BACTERIAL CORNEAL ULCER

BACTERIAL CORNEAL ULCER

Labeeb Pc

AETIOLOGY

Corneal epithelial damage

Prolonged use of steroids

Wearing contact lenses

Poor local hygiene

Corneal Epithelial Damage

Corneal Abrasion

Epithelial drying

Necrosis - keratomalacia

Desquamation – bullous keratopathy

Trophic changes – neurotrophic keratitis

TRICHIASIS

ENTROPION

LAGOPHTHALMOS

Sources Of Infection

Exogenous

Ocular tissue

Causative organisms

Invade normal epithelium –

N.gonorrhoeae & C. diphtheriae

PATHOGENESIS

Stage of progressive infiltration & ulceration

Saucer shaped ulcer

Walls project above normal surface

Grey zone of infiltration

Hypopion

Progress laterally or deeper

Stage of regression

A line of demarcation.

Necrotic material shed off

Begins to heal

Vascularisation

Stage of cicatrisationIf epithelium only – no scarNebular – Bowman’s membrane &

superficial stroma

Macular – upto half of stroma

Leucomatous – more than half of stroma

Corneal Facets

Corneal Opacities

Nebular Macular Leucomatous

AdherentLeucoma

Nebular

Macular

Leucomatous

Adherent Leucoma

SYMPTOMS

Pain & fb sensation

Lacrimation

Photophobia

Blurred vision

Blepharospasm

Redness of eyes

Circum corneal congestion

SIGNS

Swelling of lids

Conjunctiva – chemosis, CCC

Corneal ulcer –

Margins – swollen, over hanging

Floor - necrotic material

Stromal edema around

AC – hypopion - mobile

Iris – slightly muddy

Pupil – small

INFILTRATEEPITHELIAL DEFECT

HYPOPYONCORNEAL CONGESTION

COMPLICATIONS

Ectatic Cicatrix

Descemetocele

Ectatic cicatrix

Descemetocele

Toxic Iridocyclitis

Inflammatory glaucoma

Corneal perforation

Prolapse of iris

Adherent Leucoma

Pseudocornea

Anterior Staphyloma

Anterior Subcapsular cataract

Anterior Synechia

Corneal fistula

Secondary glaucoma

Spontaneous expulsion of lens & vitreous

Intraocular hemorrhage , Expulsive

Hemorrhage

Endophthalmitis or Panophthalmitis

INVESTIGATIONS

Routine blood examination

Lid & Adnexa Examination

Corneal Scraping – kimura spatula

Corneal biopsy

Culture of contact lens & solution

TREATMENT

Treatment of Uncomplicated Ulcers

1. AntibioticsFortified Cephazolin 5%, fortified Tobramycin 1.3%

Fortified Vancomycin 0.3%, Fluroquinolones

2. Atropine

3. Steroids

4. Cauterisation – carbolic acid, trichloroacetic a

5. Rigid gas permeable contact lenses

6. Dense corneal scars with visual potential-

Lamellar keratoplasty, full thickness graft

7. Without visual potential –

Cosmetic contact lenses, tattooing.

8. Analgesics

9. Hot Fomentation

10. Dark Goggles

11. Rest, good diet, fresh air

Perforated ulcer1. Avoid straining

2. Tissue adhesive –

N-butyl 2-ethyl cyanoacrylate

3. Bandage soft contact lenses

4. Therapeutic keratoplasty , Dacrocystorhinostomy

5. Conjuctival flap, amniotic membr transplant

6. Antiglaucoma

Marginal Catarrhal UlcerNear limbus

Old pupil

Hypersnsitivity to staphylococcal toxins

HYPOPION ULCER

Pneumococcus – Ulcus Serpens

Pseudomonas, Staphylococcus, Gonococci,

Streptococcus, Moraxella

C/c Dacrocystitis

Sterile , mobile, rapidly absorbed

Ulcus serpens Greyish white or

yellowish disc like.

Opacity greater at the edges

One edge – infiltration , other - cicatrization

Cornea – lustreless

Violent iritis and aqueous is cloudy

THANK-YOU