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    Corneal Ulcers

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    Avinash Nagar
    Corneal ulcers can be caused by bacteria, fungi, viruses, or protozoa. Bacterial ulcers begin with epithelial necrosis and lymphocyte infiltration, progressing to active ulceration with hypopyon formation. Fungal ulcers cause severe inflammation and stromal necrosis, allowing fungi to penetrate Descemet's membrane and cause perforation. Corneal ulcers are graded based on size, depth, and presence of hypopyon, with treatment differing depending on causative agent and grade but generally involving topical and sometimes oral antibiotics, antifungals, or other medications.

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    Corneal Ulcers

    Uploaded by

    Avinash Nagar
    63 views18 pages
    Corneal ulcers can be caused by bacteria, fungi, viruses, or protozoa. Bacterial ulcers begin with epithelial necrosis and lymphocyte infiltration, progressing to active ulceration with hypopyon formation. Fungal ulcers cause severe inflammation and stromal necrosis, allowing fungi to penetrate Descemet's membrane and cause perforation. Corneal ulcers are graded based on size, depth, and presence of hypopyon, with treatment differing depending on causative agent and grade but generally involving topical and sometimes oral antibiotics, antifungals, or other medications.

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    corneal ulcers--converted

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    Corneal ulcers can be caused by bacteria, fungi, viruses, or protozoa. Bacterial ulcers begin with epithelial necrosis and lymphocyte infiltration, progressing to active ulceration with hypopyon formation. Fungal ulcers cause severe inflammation and stromal necrosis, allowing fungi to penetrate Descemet's membrane and cause perforation. Corneal ulcers are graded based on size, depth, and presence of hypopyon, with treatment differing depending on causative agent and grade but generally involving topical and sometimes oral antibiotics, antifungals, or other medications.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    63 views18 pages

    Corneal Ulcers

    Uploaded by

    Avinash Nagar
    Corneal ulcers can be caused by bacteria, fungi, viruses, or protozoa. Bacterial ulcers begin with epithelial necrosis and lymphocyte infiltration, progressing to active ulceration with hypopyon formation. Fungal ulcers cause severe inflammation and stromal necrosis, allowing fungi to penetrate Descemet's membrane and cause perforation. Corneal ulcers are graded based on size, depth, and presence of hypopyon, with treatment differing depending on causative agent and grade but generally involving topical and sometimes oral antibiotics, antifungals, or other medications.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 18

    Corneal ulcer

    Corneal ulcers

    • Discontinuation in normal epithelial surface of cornea


    associated with necrosis of the surrounding corneal
    tissue
    • It can be:
    • Bacterial corneal ulcer
    • Fungal corneal ulcers
    • Viral corneal ulcers
    • Protozal corneal ulcers
    Causative agent
    Bacterial Fungal Viral Protozoal
    Staphylococcus FILAMENTOUS YEAST HSV I Acanthamoeb
    aureus a
    Pseudomonas Fusarium Candida HSV II
    pyocyanea
    Streptococcus Alternaria Cryptococcus
    pneumoniae
    E. Coli Penicillium
    N. Meningitidis Aspergillus

    N. Gonorrhoea
    Cornybacterium
    diphtheriae
    Pathophysiology(Bacterial)
    Stage of progressive infiltration
    • Lymphocytes infiltrates in epithelium
    • Necrosis

    Stage of active ulceration


    • Greyish infiltration with circumcorneal hyperaemia
    • Hypopyon and descemetocele

    Stage of regression
    • Phagocytosis
    • Ulcers begin to heal

    Stage of cicatrization
    • Epithelium covers the ulcers
    • Scars and opacities formation
    Bacterial
    ulcer
    Pathophysiology (Fungal)
    ▫ Severe inflammatory response
    ▫ Stromal necrosis
    ▫ Filamentous fungi can penetrate the intact
    Descement’s membrane
    ▫ Corneal perforation

    Fungal
    ulcer
    Risk factors
    ▫ CL wearers
    ▫ Trauma
    ▫ Ocular surface diseases
    ▫ Immuno-compromised diseases
    ▫ Trauma with vegetable matter
    ▫ Diabetes
    ▫ Injury with animal tail
    Symptoms
    Pain
    Photophobia
    Blurred vision
    Discharge
     Foreign body sensation
     Watering
     Redness
    Signs
    Bacterial Fungal Viral Protozoal
    Swelling of lids Dry greyish-white stromal Punctate epithelial keratitis Irregular and greyish
    infiltrate eipthelial surface

    Blepharospasm Elevated rolled out margins Dendritic ulcers Epithelial pseudodendrites

    Conjunctival chemosis Satellite lesion Geographical ulcers Focal anterior stromal


    infiltrates
    Conjunctival hyperaemia Yellowish-white infiltrate Virus-laden cells at margin Radial keratoneuritis
    of ulcer stain with rose
    bengal stain
    Ciliary congestion Dense suppuration Reduced corneal sensation Enlargement and
    coalescence of infiltrates
    from ring abscess

    Greyish-white Hypopyon Scleritis may develop


    circumscribed infiltrate
    Yellowish-white Corneal melting
    oval/irregular area of ulcer stromal necrosis

    Stromal oedema
    Hypopyon
    Corneal perforation
    Endophthalmitis
    Dendritic
    ulcer

    Superficial punctate
    keratitis
    Hypopyo
    n

    Acanthamoeba
    keratitis
    Corneal
    oedema

    Endophthalmiti
    s
    Geographic
    ulcer

    Satelite
    lesion
    Grading of corneal ulcers

    features Mild Moderate Severe

    Size < 2 mm 2-5 mm > 5 mm

    Depth of ulcer < 20% 20-50% > 50%

    Stromal infiltrate Dense Dense upto mid Dense deep


    Superficial stroma stromal
    Scleral - - present
    involvement
    Grading
    Grade AC cells
    Grade 0 None
    Grade 1 1-15 cells
    Grade 2 15-25 cells
    Grade 3 > 25 cells

    Grade Aqueous flares


    Grade 0 Absent
    Grade 1 Mild (barely detected)
    Grade 2 Moderate (iris and lens seen)
    Grade 3 Severe (iris and lens not seen)
    Grade Corneal oedema

    Grade 0 Absent

    Grade 1 Mild

    Grade 2 Moderate

    Grade 3 Severe

    Grade Conjunctival congestion

    Grade 0 None

    Grade 1 Mild (some vessels injected)

    Grade 2 Moderate (diffusely injected)

    Grade 3 Severe (intensely injected)


    Treatment
    Bacterial Fungal Viral Protozoal
    Topical antibiotics: Removal of eithelium Antiviral agent: Antiamoebic agent
    Ciprofloxacin Acyclovir e/d (3%) Propamidine isoethionate
    Vancomycin Gancyclovir e/d (0.15%) (0-1%)
    Ofloxacin Trifluorothymidine e/d (1%) Polyhexamethylene
    Moxifloxacin biguanide (0.02%)
    Ciprofloxacin Clotrimazole
    Miconazole

    Oral antibiotics: Topical- Debridement Debridement


    T. Ciprofloxacin Filamentous: For dendritic ulcers
    Natamycin (5%)
    Econazole (1%)
    Amphotericin B (0.15%)
    Miconazole (1%)

    Mydriatics: Candida: Oral ketoconazole (200mg)


    Atropine (1%) Econazole (1%)
    cyclopentolate (1%) Natamycin (5%)
    Fluconazole (2%)
    Clotrimazole (1%)
    Topical steroids: Subconjunctival fluconazole

    Systemic antifungals:
    Itraconazole (100mg)
    Voriconazole (100mg)
    Excisional penetrating
    keratoplasty
    Thank you…

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