Suppurative Superficial Keratitis (Corneal Ulcers)
Definition Localized Necrosis of Sup. Stroma with destruction of overlying Epith.
Etiology
- Predisposing Factors
- Precipitating Factors
- Causative Organisms
Predisposing Factors
Local
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a) Trauma
- Abrasion (Gono & Diph can invade normal epithelium)
- FB, Rubbing lashes, PTDs, CL
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b) Loss of corneal sensations
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c) Ocular causes (xerosis, A deficiency, Lagoph.)
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d) Prolonged use of Steroids
General
- Malnutrition
- Diabetes
- Pregnancy
- Liver & Renal Failure
Precipitating Factors
Infection of nearby structures
Causative Organisms
- a) Bacterial e.g. Gono, Diphth., Pneumo, Staph, Strept…
- b) Fungal
- c) Viral e.g. Herpes Simplex and Zoster
- d) Acanthamoeba (C.L.)
Pathology of Corneal Ulcers
Stage of Infiltration
- Inflammatory reaction PNLs
Stage of Ulceration
- Progressive unclean Stage
- Regressive Clean Stage
- Healing stage
Clinical Picture
Symptoms
- Pain Severe (FB or pricking sensation)
- Irritation of nerve endings
- Photophobia
- Lacrimation
- Diminution of vision
Signs
-
Lids: Oedema
-
Conj.: Ciliary injection
-
Cornea: Loss of luster, Grey infilt., Oedema & +ve FT
-
Iris: Const. pupil & Aqueous flare
-
Fluorescein
-
Instillation under the cornea is safe, comfortable and standard technique for tear film
Complications of Corneal Ulcers
A) Non-Perforated Corneal Ulcer Early Complications
- 2ry Iridocyclitis: (Toxins)
- 2ry Glaucoma: Open angle glaucoma
Late Complications (Healing abnormalities)
- Corneal opacity
- Keratectasia: (weak corneal scar & IOP)
B) Perforated Corneal Ulcers Cornea:
- Anterior synechia (Small periph. Perforati
- Corneal Fistula (Small central perforation)
- Lost AC
- IOP
- River Green Sign
- Leucoma Adherent (Scar)
Lens:
- Malposition of the Lens
- Sublaxation
- Ant. Dislocation & Extrusion
- Ant. Polar Cataract (Toxins)
Iris:
- Iris Prolapse
Globe:
- Intra-ocular Hge
- Endo or Panophthalmitis
- Atrophia bulbi (atrophy of the cil. processes)
iris prolapse
Management of Corneal Ulcers
Investigations + Treatment
A) Corneal Scrapping (Culture & Sensitivity)
- for Bacteria & Trachoma & Acanthamoeba
- Silver Stain for Fungi
B) Local TreatmentZ ABCD
- Atropine sulphate 1% or cycloplejico
- Dressings (Antibiotic dps & oint)
- Bandage or Dark Glasses
- Counter irritant
C) Systemic Treatment
- Antibiotics
- Analgesics
- Vitamins A & C
Treatment of Complications
-
2ry Glaucoma
- Usual Treatment
- Antiglaucoma Treatment
- Paracentesis
-
Perforation
- Small → Cyanoacrylate Tissue Adhesive
- Large → Penetrating keratoplasty (PKP)
Treatment of Corneal Opacity
-
Central Nebula
- Glasses or CL
- Eximer Laser
- Lamellar KP
-
Leucoma → Penetrating keratoplasty PKP
Treatment of Resistant Corneal Ulcer CU
- Scrapping for Culture & Sensitivity
- Subconjunctival (S.C). injection of antibiotics (AB)
- Therapeutic KP (Lamellar or Penetrating)