Fungal corneal ulcer

History : Injury with

vegetable matter Aspergillus, Fusarium, Candida

Symptoms

•Pain

•Redness

•Tearing

•Photophobia

•Defective vision

•Blepherospasm

signsSigns out of proportion

to symptomsDry, raisedFeathery marginsImmune ringSatellite lesionsEndothelial plaque

HypopyonFixedConvexNon sterile

Management

Diagnosis Treatment

History

Microbiological investigationsKOH, Calcofluor

white, Giemsa

Sabouraud’s dextrose agar

Specific treatment Topical

NatamycinAmphotericin B

SystemicKetoconazole

NO CORTICOSTEROID

Therapeutic Keratoplasty

Non specific treatment

Acanthamoeba Keratitis

Free living amoeboid protozoanTrophozoites and cystsUbiquitous in natureFound in air, soil & all water sources.

Acanthamoeba Keratitis• Symptoms out of proportion to signs

• More in contact lens wearers , swimming pool, soil contamination

• Epithelium initially intact• Stromal infiltrate, dendrite like infiltrate.• Ring infiltrate• Radial keratoneuritis• Limbitis

Management • Calcofluor white – cysts

• Culture – • non nutrient agar enriched with E

coli

• Specific• Propamidine isothionate

0.1 % ( Brolene )

• Polyhexamethylene biguanide (PHMB)

• Neomycin• Fluconazole, Micanazole• NO CORTICOSTEROIDS

• Therapeutic Keratoplasty• Non specific treatment

Herpetic KeratitisHerpes Simplex – 1 : above the waist Primary HSV - 6 months to 5years - and self limiting

Acute follicular keratoconjunctivitis

Blepharitis

Corneal lesions

Herpetic Keratitis

Corneal lesions Epithelial lesions Dendritic ulcer Amoeboid ulcer geographic ulcer

Stromal(necrotising and non necrotising)

Endothelial

Dendritic ulcerSuperficial punctate erosions

Infiltrates spread in all direction- coalesce

Large shallow ulcers with crenated edges.

Increase in length ,send out lateral branches and are knobbed at the ends

Giving rise to dendritic form configuration

Linear branching Ulcer stains with Fluorescein

Reduced corneal sensation

Rose bengal stain

Management Investigations TreatmentImmunoflurescence and

culture of epithelial scrapings.

Antivirals

Acyclovir 3% 5 times/ day

Triflurothymidine IDU 0.1% drops

Antibiotic eye drops

DebridementCycloplegics

Stromal keratitis Disciform keratitis

Necrotising ulcerative keratitis Interstitial keratitis

SclerokeratitisEndotheleitisIndolent & trophic ulcerationUveitis

Reactivated infection of the endothelium and

keratocytes

Past history of dendritic ulcer

Disc shaped corneal dedep lesionOedema

Immune ring KPS

Anterior uveitisIOP may be high

Old lesions – faint opacities

Treatment of disciform keratitisTopical Antivirals e.g acyclovir

Steroids under the cover of anti viral drops.

Tapered over weeks eg. 4x to 6x a day over 2weeks and then to taper.

Herpes ZosterChicken pox- Varicella Zoster virusVirus dormant in Gasserian

ganglion

Immunity depressed

Infection activates and virus travels down the branches of ophthalmic division of trigeminal nerve(supra orbital aupre and infra trochlear)

Herpes zoster ophthalmicusOphthalmic division of the trigeminal nerveAcute phase

Prodromal phase- Influenza like illness Neuralgia

Ocular lesions – vesicles over the lids eyelids ,conjunctivitis, episcleritis,

scleritis, keratitis,anterior uveitis,retinal vasculitis,optic neuritis, cranial nerve palsy.

Hutchinson's sign –involvement of the tip of the nose is associated with ocular involvement.

Rash Maculapapular rash

VesiclesPustules

CrustOedema

Along distr. Of nerveDoes not cross midline

Ocular Complications

IridocyclitisKeratitis

Sec. Glaucoma

Treatment Oral Acyclovir 800mg 5 times/day for 10 days Topical acyclovir

ointmentTopical antibioticsIn case of iridocyclitis

add topical steroids and cycloplegics