KERATITIS

H. IZAR AZIZ

Function of the cornea :

as Window of the globe & refractive media:

clear & transparent with power + 42 D.

as microorganisms barrier

Dr.H.Izar Aziz,SpM(

Loss of transparency caused

endothelial damage
epithelial damage.

Dr.H.Izar Aziz,SpM(

by :

Keratitis : is

inflammation of cornea ,caused by

microorganism infection
antigen antibodies / allergic reaction.

Dr.H.Izar Aziz,SpM(

Epithelium covered by tear film :as a barrier

microorganisms infection .
(except
N. Gonorrhoea)
Descemets membrane as barrier for bacterial
infection to COA .(but not for fungus)

Etiology of keratitis :
Exogenous : bacteria ,fungus , virus,
parasite
Endogenous : allergic reaction.

Dr.H.Izar Aziz,SpM(

 Bacteria :
-Pure Pathogen : Streptococcus pneumoniae,
Pseudomonas aeroginosa
-Opportunistic bacteria :
-Staphylococcus,Moraxella, Serratia(as flora
at conjunctiva
. Alcoholic/ B6 deficiency
.Topical steroid >>>
. Corneal abrasion

Pathogen bacteria

Corneal infection

Dr.H.Izar Aziz,SpM(

 Fungus (usually

opportunistic)

Candida, Fusarium, Aspergillus

Virus
VHS
VVZ

Parasite : Acanthamoeba
in Contact lens user

Dr.H.Izar Aziz,SpM(

Symptoms & Signs

Subjective (patients

pain
glare (photophobia)
blur vision
tearing (lacrimation)

Objective

history

loupe or slit lamp examination

blepharospasme
ciliary injection
tearing (lacrimation)
superficial infiltrate or corneal ulcer
hypopyon- in advanced cases.

Dr.H.Izar Aziz,SpM(

Dr.H.Izar Aziz,SpM(

 Special examinations :
Flourescein test for corneal ulcer
Seidel test for perforating cornea

Dr.H.Izar Aziz,SpM(

10

Laboratory Studies
Etiologic diagnosis.
Scraping from:
infiltrate / edge of the ulcer
fornices of conyunctiva
Slide Staining :
Gram ( for bacteria)
Giemsa (for fungus )

Dr.H.Izar Aziz,SpM(

11

Clinical course
Subepithelial /epithelial
keratitis
Recover
without scar
Recover
with scar
Nebula
Makula
Leukoma

Become
corneal ulcer

Perforating cornea,
accompanied bulging of the
cornea & iris prolaps
Recover with scar :
Leukoma adherent
staphyloma cornea

Advanced
inflamation
-endophtalmitis
-panophtalmitis
recover

Phtysis bulbi

Corneal blindness

Permanent blindness

Extirpation
of the globe

Abulbi

12

Clinical appearance of corneal ulcers

Serpeginous corneal ulcer.

Etiology : Pneumococcus
acute, well circumscribed
gray ulcer, tends to spread to center of cornea
hypopyon is common (sterile)

Dr.H.Izar Aziz,SpM(

13

Pseudomonas ulcer.

Etiology : Pseudomonas aerg. (present in Flourescein

sol.)
bluish-green exudate
very acute ,spread rapidly to all direction ,because
proteolytic enzyme destroy the corneal stroma

descemetocele

Dr.H.Izar Aziz,SpM(

14

 Marginal Ulcer

Etiology : Staphylococcus
affect limbal area

Fungal ulcer

history: agriculture trauma

topical steroid usage >>>>

gray Infiltrate
thick hypopyon & irregular surface
satellite lesions - in endothelium

Dr.H.Izar Aziz,SpM(

15

Herpes Simplex keratitis.

Etiology : VHS type I

corneal sensibility <<<
lesion : filament, punctate, dendritic, disciform

Dr.H.Izar Aziz,SpM(

16

 Moorens Ulcer
Etiology : antigen antibodies reaction
Progressive excavation of the limbus.

Dr.H.Izar Aziz,SpM(

17

 Keratomalacia
Etiology : Vitamin A deficiency
advance stage of xerosis conjunctiva & corne
No ciliary injection

Dr.H.Izar Aziz,SpM(

18

Treatment
atropine eye drops
Anti microorganisms depend on laboratory
finding (scraping & culture)
Antibiotic for bacteria
Anti fungus for fungal infection
Antiviral for viral infection

High dose Vit. A for keratomalacia

Steroid for Moorens ulcer
eye bandage

Dr.H.Izar Aziz,SpM(

19

 Prognosis depends on :

depth & width of the ulcer

Corneal scar

Dr.H.Izar Aziz,SpM(

20

Nebula
Makula
Leukoma
Leukoma adherent

Central ,-->corneal
blindness
-Periphery (No visual
disturbance )

Dr.H.Izar Aziz,SpM(

21

Prevention
Avoid corneal trauma
Avoid overuse of topical steroid
Cure external eye infection as soon
as possible.
Avoid trigger factor for relapsing
H.simplex keratitis.

Dr.H.Izar Aziz,SpM(

22

Have a nice
day !

Dr.H.Izar Aziz,SpM(

23

Reference Books
Vaughn D, Asbury T; General
Ophthalmology, 15th edition, Appleton &
Lange
Miller S; Parsons Diseases of the eye, 17
th Edition, Churcill Livingstone, 1984
Kanski JJ, Clinical Ophthalmology, 4th
edition,Oxford Butter Worth Heineman
Ltd, 1999
Dr.H.Izar Aziz,SpM(

24