissue may occur.
  9. 9. 2. Stage of active ulceration:  Active ulceration results from necrosis & sloughing of the epithelium, bowman’s membrane & the involved stroma.  During this stage, accumulation of purulent exudates on the cornea.  There occurs vascular congestion of the iris & ciliary body & some degree of iritis due to absorption of toxins from the ulcer.
  10. 10. 3. Stage of regression:  Regression is induced by the natural host defence mechanisms.  A line of demarcation develops around the ulcer.  The digestion of necrotic material may result in initial enlargement of the ulcer.  This process may be accompanied by superficial vascularization that increases the humoral & cellular immune response.  The ulcer now begins to heal & epithelium starts growing over the edges.
  11. 11. 4. Stage of cicatrization:  In this stage, healing continues by progressive epithelization which forms a permanent covering.  Beneath the epithelium, fibrous tissue is laid down partly by the corneal fibroblasts & partly by the endothelial cells of the new vessels.  The degree of scarring from healing varies.  If the ulcer is very superficial & involves the epithelium only, it heals without leaving any opacity behind.  When ulcer involves bowman’s layer& few superficial stromal lamellae, the resultant scar is called a ‘nebula’.
  12. 12.  Perforation of corneal ulcer occurs when the ulcerative process deepens & reaches up to descemet’s membrane.  This membrane is tough & bulges out as Descemetocele.  At this stage, any exertion on the part of patient, such as coughing, sneezing, straining for stool etc. will perforate the corneal ulcer.  Immediately after perforation, the aqueous escapes, IOP falls & the iris-lens diaphragm moves forward.  When the perforation is small & opp. to iris tissue, it is usually plugged & healing by cicatrization proceeds rapidly.
  13. 13. i. HYPOPYON CORNEAL ULCER  Causative Organisms: i. Staphylococci ii. Streptococci iii. Gonococci iv. Moraxella v. Pseudomonas pyocyanea vi. Pneumococcus.  Source Of Infection: For pneumococcal infection is usually the chronic dacryocystitis.
  14. 14. Clinical features:  Symptoms: i. Pain ii. Foreign body sensation iii. Watering iv. Photophobia v. Blurred vision vi. Redness of eye.  Signs: i. Lids are swollen ii. Blepharospasm iii. Conjunctiva is chemosed iv. Hyperaemia & ciliary congestion.
  15. 15.  Complications Of Corneal Ulcer: 1. Toxic iridocyclitis: usually associated with cases of purulent corneal ulcer. 2. Secondary glaucoma: occurs due to fibrinous exudates blocking the angle of ant. chamber (inflammatory glaucoma) 3. Descemetocele: occurs when virulent organisms extends upto descemet’s memb. 4. Perforation Of Corneal Ulcer: occurs due to sudden strain due to cough, sneeze or spasm of orbicularis muscle. 5. Corneal Scarring: It is the usual end result of healed corneal ulcer.
  16. 16. TREATMENT: i. Topical antibiotics: Ciprofloxacin or Ofloxacin or Gatifloxacin (0.3%) eye drops, ii. Cycloplegic drugs iii. Systemic analgesics iv. Anti-inflammatory drugs such as paracetamol & ibuprofen v. Vitamins ( A, B-complex & C) vi. Hot fomentation vii. Removal of any known cause of non-healing ulcer viii. Peritomy
  17. 17. ii. MARGINAL CATARRHAL ULCER  These superficial ulcers situated near limbus are frequently seen especially in old people. ETIOLOGY:  Marginal catarrhal ulcer is thought to be caused by a hypersensitivity rxn to staphylococcal toxins.  It occurs in association with chronic staphylococcal blepharoconjunctivitis.  Moraxella & Haemophilus are also known to cause such ulcers.
  18. 18. Clinical Features: i. Patient usually presents with mild ocular irritation, pain, photophobia & watering. ii. The ulcer is shallow, slightly infiltrated & often multiple, usually associated with staphylococcal conjunctivitis. iii. Recurrences are very common. Treatment: i. Topical corticosteroid ii. Antibiotic therapy iii. Treatment of associated blepharitis & chronic
  19. 19. iii. MYCOTIC CORNEAL ULCER  The incidence of suppurative corneal ulcers caused by fungi has increased in the recent years due to injudicious use of antibiotics & steroids. ETIOLOGY: 1. Causative fungi: i. Aspergillus ii. Fusarium iii. Alternaria iv. Penicillium. v. Candida & Cryptococcus.
  20. 20. CLINICAL FEATURES: Symptoms: i. Pain ii. Foreign body sensation iii. Watering iv. Photophobia v. Blurred vision vi. Redness of eye. Signs: i. Dry-looking ii. Greyish white iii. Delicate feathery finger-like extensions iv. A sterile immune ring may be present v. Multiple, small satellite lesions may be present
  21. 21. TREATMENT: i. Antifungal drugs ii. Natamycin, Fluconazol, Nystatin iii. Therapeutic penetrating keratoplasty
  22. 22. i. HERPES SIMPLEX KERATITIS  Ocular infections with herpes simplex virus (HSV) are extremely common & constitute herpetic keratoconjunctivitis & iritis. ETIOLOGY: Herpes simplex virus (HSV):  It is a DNA virus.  Its only natural host is man.  According to different clinical & immunological properties, HSV is of two types: HSV type I typically causes infection above the waist & HSV type II below the waist (herpes genitalis).
  23. 23. Mode Of Infection: 1. HSV-I infection: It is acquired by kissing or coming in close contact with a patient suffering from herpes labialis. 2. HSV-II infection: It is transmitted to eyes of neonates through infected genitalia of the mother. Ocular Lesions Of Herpes Simplex: [A] Primary herpes: 1. Skin lesions 2. Conjunctiva-acute follicular conjunctivitis 3. Cornea
  24. 24. [B] Recurrent herpes: 1. Epithelial keratitis: i. Punctuate epithelial keratitis ii. Dendritic ulcer iii. Geographical ulcer 2. Stromal keratitis i. Disciform keratitis ii. Diffuse stromal necrotic keratitis 3. Metaherpetic keratitis
  25. 25. [A] Primary Ocular Herpes  Primary infection (first attack) involves a nonimmune person.  It typically occurs in children betn 6 months & 5 yrs & in teenagers. Clinical Features: 1. Skin lesions: Vesicular lesions may occur involving skin of lids, periorbital region & the lid margin. 2. Acute follicular conjunctivitis with regional lymphadenitis is the usual. 3. Keratitis: Cornea is involved in about 50% of the cases. The keratitis can occur as a coarse punctuate or diffuse branching epithelial.
  26. 26. [B] Recurrent Ocular Herpes  The virus which lies dormant in the trigeminal ganglion, periodically reactivates & causes recurrent infection. 1. Epithelial keratitis: i. Punctuate epithelial keratitis:  The initial epithelial lesions of recurrent herpes resemble those seen in primary herpes & may be either in the form of fine or coarse superficial punctuate lesions. ii. Dendritic ulcer:  Dendritic ulcer is a typical lesion of recurrent epithelial keratitis.  The ulcer is of an irregular, zigzag linear branching shape.
  27. 27. iii. Geographical ulcer:  Sometimes, the branches of dendritic ulcer enlarge & coalesce to form a large epithelial ulcer with a ‘geographical’ or ‘amoeboid’ configuration, hence the name. Symptoms i. Photophobia ii. Lacrimation iii. Pain. Treatment same as of epithelial keratitis.
  28. 28. 2. Stromal Keratitis: i. Disciform keratitis:  Endothelium damage results in corneal oedema due to imbibation of aqueous humour. Signs: i. Focal disc-shaped patch of stromal oedema w/o necrosis ii. Folds in descemet’s memb iii. Keratic precipitates iv. Ring of stromal infiltrate v. Corneal sensations are diminished vi. IOP may be raised. Treatment: consists of diluted steroid eye drops (acyclovir 3%).
  29. 29. ii. Diffuse Stromal Necrotic Keratitis:  It is a type of interstitial keratitis caused by active viral invasion & tissue destruction. Symptoms: i. Pain ii. Photophobia iii. Redness Signs: i. Necrotic ii. Blotchy iii. Cheesy white infiltrates Treatment: Keratoplasty.
  30. 30. 3. Metaherpetic Keratitis:  It is not an active viral disease, but is a mechanical healing problem which occurs at the site of a previous herpetic ulcer. Clinically it represents as an indolent linear or ovoid epithelial defect. Treatment i. Lubricants (artificial tears) ii. Bandage soft contact lens iii. Lid closure (tarsorrhaphy).
  31. 31. ii. HERPES ZOSTER OPHTHALMICUS  Herpes zoster ophthalmicus is an acute infection of Gasserian ganglion of the Vth cranial nerve by the varicella-zoster virus (VZV).  It constitutes approx 10% of all cases of herpes zoster. ETIOLOGY Varicella-zoster virus:  It is a DNA virus & produces acidophilic intranuclear inclusion bodies.  It is neurotropic in nature.
  32. 32. Clinical Features i. Frontal nerve is more frequently affected than the lacrimal & nasociliary nerves. ii. About 50% cases of herpes zoster ophthalmicus get ocular complications. iii. The Hutchinson’s rule, which implies that ocular involvement is frequent if the side or tip of nose presents vesicles, is useful but not infallible. iv. Lesions of herpes zoster are strictly limited to one side of the midline of head.
  33. 33. Clinical Phases of H. zoster ophthalmicus are: i. Acute, which may totally resolve. ii. Chronic, which may persist for years. iii. Relapsing, where the acute or chronic lesions reappear sometimes years later. Treatment: i. Oral antiviral drugs ii. Cimetidine iii. Amitriptyline iv. Antibiotic-corticosteroid skin ointment or lotions v. Keratoplasty
  34. 34. i. ACANTHAMOEBA KERATITIS  Acanthamoeba keratitis has recently gained importance because of its increasing incidence, difficulty in diagnosis & unsatisfactory treatment. ETIOLOGY  Acanthamoeba is a free lying amoeba found in soil, fresh water, well water, sea water, sewage & air.  It exists in trophozoite & encysted forms.
  35. 35. CLINICAL FEATURES Symptoms : i. Very severe pain ii. Watering iii. Photophobia iv. Blepharospasm v. Blurred vision. Signs : i. Initial lesions in the form of Limbitis, Coarse, Opaque Streaks, Fine Epithelial & Sub- Epithelial Opacities & Radial Kerato-neuritis. ii. Advanced cases shows a central or paracentral ring-shaped lesion with stromal.Hypopyon may also be present.
  36. 36. Treatment : It is usually unsatisfactory: i. Non-specific treatment is on the general lines for corneal ulcer. ii. Specific medical treatment includes: propamidine isethionate(0.1%), neomycin drops, polyhexamethylene biguanide (0.01- 0.02%). iii. Penetrating keratoplasty is frequently required in non-responsive cases.
  37. 37. I. PHLYCTENULAR KERATITIS  Corneal involvement may occur secondarily from extension of conjunctival phlycten; or rarely as a primary disease.  It may present in 2 forms: A. Ulcerative phlyctenular keratitis B. Diffuse infiltrative keratitis
  38. 38. A. Ulcerative Phlyctenular Keratitis May occur in the following 3 forms: 1. Sacrofulous ulcer: • Is a shallow marginal ulcer formed due to breakdown of small limbal phlycten. • Such an ulcer usually clears up without leaving any opacity. 2. Fascicular ulcer: • It has a prominent parallel leash of blood vessels. • This ulcer usually remains superficial but leaves behind a band-shaped superficial opacity after healing. 3. Miliary ulcer: • In this form multiple small ulcers are scattered over a portion of or whole of the cornea.
  39. 39. B. Diffuse Infiltrative Phlyctenular Keratitis  It may appear in the form of central infiltration of cornea with characteristic rich vascularization from the periphery, all around the limbus.  It may be superficial or deep. Recurrences are very common. Treatment i. Topical steroids ii. Antibiotic drops & ointments iii. Atropine (1%) eye ointment.
  40. 40. II. VERNAL KERATITIS  Corneal involvement in VKC may be primary or secondary due to extension of limbal lesions.  Vernal keratitis includes following 5 types of lesions: 1. Punctuate epithelial keratitis 2. Ulcerative vernal keratitis (shield ulcertaion) 3. Vernal corneal plaques 4. Subepithelial scarring 5. Pseudogerontoxon
  41. 41. 1. Punctuate epithelial keratitis • Involving upper cornea is usually associated with palpebral form of disease. 2. Ulcerative vernal keratitis • Presents as a shallow transverse ulcer in upper part of cornea. • The ulceration results due to epithelial macroerosions. 3. Vernal corneal plaques • Result due to coating of bare areas of epithelial macroerosions with a layer of altered exudates. 4. Subepithelial scarring • Occurs in the form of a ring scar. 5. Pseudogerontoxon • Is characterised by a classical ‘cupid’s bow’ outline.
  42. 42. Treatment i. Topical steroids ii. Mast cell stabilizers iii. Topical antihistaminics iv. Acetyl cysteine v. Topical cyclosporine vi. Supratarsal injection vii. Cryo application viii. Surgical excision
  43. 43. III. ATOPIC KERATITIS  It is an adult equivalent of vernal keratitis & is often associated with atopic dermatitis.  Most of the patients are young atopic adults, with male predominance. Symptoms include: i. Itching, soreness, dry sensation ii. Mucoid discharge iii. Photophobia or blurred vision Signs i. Lid margins are chronically inflammed with rounded posterior borders. ii. Tarsal conjunctiva has milky appearance. iii. Cornea may show punctuate epithelial keratitis.
  44. 44. Treatment is often frustrating i. Treat facial eczema & lid margin disease. ii. Sodium cromoglycate drops, steroids & tear supplements may be helpful for conjunctival lesions.
  45. 45.  Trophic corneal ulcers develop due to disturbance in metabolic activity of epithelial cells.  This group includes: I. Neuroparalytic Keratitis II. Exposure Keratitis
  46. 46. I. NEUROPARALYTIC KERATITIS  Neuroparalytic keratitis occurs due to paralysis of the sensory nerve supply of the cornea. Causes 1. Congenital i. Familial dysautonomia (Riley-Day syndrome) ii. Congenital insensitivity to pain. iii. Anhidrotic ectodermal dysplasia. 2. Acquired i. Following alcohol-block or electrocoagulation of Gasserian ganglion or section of the sensory root of trigeminal nerve for trigeminal neuralgia.
  47. 47. ii. A neoplasm pressing on Gasserian ganglion. iii. Gasserian ganglion destruction due to acute infection in herpes zoster ophthalmicus. iv. Acute infection of Gasserian ganglion by herpes simplex virus. v. Syphilitic (luetic) neuropathy. vi. Involvement of corneal nerves in leprosy. vii. Injury to Gasserian ganglion.
  48. 48. Clinical Features i. Characteristics features are no pain, no lacrimation, & complete loss of corneal sensations. ii. Ciliary congestion is marked. iii. Corneal sheen is dull. iv. Initial corneal changes are in the form of punctuate epithelial erosions in the inter- palpebral area followed by ulceration due to exofoliation of corneal epithelium. v. Relapses are very common, even the healed scar quickly breaks down again.
  49. 49. Treatment i. Initial treatment with antibiotic & atropine eye ointment. ii. Topical nerve growth factor drops & amniotic membrane transplantation. iii. If, however, relapses occur, it is best to perform lateral tarsorrhaphy which should be kept for at least one year. iv. Along with it prolonged use of artificial tears is also recommended.
  50. 50. II. EXPOSURE KERATITIS  Normally cornea is covered by eyelids during sleep & is constantly kept moist by blinking movements during awaking.  When eyes are covered insufficiently by the lids & there is loss of protective mechanism of blinking the condition of exposure keratopathy develops. Causes 1. Extreme proptosis due to any cause will allow inadequate closure of lids. 2. Bell’s palsy or any other cause of facial palsy. 3. Ectropion of severe degree. 4. Symblepharon causing lagophthalmos.
  51. 51. Clinical Features i. Initial dessication occurs in the interpalpebral area leading to fine punctuate epithelial. ii. Bacterial superinfection may cause deep suppurative ulceration which may even perforate. Treatment i. Topical antibiotics ii. Cycloplegic drugs iii. Systemic analgesics iv. Vitamins (A,B-complex & C ) v. Hot fomentation.
  52. 52. I. ROSACEA KERATITIS Clinical Features i. The condition typically occurs in elderly women in the form of facial eruptions presenting as butterfly configuration. ii. Ocular lesions include chronic blepharoconjunctivitis & keratitis. iii. Rosacea keratitis occurs as yellowish white marginal infiltrates & small ulcers. Treatment i. Topical steroids ii. Long course of systemic tetracycline.
  53. 53.  Peripheral corneal ulceration &/or melting of corneal tissue is not infrequent occurrence in patients suffering from systemic diseases such as rheumatoid arthritis, systemic lupus rythematosus, polyarteritis nodosa & Wegener’s granulomatosis.  Such corneal ulcers are usually indolent & difficult to treat.  Systemic treatment of the primary disease may be beneficial.
  54. 54. I. MOOREN’S ULCER The Mooren’s ulcer (chronic serpiginous or rodent ulcer) is a severe inflammatory peripheral ulcerative keratitis. ETIOLOGY Exact etiology is not known. Different views are: 1. It is an idiopathic degenerative condition. 2. It may be due to an ischaemic necrosis resulting from vasculitis of limbal vessels. 3. It may be due to the effects of enzyme collagenase & proteoglyconase from conjunctiva.
  55. 55. Clinical Features Two clinical varieties of Mooren’ ulcer have been recognised. 1. Benign form which is usually unilateral, affects the elderly people & is characterised by a relative slow progress. 2. Virulent type also called the proressive form is bilateral, more often occurs in younger patients. The ulcer is rapidly progressive with a high incidence of scleral involvement.
  56. 56. Symptoms i. Severe pain ii. Photophobia iii. Lacrimation iv. Defective vision. Signs i. Patches of grey infiltrates which coalesce to form a shallow furrow over the whole cornea. ii. Whitish overhanging edge. iii. The ulcer rarely perforates & the sclera remains uninvolved.
  57. 57. Treatment i. Topical corticosteroids ii. Immunosuppressive therapy iii. Soft contact lenses iv. Lamellar or full thickness corneal grafts.
  • ShashiRay3

    Aug. 31, 2021
  • MohsinRaza406

    Aug. 5, 2021
  • KajalBhagat11

    Jul. 19, 2021
  • AbiaShahid

    Jul. 2, 2021
  • Aathikasyed

    Jun. 5, 2021
  • SakkurthiSaroja

    May. 28, 2021
  • rashmirithusha

    May. 18, 2021
  • aryanlekhi

    May. 18, 2021
  • gyangirikanand

    May. 18, 2021
  • RubiniS4

    Mar. 17, 2021
  • RinkalTarpada

    Mar. 17, 2021
  • shravya007

    Mar. 1, 2021
  • Sivasuryasivakumar

    Feb. 19, 2021
  • OstartPrince

    Feb. 18, 2021
  • PoojaPuja3

    Feb. 18, 2021
  • NgariyaGeorge

    Feb. 12, 2021
  • swatijojar

    Feb. 1, 2021
  • UmmeMariyamSiddiquea

    Jan. 7, 2021
  • kavyaVasa2

    Jan. 3, 2021
  • RahulYekula

    Dec. 22, 2020

Corneal Ulcers, description & classification of almost all types of corneal ulcers, pathology of corneal ulcers & much more

Views

Total views

20,425

On Slideshare

0

From embeds

0

Number of embeds

10

Actions

Downloads

846

Shares

0

Comments

0

Likes

182

×