Keratitis 09
Keratitis 09
Keratitis 09
Cornea.
The cornea is the
eye’s optical window
that makes it possible
for humans to see.
The cornea tissue
consist of five layers.
1. The surfase of the
cornea is formed by
stratified
nonkeratinized
squamous
epithelium.
The cornea tissue consist of five layers.
2. A thin basement
membrane anchors the
basal cells of the
stratified squamous
epithelium to
Bowman’s layer.
3. The stroma is a highly
bradytrophic tissue
The cornea tissue consist of five layers.
4. Descemet’s
membrane is a
relatively strong
membrane
5. The corneal
endothelium is
responsible for the
transparency of the
cornea. The corneal
endothelium does not
regenerate.
Infectious Keratitis (purulent ulcer of the
cornea)
Protective Mechanisms of the Cornea
* Reflexive eye closing.
* Flushing effect of tear fluid (lysozyme).
* Its hydrophobic epithelium forms a diffusion barrier.
* Epithelium can regenerate quickly and completely.
Pathogens causing corneal infections may
include:
Viruses.
Bacteria.
Acanthamoeba.
Fungi.
Pathogenesis:
Once these pathogens have invaded the
bradytrophic tissue through a superficial
corneal lesion, a typical chain of events will
ensue:
Corneal lesion.
Pathogens invade and colonize the corneal
stroma (red eye).
Antibodies will infiltrate the site.
As a result, the cornea will opacity and the
point of entry will open further, revealing the
cornea infiltrate.
Pathogenesis:
Irritation of the anterior
chamber with hypopyon
(typically pus will accumulate
on the floor of the anterior
chamber).
The pathogens will infest the
entire cornea.
As a result the stroma will
melt down to Descemet's
membrane, which is
relatively strong This is
known as a descemetocele;
only Descemet’s membrane
is still intact.
Pathogenesis:
As the disorder
progresses, perforation of
Descemet’s membrane
occurs and the aqueous
humor will be seen to
leak. This is referred to as
a perforated corneal
ulcer and is an indication
for immediate surgical
intervention (emergency
keratoplasty).
Pathogenesis:
Prolapse of the iris (the iris
will prolapse into the newly
created defect) closing the
corneal perforation posteriorly.
This rapidly progressing form
of infectious corneal ulcer
(usually bacterial) is referred to
as a serpiginous corneal ulcer.
It penetrates the cornea
particularly rapidly
A serpiginous corneal ulcer is
one of the most dangerous
clinical syndromes as it can
rapidly lead to loss of the eye.
General Notes on Diagnosing
Infectious Forms of Keratitis
Symptoms:
Patients report a foreign body sensation,
moderate pain in the eye,
photophobia,
impaired vision,
tearing,
and purulent discharge
Treatment: Conservative therapy.
Treatment is initiated with topical antibiotics :
Eye drops: 0,25% Laevomycetin, 0,5%
Gentamycin, 1% Erythromycin, 0,5% Neomycin,
0,3% Ciprolet, 0,3% Ciromed, 0,3% Ocacin, 0,3%
Tobramycin, 0,3%Floxal
Ointments:0,3% Tobramycin, 0,3%Floxal
Mydriatics: 1% Atropin, 0,1%-0,25% Scopolamin,
0,5% Homotropin, 0,1% Platyphyllin, 0,1%
Adrenalin,0,5% Mydriacyl, 1% Tropicamide, 1%
Ciclomed, 2,5% Eryphrin
Treatment: