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Bacterial_Corneal_Ulcer_notes...PPT.pptx
- 1. Bacterial Corneal Ulcer •Bacterial Keratitis • Definition, Etiology, Clinical Features & Management
- 2. Definition • Loss ofcorneal epithelium with stromal infiltration • Caused by bacterial infection • Rapid progression with risk of perforation
- 3. Epidemiology • Common worldwide •More common in contact lens users • Seen in trauma and hospital settings
- 4. Causative Organisms –Gram Positive • Staphylococcus aureus • Streptococcus pneumoniae • Staphylococcus epidermidis
- 5. Causative Organisms –Gram Negative • Pseudomonas aeruginosa (most dangerous) • Moraxella • Haemophilus influenzae • Neisseria gonorrhoeae
- 6. Risk Factors • Cornealtrauma • Contact lens wear • Dry eye disease • Blepharitis • Chronic dacryocystitis • Diabetes mellitus
- 7. Pathogenesis • Break incorneal epithelium • Bacterial adherence and multiplication • Toxin and enzyme release • Rapid stromal necrosis • Risk of perforation within 24–48 hours
- 8. Symptoms • Severe eyepain • Redness and watering • Photophobia • Rapid decrease in vision • Purulent discharge
- 9. Signs • Gray-white suppurativeinfiltrate • Wet-looking ulcer • Well-defined margins • Surrounding corneal edema • Mobile hypopyon
- 10. Pseudomonas Corneal Ulcer •Seen in contact lens users • Rapid progression • Greenish discharge • Early corneal perforation • Poor prognosis
- 11. Differential Diagnosis • Bacterialulcer – acute, wet, sharp margins • Fungal ulcer – slow, dry, feathery margins
- 12. Investigations – CornealScraping • Done before starting antibiotics • Scraping from edge and base of ulcer
- 13. Laboratory Tests • Gramstain • Giemsa stain • Culture on blood and chocolate agar
- 14. Medical Management • Topicalfluoroquinolones – moxifloxacin, gatifloxacin • Fortified antibiotics – cefazolin, tobramycin • Cycloplegics and lubricants • Topical steroids contraindicated
- 15. Surgical Management • Non-respondingulcers • Impending or actual perforation • Tissue adhesive with bandage contact lens • Therapeutic keratoplasty
- 16. Complications • Corneal perforation •Iris prolapse • Endophthalmitis • Secondary glaucoma • Permanent visual loss
- 17. Prognosis • Depends onorganism virulence • Early diagnosis and treatment • Poor prognosis in Pseudomonas ulcers
- 18. Prevention • Proper contactlens hygiene • Early treatment of ocular trauma • Control lid and lacrimal infections • Avoid self-medication
- 19. Exam Pearls • Mostdangerous organism – Pseudomonas • Mobile hypopyon suggests bacterial ulcer • Start treatment immediately • Do not wait for culture report