Bacterial keratitis Predisposing factors - Contact lens wear - Chronic ocular surface disease - Corneal hypoaesthesia C/P - Expanding

oval, yellow-white, dense stromal infiltrate - Stromal suppuration and hypopyon

Fungal keratitis Frequently preceded by ocular trauma with organic matter

INFECTIVE CORNEAL ULCERS Acanthamoeba keratitis - Contact lens wearers at particular risk - Symptoms worse than signs - Small, patchy anterior stromal infiltrates - Perineural infiltrates (radial keratoneuritis) - Ulceration, ring abscess & small, satellite lesions - Stromal opacification

Herpes simplex keratitis

Herpes zoster keratitis

- Greyish-white ulcer which may be surrounded by feathery infiltrates - Slow progression - occasionally hypopyon

- Dendritic ulcer with terminal bulbs May enlarge to become geographic Epithelial : 1 - dendritic Criteria of dendritic ulcer : - Dendritiform shape - Recurrences - Hyposthesis - No vascularization 2 - geographic Stromal : 1 - interstitial 2- disciform 3- Metaherpetic - Aciclovir 3% ointment x 5 daily - Trifluorothymidine 1% drops 2-hourly

Varicella Zoster virus Dermatitis Keratitis Iridocyclitis Retinitis Optic neuritis

Rx

- topical ciprofloxacin 0.3% or ofloxacin 0.3%

- Topical antifungal agents - Penetrating keratoplasty if unresponsive Yeast fungi : candida Filamentous : fusarium , aspergillus Criteria : - trauma by organic matter/ CL - ulcer with feathery edges and satellite lesions - deep stromal infiltrations - A ch reaction - hypopyon steroids contraindicated!! antifungal topical ( diflucan ) systemic ( sporanox ) surgery : hot PKP

- chlorhexidine or polyhexamethylenebigua nide

- early systemic Acyclovir - +/- systemic steroids

ulcers!!

**HYPOPYON ULCER! Acute serpiginous ulcer , ulcus serpens Criteria : - central ulcer with undermined edge - central posterior abscess - hypopyon

Rx of ulcers

Emergency , close follow up Culture & sensitivity Frequent topical antibiotic drops Subconjunctival antibiotics Fortified antibiotic drops Systemic antibiotics

NON-INFECTIVE CORNEAL ULCER MOORENS ULCERS Limited form - usually unilateral, affects elderly Progressive form - bilateral, affects younger patients C/P 1. Peripheral ulcerative keratitis 2. Circumferential and central spread 3. End-stage scarring and vascularization EXPOSURE ULCERS Due to loss of protection of lids in lagophthalmos : Bells palsy, LL ectropion, proptosis NEUROPARALYTIC KERATITIS

SUPERFICIAL NON-SUPPURATIVE ULCERS SUPERFICIAL PUNCTATE KERATITIS Viral : Adenovirus,Herpes Vernal catarrh Superior limbic kc Photophthalmia : UVR Stain : rose bengal Lacrimation, redness, photophobia signs: Scarring +/- vascularization Post traumatic Post vernal catarrh Post trachomatous Post infections RECURRENT EPITHELIAL EROSION Recurrent attacks of eye irritation or severe pain and lacrimation and photophobia on awakening in the morning Epithelia corneal defect with heaped irregular loose epithelium due to weak BM adhesion

corneal ulceration in lower cornea

little

Rx

systemic steroids and/or cytotoxic drugs

- freq. tears substitute, - therapeutic CL - lid tapping at night - tarsorrhaphy - causal treatment

CORNEAL DEGENERATIONS ARCUS SENILIS BAND SHAPED KERATOPATHY bilateral, annular, peripheral lipoid calcium deposition infiltration of corneal stroma - 2ry to chronix eye disease (eg: absoulute glaucoma, chr old age! uveitis) * young age = ARCUS JUVENILIS (hypercholesterolemia)

CORNEAL ECTASIA KERATOCONUS nd - in 2 decades + females conical ectasia of central cornea + thinning + scarring

CORNEAL EDEMA impairment of epitheliul & endothelial pumping fx corneal swelling Causes: 1. IOP ( acute angle closure glaucoma/ congenital glaucoma) 2. Endothelial damage - trauma (birth trauma/ during cataract surgery) - post-inflammatory endothelial dysfx ( uveitis, keratitis, graft rejection) 3. Epithelial damage - mechanical/chemical/radiation stromal edema VA epithelial edema significant VA impairment + painful surface breakdown

C/P

Vogt Lucid interval Asymptomatic

band-shaped horizontal opacity in middle 1/3 of cornea

painless + progress VA + Irregular MYOPIC astigmatism - scissoring red reflex - Munsons sign - break in endothelium & Descemet membrane acute corneal hydrops + pain + rapid VA - Fleischers ring (iron deposits) Inv : topography + pachymetry - Glasses (early cases) - Rigid CL - Corneal cross linkage - NaCl acute hydrops - Keratoplasty ( when CL no longer correct Irregular astigmatism/ central cornea is scarred or edematous)

Rx

NO Rx

sodium versenate

- treat inflammation + IOP - hypertonic agents (NaCl, Colloid osmotic solution) - Therapeutic soft CL - Keratoplasty