CORNEAL ULCER

Concept: Local necrosis of the corneal tissue due to an invasion by bacteria, fungi, viruses or acanthamoeba. Causes: Corneal ulcers are mainly caused by staphylococcus, pseudomonas, and streptococcus pneumonea. The invasion of the bacteria with frequency is caused by sleeping with the contacts lens, the inadequate sterilization, corneal trauma and foreign objects. It can also occur as a complication of queratitis by herpes, neurotrofic queratitis and gonorrea. It can also be the result of a disorder of the corneal nutrition secondary to a deficiency of vitamin A or proteic deficiency. Other causes are due to disorders of the eyelids for example the incomplete closure of the eyelid, bells paralysis and trauma of the eyelid. Signs and symptoms: Pain and the sensation of foreign object, photophobia, tears, however these can be minimum. The corneal ulcer starts with a dull and grey superficial opacity, and then it turns necrotic and discharges leaving an excavated ulcer. The epithelial alteration turns green, when dyed with fluorescein. Peri-corneal intense redness if very frequent and in prolong cases the blood vessels can go into the cornea through the limbo. The ulcer can cover the whole cornea and can go deeper in some occasion pus can be found in the anterior chamber. There could be ulceration without significant infiltration in the queratitis by herpes. The ulcers caused by fungi have a more chronic course than the ones caused by bacteria; they show a more dense infiltration sometimes small dispersed lesions on the borders of the cornea. The ulcers caused by acanthamoeba are extremely painful, they can also present transitory epithelial defects and multiple stromal infiltration.

MOOREN ULCER.
The mooren ulcer is a very rare disease probably caused by an autoimmune response to antigens of the corneal estroma. Classification: according to the clinical signs, the finding with fluorescein and the response to the treatment we can identify 3 types. 1. Unilateral ulcer affects mainly elderly women of white skin complexion.

a. Progressive ulcer, extremely painful and associated with the obliteration of the superficial juxtalimbic superficial vascular plexus. b. Treatment is very difficult since the response to systemic and topic immunotherapy is very scarce. 2. Bilateral aggressive ulcer affects mainly young people from Hindu origin it is less painful than the unilateral ulcer. a. Circumferential progressive ulcer. The angiography with fluorescein show new vascular proliferation that extends to the base of the ulcer. b. The initial treatment is with intravenous methylprednisolone followed by topic and systemic corticosteroids and cytotoxic agents. Topic cephalosporin may also have a roll. 3. The painless bilateral ulcer affects mid-age, malnourished, Hindu patients. a. Progressive peripheral groove with minimal inflammatory response that heals spontaneously. b. The treatment include the improvement of diet and treatment of the associated infection The common signs of all moorens ulcers in chronological order are: Peripheral corneal infiltration 2-3 from the eyes limbo Corneal ulceration in the shape of a half moon Circumferential and central dissemination The healing phase is characterized by thinning and vascularization and scaring. Cataract can form secondarily, but perforation is rare and the sclera is not affected.