Corneal Ulcer

Bacterial Keratitis
 Natural defenses
 Eyelids
 Epithelial barrier
 Tears
 Risk factors
 Lid abnormalities; Dry eye; Steroids ;
 prior herpetic infection; Contact lens user;
 LASIK; Immune compromise
 Trauma
 lagophthalmos; neurotrophic keratitis
 Pathophysiology
 Interruption of an intact corneal
epithelium -> entrance of
microorganisms into the corneal
stroma -> proliferate and cause
ulceration -> inflammation, necrosis
-> corneal perforation/ scar tissue
 Pathophysiology
 Organisms –
 staphylococcus
 streptococcus,

 pseudomonas,

 Enterobacteriaceae (including Klebsiella,

Enterobacter, Serratia, and Proteus)
 Moraxella

.
 Clinical Features
 Rapid onset of pain, photophobia
 Decreased vision.
 Lid erythema, edema;
 Conjunctival congestion; chemosis; lacrimation;
 Mucopurulent discharge
 Ulceration of the epithelium;
 Corneal infiltrate
 Dense, suppurative stromal inflammation and
surrounding stromal edema
 Stromal tissue loss;
Small ulcer with active area towards the center.
The central cornea is hazy and shows Descemet's
 Clinical Features
 Anterior chamber – inflammation;
hypopyon
 Esp. with pseudomonas pyocyanea and
pneumococci -> called hypopyon ulcers
 Regressive stage -> vascularization
-> cicatrization -> opaque scar
 Diagnosis
 Clinical history & examination
 Slit lamp examination – size/depth/
location/ AC reaction
 Fluorescein stain
 Confirmation – corneal scraping for smear
and culture
 Scrapings including the edges -> plated in blood,
chocolate, and Sabouraud agar plates
 Stained smears with gram, Giemsa,KOH
 Treatment
 Initial therapy – broad spectrum topical
Antibiotics, (no organisms in slide smear)
 Fluoroquinolones include ciprofloxacin,
ofloxacin, moxifloxacin or gatifloxacin.
 Fortified Tobramycin 1 drop every hour
alternating with.
 Fortified Cefazolin 1 drop every hour.
 Fortified Vancomycin eye drops – reserved
drug
 Treatment
 The frequency of antibiotic administration
should be tapered off parameters:
 Decreased density of infiltrate
 Decreased anterior chamber inflammation
 Reepithelialization of the corneal epithelial
 Improvement in pain
Corneal Ulcer, Bacterial, Under Treatment No
longer hypopyon, thus indicating effective
 Treatment
 Cycloplegic agents – atropine,
Homatropine, Cyclopentolate
 Relieve ciliary spasm
 Prevent synechiae

 Oral pain medications

 Oral antibiotics – scleral expansion
 Repeated scraping
 Complications
 Descematocele
 Perforation – iris prolapse
 Pseudocornea
 Secondary glaucoma
 Anterior capsular cataract
 Spontaneous expulsion of lens and vitreous
 Endophthalmitis
Descemetcele, Old
nter the tissue has melted away and a Descemetocele has d
 Treatment of complicated
ulcers
 Perforated ulcers –
 Firmly applied bandage; Bandage contact lenses
 forced expiration avoided
 Tissue adhesives
 antiglaucomas
 Corneal transplant
 Secondary glaucoma – iv mannitol/
Acetazolamide; Topical antiglaucomas
 Late management – Corneal grafts;
Cosmetic CL; Tattoing
Perforated Corneal Ulcer, Keratoplasty