Bacterial corneal ulcer
Transcript of Bacterial corneal ulcer
![Page 1: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/1.jpg)
BACTERIAL CORNEAL ULCER
BACTERIAL CORNEAL ULCER
Labeeb Pc
![Page 2: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/2.jpg)
AETIOLOGY
![Page 3: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/3.jpg)
Corneal epithelial damage
Prolonged use of steroids
Wearing contact lenses
Poor local hygiene
![Page 4: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/4.jpg)
Corneal Epithelial Damage
Corneal Abrasion
Epithelial drying
Necrosis - keratomalacia
Desquamation – bullous keratopathy
Trophic changes – neurotrophic keratitis
![Page 5: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/5.jpg)
TRICHIASIS
![Page 6: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/6.jpg)
ENTROPION
![Page 7: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/7.jpg)
LAGOPHTHALMOS
![Page 8: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/8.jpg)
Sources Of Infection
Exogenous
Ocular tissue
![Page 9: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/9.jpg)
Causative organisms
Invade normal epithelium –
N.gonorrhoeae & C. diphtheriae
![Page 10: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/10.jpg)
PATHOGENESIS
![Page 11: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/11.jpg)
![Page 12: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/12.jpg)
Stage of progressive infiltration & ulceration
Saucer shaped ulcer
Walls project above normal surface
Grey zone of infiltration
Hypopion
Progress laterally or deeper
![Page 13: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/13.jpg)
Stage of regression
A line of demarcation.
Necrotic material shed off
Begins to heal
Vascularisation
![Page 14: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/14.jpg)
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
![Page 15: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/15.jpg)
![Page 16: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/16.jpg)
Corneal Opacities
Nebular Macular Leucomatous
AdherentLeucoma
![Page 17: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/17.jpg)
Nebular
Macular
![Page 18: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/18.jpg)
Leucomatous
![Page 19: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/19.jpg)
Adherent Leucoma
![Page 20: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/20.jpg)
SYMPTOMS
![Page 21: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/21.jpg)
Pain & fb sensation
Lacrimation
Photophobia
Blurred vision
Blepharospasm
Redness of eyes
![Page 22: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/22.jpg)
![Page 23: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/23.jpg)
Circum corneal congestion
![Page 24: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/24.jpg)
SIGNS
![Page 25: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/25.jpg)
Swelling of lids
Conjunctiva – chemosis, CCC
Corneal ulcer –
Margins – swollen, over hanging
Floor - necrotic material
Stromal edema around
![Page 26: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/26.jpg)
AC – hypopion - mobile
Iris – slightly muddy
Pupil – small
![Page 27: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/27.jpg)
INFILTRATEEPITHELIAL DEFECT
HYPOPYONCORNEAL CONGESTION
![Page 28: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/28.jpg)
COMPLICATIONS
![Page 29: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/29.jpg)
Ectatic Cicatrix
![Page 30: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/30.jpg)
Descemetocele
![Page 31: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/31.jpg)
Ectatic cicatrix
Descemetocele
Toxic Iridocyclitis
Inflammatory glaucoma
![Page 32: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/32.jpg)
Corneal perforation
Prolapse of iris
Adherent Leucoma
![Page 33: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/33.jpg)
Pseudocornea
![Page 34: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/34.jpg)
Anterior Staphyloma
![Page 35: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/35.jpg)
Anterior Subcapsular cataract
Anterior Synechia
![Page 36: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/36.jpg)
Corneal fistula
Secondary glaucoma
Spontaneous expulsion of lens & vitreous
Intraocular hemorrhage , Expulsive
Hemorrhage
Endophthalmitis or Panophthalmitis
![Page 37: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/37.jpg)
INVESTIGATIONS
![Page 38: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/38.jpg)
Routine blood examination
Lid & Adnexa Examination
Corneal Scraping – kimura spatula
Corneal biopsy
Culture of contact lens & solution
![Page 39: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/39.jpg)
TREATMENT
![Page 40: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/40.jpg)
Treatment of Uncomplicated Ulcers
1. AntibioticsFortified Cephazolin 5%, fortified Tobramycin 1.3%
Fortified Vancomycin 0.3%, Fluroquinolones
2. Atropine
3. Steroids
![Page 41: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/41.jpg)
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.
![Page 42: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/42.jpg)
8. Analgesics
9. Hot Fomentation
10. Dark Goggles
11. Rest, good diet, fresh air
![Page 43: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/43.jpg)
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
![Page 44: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/44.jpg)
Marginal Catarrhal UlcerNear limbus
Old pupil
Hypersnsitivity to staphylococcal toxins
![Page 45: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/45.jpg)
HYPOPION ULCER
![Page 46: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/46.jpg)
Pneumococcus – Ulcus Serpens
Pseudomonas, Staphylococcus, Gonococci,
Streptococcus, Moraxella
C/c Dacrocystitis
Sterile , mobile, rapidly absorbed
![Page 47: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/47.jpg)
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
![Page 48: Bacterial corneal ulcer](https://reader036.fdocuments.us/reader036/viewer/2022062400/586e12b31a28ab8a588b5ba1/html5/thumbnails/48.jpg)
THANK-YOU