| ID | 261 |
|---|---|
| Name | CORNEAL ULCER |
| Cause | |
| Signs Symptoms | |
| Diagnosis | Diagnostic criteria of corneal ulcer: 1. Raw area on the cornea with sorrounding haziness. Rawness demonestrated by staining with fluorescein and absence of window reflex. 2. Pain, watering, ciliary congestion, generalised conjunctival hyperemia. |
| Investigations | |
| Management | |
| Introduction | It means loss of corneal substance as a result of infection and formation of t raw excavated area. Majority of the cases are due to exogenous infection by various microorganisms such as streptococcus, staphylococcus, pneumococcus etc. or as a complication of herpes simplex keratitis, chronic blepharitis, dacryocystitis, gonorrhoea, acute infectious diseases. It may be of infective or purulent non-purulent, allergic and degenerative type. |
| History | |
| Etiology | |
| Clinical Features | Clinical feature: 1. Pain in the eye. 2. Lacrimation. 3. Photophobia. 4. Headache and blurring of vision. 5. Marked blepharospasm. 6. Rough and raw yellowish white area on the cornea which stains with 2% fluorescein. 7. Ciliary congestion. 8. Profuse watering. 9. Iris is slightly muddy in colour. 10. Hypopyon may or maynot be present. |
| Preventions | |
| Treatment | Treatment: General: 1. Hospitalization 2. Rest of the eye by dark glass &1% atropine ointment, twice daily. 3. Vitamin A & C suppliment 4. Heat provocation Symptomatic: 1. Diclofenac l00mg daily 2. Use of dark glass to protect from light. Specific: Bacterial keratitis: antibiotic therapy: 1. Chloramphenicol 0.5% eye drops given half-hourly. Or, 2. Gentamycin eye drops 0.3% given half-hourly. Or, 3. Ciprofloxacin 0.3% 2-hourly. It is preferable to start high concentration topical antibiotic after gram’s stain, culture & sensitivity test of the scraped material from ulcer. Viral (e.g herpes simplex) keratitis: (Diagnosis: reduced corneal sensation, no discharge, dendritic or branching ulcer). 1. Acyclovir 3% eye ointment 5 times daily. Or, 2. Trifluridine 1% 1-hourly in the day & 2-hourly at night. Or, 3. Adenine arabinoside 0.1% drop or 3% ointment 1-hourly in the day & 2-hourly at night. Or, 4. Idoxuridine 0.1% drop or 0.5% ointment, 1-hourly in day & 2-hourly at night. Fungal corneal ulcer: 1. Fungizol ointment 4-5 times daily. 2. To prevent secondary infection give antibiotic ointment or drops as given in bacterial corneal ulcer. Indolent corneal ulcer: It is usually treated surgically- 1. Cauterization with pure carbolic acid or with absolute alcohol or with 7% iodine, 25% KI in 100% spirit. 2. Paracentasis-if hypopyon 3. Conjunctival hood operation 4. Tarsorraphy- central or lamellar 5. Corneal graft- may be requird in the acute stage to arrest the progression of infection or after resolution of the infection to restore vision. N.B: No local steroid, cocaine or pad bandage should be applied in the management of corneal ulcer. |
| Complications | |
| Prognosis | |
| Types | |
| Classification | Classification: 1. Purulent ulcer or suppurative keratitis a. Ordinary pyogenic corneal ulcer, b. Hypopyon ulcer or surpeginous ulcer of cornea, c. Mycotic ulcer, d. Marginal ulcer. e. Ulcer associated with small pox. 2. Non-purulent ulcer- a. Ulcer in association with trachoma. b. Herpes simplex keratitis (such as dendritic ulcer) c. Lagophthalrnic ulcer d. Ulcer due to defficiency of vit-A. 3. Allergic ulcer- a. Phlyctenular ulcer 4. Degenerative ulcer- a. Atheromatous ulcer occuring in old trachoma, b. Moorens ulcer |
| Observation | |
| Pathology |
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