This document describes different types of keratitis, including ulcerative keratitis, non-ulcerative keratitis, and infective keratitis caused by bacteria, fungi, viruses, and protozoa. It discusses the classification, etiology, signs, diagnosis, and management of various forms of corneal inflammation and infection. Key pathogens mentioned include Staphylococcus aureus, Pseudomonas, herpes simplex virus, acanthamoeba, and fungi like Aspergillus and Fusarium.

1. INFLAMMATION OF
CORNEA
DONE BY
ROSE
ROLL NO 2

2. CLASSIFICATION
 MORPHOLOGICAL
1. ULCERATIVE KERATITIS
a) Depending on location
 Central and peripheral
b) Depending on purulence
 Purulent and non-purulent
c) Depending on association of hypopyon
 Simple and hypopyon corneal ulcer
d) Depending upon depth of ulcer
 Superficial and deep
 Corneal ulcer with impending perforation
and perforated corneal ulcer
e) Depending on slough formation
 Non sloughing and sloughing corneal
ulcer
2. NON- ULCERATIVE KERATITIS
 Superficial and deep
 ETIOLOGICAL
1. INFECTIVE KERATITIS
2. ALLERGIC KERATITIS
3. TROPHIC KERATITIS
4. KERATITIS ASSOCIATED WITH
DISEASES OF SKIN AND MUCUOS
MEMBRANE
5. KERATITIS ASSOCIATED WITH
SYSTEMIC COLLAGEN VASCULAR
DISORDERS
6. TRAUMATIC KERATITIS
7. IDIOPATHIC KERATITIS

3. Keratitis is characterised by corneal oedema,
cellular infiltration and cilliary congestion.
INFECTIVE KERATITIS
Bacterial keratitis
Fungal keratitis
Viral keratitis
Protozoal keratitis

4. ULCERATIVE KERATITIS/CORNEAL
ULCER
Corneal ulcer can be defined as discontinuation
in normal epithelium surface of cornea
associated with necrosis of the surrounding
corneal tissue.

5. BACTERIAL KERATITIS
Common pathogens
 Staphylococcus aureus
 Streptococcus pneumoniae
 Pseudomonas
 Cornybacterium diphtheria
 Neisseria gonorrhoeae

6. ETIOLOGY
Predisposing factors which increase the risk of
corneal ulcers are:
 Introduction of organism during trauma
 Prolonged used of tropical steroids
 Dry eyes
 Entropion with trichiasis
 Wearing of contact lenses
 Bullous keratopathy and poor hygiene

7. PATHOLOGY
 The ulcer is usually saucer shaped, and the walls project above
normal surface of the cornea owing to swelling. Surrounding
is packed with leucocytes and appears as a grey zone of
infiltration. This is the progressive stage.
 When the necrotic material has been shed off the ulcer is
somewhat larger, but as the surrounding infiltration and swelling
disappears, the floor and edges become more smooth and
transparent, and the regressive stage is reached.
 Vascularization and minute superficial vessels grow in from the
limbus near the ulcer to restore the loss of substance.
 When ulcer is vascularized, Cicatrization occurs which is carried
by the regeneration of collagen and formation of fibrous tissue.

8. STAGES OF
CORNEAL
ULCER

9. SYMPTOMS
 Irritative effect upon the vessels of the iris and
ciliary body.
 Formation of hypopyon.
 During the progressive stage there is
lacrimation, photophobia, blepharospasm
and pain.
 SIGNS
 Blurred vision, pain and redness of the eye.

10.  Staphylococcus aureus and streoptococcus
pneumoniae produce an oval yellowish
white densely opaque ulcer which is
surrounded by a clear cornea.

12.  Pseudomonas species produces an irregular
sharp ulcer with thick greenish mucopurulent
exudate, diffuse liquefactive necrosis and semi-
opaque surrounding cornea.

14.  Enterobacteriae produce a shallow ulcer with
greyish white pleomorphic suppuration and
diffuse stromal opalescence. These gram
negative bacilli produce ring-shaped corneal
infiltrate.

15. BACTERIAL CORNEAL ULCER: RING SHAPED ULCER

16.  Pneumococcus produce characteristic
hypopyon corneal ulcer called ulcus serpens. It
is a greyish white or yellowish disc shaped ulcer
occurring near the centre of cornea .

17. BACTERIAL CORNEAL ULCER: ULCUS SERPENS

18. COMPLICATIONS
 Toxic iridocyclitis
 Secondary glaucoma
 Descemetocele- herniation of a transparent vesicle due to
effect of intraocular pressure on Descemet’s membrane when
ulcer reaches upto it.
 Perforation of corneal ulcer- caused by sudden strain due to
cough, sneeze or spasm of orbicularis muscle.
 Sequels of corneal ulcer perforation: anterior dislocation of
lens, iris prolapse,leucoma, intraocular haemorrhage,corneal
fistula, anterior synechiae, anterior capsular cataract, purulent
infections, anterior staphyloma and phthisis bulbi.
 Corneal scarring

19. DESCEMETOCELE

20. HEALED PERFORATED CORNEAL ULCER

21. MANAGEMENT
 Identification of causative organism
 Hospitalization
 Standard combined therapy with aminoglycosides
and cephalosporins like fortified 5% cephazoline,
fortified1.3% tobramycin
 Monotherapy with fluoroquinolone like 0.3%
ciprofloxacin or 0.5% moxifloxacin.
 Cycloplegics ( Atropin sulphate 1%) to prevent
posterior synechiae and pain
 Systemic analgesics and anti-inflammatory drugs
like paracetamol and ibuprofen for pain and
oedema.

22. FUNGAL KERATITIS
Commonly due to
 Aspergillus
 Fusarium
 Candida albicans

23. ETIOLOGY
 Injury by vegetative material such as crop
leaf,thorn, branch of a tree.
 Secondary fungal ulcers are common in
immunosuppressed patients.
 Injury by animal tail
 Excessive use of antibiotics

24. SIGNS
 Ulcer is dry looking, greyish white, with elevated
rolled out margins.
 Pigmented ulcer caused by dermatiaceous fungi.
 Delicate feather like extensions are present into
the surrounding stroma under intact epithelium
 A sterile immune ring
 Multiple, small satellite lesions
 Big hypopyon is present.
 Endothelial plaque

25. FUNGAL CORNEAL ULCER

26. DIAGNOSIS
 Lab investigations required for confirmation
include examination of wet KOH, calcofluor
white, Grams and Giemsa stained films for
fungal hyphae and culture on Sabouraud’s
medium’.
 Confocal microscopic examination.
 PCR

27. TREATMENT
 Topical antifungal eyedrops like 5%
Natamycin, 0.1-0.3% Amphotericin, 0.2%
Fluconalzole.
 Intracameral administration of voriconazole
 Therapeutic penetrating keratoplasty may be
required for unresponsive cases.

28. VIRAL KERATITIS
Commonly caused by:
 Herpes simplex virus
 Herpes zoster
 Adenovirus

29. HERPES SIMPLEX KERATITIS

30. ETIOLOGY
 HSV-1 is acquired by close contact with a
patient suffering from herpes labialis.
 HSV-2 is transmitted to eyes of neonates
through infected genitalia of mother.

31. PATHOLOGY
(Ocular lesions)
PRIMARY HERPES
 Skin lesions
 Conjunctiva
 Acute follicular conjunctivitis
 Cornea
 Fine epithelial punctuate
keratitis
 Course epithelial punctuate
keratitis
 Dentritic ulcer
RECURRENT HERPES
 Active epithelial keratitis
 Punctuate epithelial keratitis
 Dendritic ulcer
 Geographical ulcer
 Stromal keratitis
 Disciform keratitis
 Diffuse stromal necrotic
keratitis
 Trophic keratitis

32. LESIONS OF
RECURRENT HERPES
SIMPLEX KERATITIS

33. SYMPTOMS
 Acute pain
 Photophobia
 Lacrimation
 Redness
 Blurring of vision

34. DIAGNOSIS
 Immunofluorescene of epithelial scrapings
 Demonstration of elementary bodies in tissue
biopsy and culture.

35. TREATMENT
 Supportive- hot fermentation to relive pain and congestion,
eye irrigation with normal saline, eye pads to prevent
exposure to dust, wind etc., dark goggles for photophobia,
rest, good diet and fresh air for speedy recovery.
 Oral antiviral drugs- Acyclovir in a dose of 800mg,
Valaciclovir in a dose of 500mg
 Analgesics- combination of mephenamic acid and
paracetamol
 Systemic steroids
 Cyclopegic drugs- 1% atropine
 Surgical treatment- lateral tarsorrhaphy, amniotic membrane
transplantation
 Keratoplasty

36. PROTOZOAL KERATITIS
 ACANTHAMOEBA

37. ETIOLOGY
 Corneal infection with acanthamoeba results from direct
corneal contact with any material or water contaminated
with the organism.
 It is always associated with contact lens use, as
acanthamoeba can survive in the space between lens and
the eye.

38. SIGNS
 Epithelial lesions include: Epithelial roughening and
irregularities, Epithelial ridges, Pseudodendrites
formation.
 Stromal lesions include : Radial keratoneuritis,
patchy and stromal infiltrates, ring infiltrates, ring
abscess.
 Limbal and scleral lesions include: Limbitis, Scleritis

39. ACANTHAMOEBA
KERATITIS: STROMAL
LESIONS

40. DIAGNOSIS
 Confocal microscopy
 KOH mount
 Lactophenol cotton blue stained
 Culture on non-nutrient agar
 PCR
 Corneal biopsy

41. TREATMENT
 Specific treatment:
Topic antiamoebic agents: Diamidines, Biguanides,
aminoglycosides, multiple drug therapy
(chlorhexidine+neomycin or paromycin+clotrimazole)
Oral ketoconazole
Penetrating keratoplasty
 Non-specific treaments : analgesics, anti-inflammatory drugs,
cycloplegic drugs