The document outlines infective corneal ulcers, detailing their definitions, types, etiologies, symptoms, diagnosis, and management principles. It emphasizes the distinction between infectious and non-infectious keratitis, highlighting the critical need for timely treatment to prevent vision loss. The management strategies include infection control, inflammation management, and re-epithelialization promotion, with specific treatments based on the underlying cause of the corneal ulcer.

1. INFECTIVE CORNEALULCERS
Presented By:

2. ◦ DEFINITION:
◦ Corneal ulcers are defects in the corneal epithelium with or without stromal infilitration.
TYPES:
A. Infectious ulcerative keratitis
B. Non infectious ulcerative keratitis.
ETIOLOGY:
Infectious
◦ bacterial & fungi
◦ Viruses
◦ Acanthamoeba
Non infectious
◦ Systemic autoimmune/ inflammatory
◦ Local toxic

3. INFECTIOUS NON INFECTIOUS
Pain No pain
Discharge No discharge
AC reaction present AC reaction: absent
Central Peripheral
Trauma Trauma

4. NON INFECTIOUS ULCERATIVE KERATITIS
Causes:
◦ Local causes;
Punctuate marginal keratitis: staphylococci, streptococci, hypersensitivity to
medications.
◦ Systemic causes:
General manifestations of systemic, immune-mediated disease.
Most common: Rheumatoid arthritis, wagner’s granulomatosis & polyarteritis
nodusa

5. INFECTIOUS KERATITIS
◦ A corneal ulcer is an ocular emergency that raises high stakes of questions
about diagnosis & management.
◦ When a large corneal ulcer is staring you in the face time isn’t in your side.
◦ Despite varying etiologies & presentations, as well as different treatment
approaches, cornealulcers have one thing in common: the potential to cause
devastating loss of vision.

6. PRINCIPLES OF MANAGEMENT OF CORNEAL DISEASE
1. Control of infection
2. Control of inflammation
3. Promotion of re-epithelialization
• Lubrication
• Lid closure
◦ Bandage soft contact lens
4. Prevention of perforation
• Tissue adhesive glue
• Conjectival flap
• Systemic immunosuppressive agents
• Corneal grafting

7. RISK FACTORS:
◦ Contact lens wear
◦ Trauma to the eye
◦ Reduced immunity (e.g., diabetes, immunosuppression)
SYMPTOMS:
◦ Eye pain
◦ Redness
◦ Photophobia (sensitivity to light)
◦ Blurred vision
◦ Excessive tearing

8. DIAGNOSIS:
◦ Clinical examination
◦ Corneal scraping for microscopy and culture
◦ Fluorescein staining
CAUSES:
◦ Bacterial causes (e.g., Staphylococcus, Streptococcus)
◦ Fungal causes (e.g., Fusarium, Aspergillus)
◦ Viral causes (e.g., Herpes simplex virus)

9. MICROBIAL KERATITIS (Bacterial)
Predisposing factors:
Ocular surface diseases:
◦ Post-herpetic
◦ Corneal disease,
Bullous keratopathy,
Corneal exposure,
Dry eye,
Diminished corneal sensation
Contact lens wear

10. Causative Organisms
80% of cases >>>> Staphylococcus aurous, Streptococuss pneumonia and
pseudomonas species
Pseudomonas aeruginosa
Is the most frequent and the most pathogenic ocular pathogen which cause
corneal perforation in just 72 hours
◦ Pathogens which can produce corneal infection in intact epithelium.
1. Neisseria gonorrhea
2. Corynebacterium diptheriae
3. Listeria
4. haemophilus

11. ◦ Staph. Aureus and strep. Pneumoniae
oval, yellow-white, densely opaque stromal suppuration surrounded by
relatively clear cornea

12. MANAGEMENT
◦ History
◦ Clinical examination
◦ Corneal scrapping

13. DIFFERENTIATORS
Acute painful injected eye.
Profuse tearing & discharge.
Decrease visual acuity.
Large F.B
Stromal invasion with epithelial excavating edge.

14. TREATMENT
1. Fluroquinolones
 Every 5 mins/hour
 Hour/24 hs
 2 hour / 24 hs
2. Fortified eye drops
 Ulcer < 2 ws,
Improvement not obvious.
(N.B) Don’t miss resistant bavteria.
3. steriods

15. FUNGAL KERATITIS
◦ Aspergillus
◦ Fusarium
◦ Yeast candida

16. CLINICAL PRESENTATION
History of vegetable matter injury
Greyish-white ulcer with indistinct margins
Surrounded by feathery infiltrates
Ring infiltrate
Endothelial plaque
Hypopyon

17. DIFFERENTIATORS
Dull grey infiltrate
Satellite lesions
Awareness of those ulcers resembling bacterial keratitis
Awareness of those caused by yeast
Real flags

18. CANDIDA KERATITIS
◦ Usually develops in pre-exixting corneal disease or immunocompromised
patient
◦ Yellow-white ulcer
◦ Dense suppuration

19. FILAMENTOUS FUNGAL kERATITIS
◦ Firm elevated necrotic slough, “hyphate” lines that extend beyond the edge of
the ulcer into the normal cornea,
◦ Multifocal granular( or feathery) Gray-white “satellete” infiltrates in the
corneal stroma.

20. MANAGEMENT
Culture
Biopsy
Antifungal therapy
◦ Initially broad-spectrum econazole 1%, voriconazole 1% topically
◦ Then depending upon sensitivity Natamycin or imidazole for 6 weeks
Systemic ketoconazole
Therapeutic penetrating keratoplasty

21. ACANTHAMOEBA KERATITIS
Protozoan
◦ Active (trophozoite)
◦ Dormant (cystic)
Common in swimmers and
CL wearers

22. CLINICAL PRESENTATION
Blurred vision & disproportionate pain
Patchy anterior stromal infilterates
Perineural infilterates (radial keratoneuritis)
Infilterates coalesce- ring abscess, ulceration and
Hypopyon
White satellite lesions

23. MANAGEMENT
Corneal scrappings stained with calcofluor white
Corneal biopsy
Treatment with chlorhexidine,
Polyhexamethylenebiguanide drops,
Dipropamidine and propamidine.
Therapeutic penetrating keratoplasty

24. VIRAL KERATITIS
HERPIS SIMPLEX VIRUS
Basically it is epitheliotropic & may become neurotropic
Two types HSV-1 & HSV-2
Primary HSV-1 infection occurs most commonly in the
mucocutaneous distribution of the trigeminal nerve

25. CLASSIFICATION:
◦ Epithelial keratitis
◦ Disciform keratitis (localized endothelitis)
◦ Metaherpitic ulcer
◦ Necrotizing keratitis
◦ keratouvetis

26. DIFFERENTIATORS
◦ Dentritic ulcer
◦ Loss of corneal sensation
◦ Photophobia
TYPES OF HSV KERATITIS:
◦ Primary
◦ Recurrent
◦ Dentritic, geographic, metaherptica
◦ Diabetic foot in the eye---- Neurotrophic

27. MANAGEMENT
◦ Epithelial keratitis is treated with topical antivirals
Acyclovir ophthalmic ointment & Trifluridine eye drops
◦ Herpetic stromal keratitis is treated initially with
Prednisolone drops every 2 hrs accompanied by a prophylactic antiviral drug
◦ Metaherpetic ulcer treated by
Artificial tears & eye lubricants, stopping toxic medications, performing punctual occlusion,
bandage contact lens & amniotic membrane transplant

28. HERPES ZOSTER KERATITIS
Caused by Varicella zoster virus
Causes-varicella (chickenpox) & herpes zoster (shingles)
RISK FACTORS:
• Increasing risk (>70years)
• Neoplastic diseases
• Immunosuppressive drugs
• Organ transplant recipients
• HIV

29. HERPES ZOSTER OPTHAIMICUS (HZO)
Unilateral painful skin rash in one or more dermatome distributions of the fifth
cranial nerve (trigeminal nerve)
HUTCHINSON’S Sign:
Vesicles at the side or tip of the nose are potential indicators of ocular diseases

30. THANK YOU