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Questions and Answers
What is one of the causes of inflammatory ulcer?
What is one of the causes of inflammatory ulcer?
What is the main symptom of an inflammatory ulcer due to exposure of the corneal nerve endings?
What is the main symptom of an inflammatory ulcer due to exposure of the corneal nerve endings?
What is the pathological process of an inflammatory ulcer?
What is the pathological process of an inflammatory ulcer?
What is a sign of an inflammatory ulcer?
What is a sign of an inflammatory ulcer?
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What is a complication of an inflammatory ulcer due to diffusion of bacterial toxins?
What is a complication of an inflammatory ulcer due to diffusion of bacterial toxins?
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What is the characteristic of a typical inflammatory ulcer?
What is the characteristic of a typical inflammatory ulcer?
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What is a complication of an inflammatory ulcer that may cause 2ry angle closure Glaucoma?
What is a complication of an inflammatory ulcer that may cause 2ry angle closure Glaucoma?
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What is the fate of the iris in a complication of an inflammatory ulcer?
What is the fate of the iris in a complication of an inflammatory ulcer?
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What is the characteristic of the ulcer floor in an inflammatory ulcer?
What is the characteristic of the ulcer floor in an inflammatory ulcer?
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What is a complication of an inflammatory ulcer that does not occur in children?
What is a complication of an inflammatory ulcer that does not occur in children?
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Study Notes
Corneal Ulcers
- Causes: Leucoma adherent, Corneal staphyloma, Dense corneal opacity with iris adherent to the back of the scar
- Characteristics:
- Irregular anterior chamber (AC)
- Irregular pupil
- Lost AC
- Weak ectatic corneal scar with iris adherent to the back of the cornea
Treatment
- Indications for treatment:
- Large (> 1.5 mm), central ulcer
- Severe infection (hypopyon, endophthalmitis)
- Poor compliance
- Failure to improve
- Treatment options:
- Broad-spectrum antibiotics (e.g., fluoroquinolone, vancomycin, ceftazidime)
- Cyclopentolate E.D, Atropine E.D to relieve ciliary body spasm (cyclitis)
- Tear substitutes (drops & gel) with preservative-free drops
- Oral vitamin A
- Aqueous suppressants (e.g., timolol E.D)
- PTK, keratoplasty
- Intravitreal antibiotics +/- vitrectomy
Corneal Perforation
- Treatment options:
- Cyanoacrylate glue
- Principle: Bridging corneal tissue gap to allow re-epithelialization and bacteriostatic effect
- Indications: Corneal perforation (< 2 mm), corneal thinning (< 3 mm), central, concave, non-infected, progressive
- Fate: Spontaneous dislodgement after re-epithelialization or removed gently after 6-8 weeks
- Fibrin glue:
- Advantages: Solidify quickly, easy to apply, less discomfort
- Disadvantages: Degrade faster, no bacteriostatic effect, risk of prion/viral diseases
- Amniotic membrane transplantation:
- Advantages: Not invaded by blood vessels, ↓ scar tissue proliferation, no immune reaction, stimulate re-epithelialization, anti-inflammatory effects
- Conjunctival flap:
- Advantages: Brings superficial blood vessels to promote healing, control pain, eliminate frequent medications
- Contraindications: Active suppurative keratitis, eyes with frank perforation
- Tectonic keratoplasty:
- Indications: Large (> 3 mm) corneal perforation
- Timing: Delay keratoplasty for 3-5 days to allow sealing of perforation and restoration of AC
- Cyanoacrylate glue
Influenza
- Risk factors: Vit A deficiency, immunocompromised individuals
- Pathology:
- Entry and adherence of organism to breached epithelium
- Multiplication and release of toxins and enzymes
- Epithelium casts off, giving an ulcer with irregular edge and necrotic floor
- Posterior abscess may form, causing descematocele or corneal perforation
- Diffusion of toxins causing iridocyclitis
Symptoms
- Lacrimation due to corneal edema and iridocyclitis
- Photophobia
- Blepharospasm
- Severe neuralgic pain due to exposure of corneal nerve endings
Signs
- Edema
- Loss of luster
- Ulcer with necrotic tissue
- +ve fluorescein stain
- Ciliary injection
- Hypopyon
Complications
- Diffusion of bacterial toxins
- Anterior chamber activity (cells and flare)
- +/- Hypopyon
- Bulging of Descemet's membrane (descematocele)
- Iris adheres to the back of the cornea, causing 2ry angle closure glaucoma
- Iris prolapses through sudden large corneal perforation
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Description
This quiz assesses knowledge of corneal ulcers, their symptoms, and treatment options. It covers conditions such as Leucoma adherent and Corneal staphyloma, and medication indications.
