No when it happens

1. Corneal Ulcer
ZERA 1

2. Corneal ulcer/Ulcerative keratitis
 Definition
• Inflammation of the cornea associated with
some destruction of a portion of the
epithelium.
• Purulent (Bacterial & fungal)
• Non-purulent (Viral, Chlamydial,allergic)
ZERA 2

3. Cornea
Transparent, avascular watch glass – like
structure
Forms anterior 1/6 of the outer fibrous coat
ZERA 3

4. Bacterial Corneal ulcer
 Etiology
• Staph Aureus
• Pseudomonas pyocyanea
• Strep. Pneumoniae
• Klebsiella
• E. coli
ZERA 4

5. • C. Dipthiriae
• H. Influenza
• N. Menengitidis
• N. Gonorrhea
• Listeria Monocytogens
ZERA 5

6.  Symptoms
• Photophobia
• Pain
• Watery discharge
• Redness of eyes
• Defective vision
ZERA 6

7.  Signs
• Swollen lids
• Blepharospasm
• chemosed & hyperaemic conjunctiva
• Corneal ulcer – yellowish white pit (Green
for +ve fluorescein dye test)
• - +/-hypopyon in AC
ZERA 7

8.  Tx
• Topical Abx
• Topical cycloplegic drugs – 1% atropine
• Systemic analgesics
• Vitamins A, B - complex, C
• Hot fomentation
ZERA 8

9. Fungal corneal ulcer
 Etiology
• Aspergillus
• Candida
• Fusarium
• Mode of infection – trauma by leaf of crop,
branch of tree, straw, hay, decaying matter
ZERA 9

10.  Symptoms
• As in bacterial corneal ulcer but less
marked
 Signs
• Generally as in BCU
• Dry with thick greyish white slough at the
base
• Satelite lesions around ulcer
• Marked hypopyon
ZERA 10

11.  Investigations
• Examination of wet KOH
• Gram’s & Giemsa staining
• Sabouraud agar medium
ZERA 11

12.  Tx
• Topical antifungal drugs – Natamycin,
Fluconazole, Nystatin, Silver sulphadiazine
• Other measures as in BCU
ZERA 12

13. Viral corneal ulcers
 Herpes simplex keratitis
 Two forms – primary & recurrent
 Primary
• Occurs in a non-immune person
• Children 6/12 – 5 years of age, teenagers
ZERA 13

14.  Clinical features
• Vesicular skin lesions – lids & periorbital
region
• Acute follicular conjunctivitis
• Epithelial keratitis
• Usually self-limiting but virus establishes
latent infection in trigeminal ganglion
ZERA 14

15.  Recurrent ocular herpes
• Due to periodic activation of the virus in
the trigeminal ganglion
• Triggers – fever, malaria, flu, UV rays, ill
health, emotional & physical exhaustion,
mild trauma
ZERA 15

16.  Clinical features
 Epithelial keratitis; punctate, dendritic,
geographic,
 Pain
• Photophobia
• Lacrimation
• Blurred vision
ZERA 16

17.  Stromal keratitis – disciform
• Due to delayed hypersensitive to HSV
antigen
• Steroid eye drops
• Antiviral cover 3% Acyclovir
ZERA 17

18.  Herpes Zoster ophthalmicus
• Acute infection of the trigeminal ganglion
by VZV
• Contracted in childhood, manifests as
chicken pox
ZERA 18

19.  Clinical features
• Fever
• Malaise
• Severe neuralgia
• Cutaneous lesions; vesicles in the areas of
distribution of trigeminal n.
• Ocular lesions – conjunctivitis, keratitis,
episcleritis, iridocyclitis
ZERA 19

20.  TX
• Analgesics
• Systemic acyclovir
• Abx steroid ointment for scar lesions
• Systemic steroids if other cranial n are
involved
• Topical acyclovir eye ointments,
cyclopentolate & steroid drops for zoster
keratitis
ZERA 20

21. Exposure Keratitis
 Etiology
• Develops when the eyeball is insufficiently
covered by eyelids
• Loss of protective mechanism of blinking
 Extreme ptosis
 Facial n palsy
 Severe ectropion
 Inadequate lid closure in deep coma
ZERA 21

22.  Clinical features
• Desiccation in inter-palpebral area
• Punctate keratitis
• Necrosis
• Frank ulceration
• vascularization
ZERA 22

23.  Tx
• Artificial tears & ointments
• Corneal should be kept covered
• Tx causative condition
ZERA 23

24. Mooren’s ulcer
 Severe inflammatory peripheral ulcerative
keratitis
 Unkown etiology
ZERA 24

25.  Clinical features
• Chronic, painful, indolent ulcer
• Usually seen in the elderly
 Tx
• Immunosuppressive drugs - cyclosporine
ZERA 25