Keratitis
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This document discusses various types of microbial keratitis, including bacterial, fungal, and viral keratitis. It describes common pathogens that can cause bacterial keratitis and their characteristic clinical features. The management of bacterial keratitis involves identifying the causative organism, administering topical antibiotics, and addressing complications. Fungal keratitis requires reculturing, antifungal therapy, and sometimes keratoplasty. Viral keratitis from herpes simplex virus can cause dendritic ulcers. Corneal ectasias like keratoconus and keratoglobus are also briefly mentioned.
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1. The anatomy and histology of the conjunctiva where pterygium develops.
2. Risk factors for pterygium include ultraviolet light exposure, which may cause genetic mutations in limbal stem cells through oxidative stress and altered expression of growth factors.
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Sources
1. Kanski’s Clinical Ophthalmology
2. Ophthalmology- Yanoff & Duker
3. Parson’s Diseases of the Eye
4. Comprehensive Ophthalmology by A.K. Khurana
5. various sources on Google and eyewiki search
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Cornea
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Keratitis
- 1. DR. ALI RAZA Associate Professor Head of Department Ophthalmology Holy Family Hospital Rawalpindi
- 4. BACTERIAL KERATITIS COMMON PATHOGENS: Neisseria gonorrhoeae Corynebacterium diphtheriae Listeria sp. Haemophilus sp.
- 5. BACTERIAL KERATITIS OTHER PAHTOGENS: Produce keratitis only after loss of corneal epithelial integrity as in: Contact lens wear: Pseudomonas aeruginosa
- 6. BACTERIAL KERATITIS Ocular surface disease Chronic dacryocistitis Topical steroids Systemic immunosuppressive agents
- 7. BACTERIAL KERATITIS CLINICAL FEATURES: Certain bacteria produce characteristic corneal response. 1- Staph. aureus and Strep. pneumoniae: Oval, yellow-white, densely opaque stromal suppuration clear cornea
- 8. Large Corneal infiltration in bacterial keratitis
- 11. CLINICAL FEATURES: 2- Pseudomonas: Mucopurulent exudate, liquefactive necrosis ground-glass adjacent stroma
- 15. CLINICAL FEATURES: 3- Enterobacteriaeceae: Shallow ulceration Grey-white pleomorphic suppuration Stromal opalescence Corneal rings
- 16. BACTERIAL KERATITIS MANAGEMENT: Bacterial corneal ulcer is a sight- threatening condition demanding Identification of causative organism Eradication Hospitalization
- 17. MANAGEMENT: Therapy is divided into: Sterilization phase Healing phase
- 18. MANAGEMENT: 1- CHOICE OF ANTIBIOTICS: Standard combined therapy with aminoglycosides and cephalosporins. Monotherapy with fluoroquinolone
- 19. MANAGEMENT: 2- PREPARATION OF FORTIFIED ANTIBIOTICS: by combination with a compatible vehicle
- 20. MANAGEMENT: 3- INSTILLATION OF TOPICAL ANTIBIOTICS: hourly intervals for first five days 2 hourly if favourable response Gradually taper and discontinue
- 21. MANAGEMENT: 4- SYSTEMIC CIPROFLOXACIN: When ulcer is close to limbus 5- WHEN TO CHANGE ANTIBIOTICS: If resistant pathogen
- 22. MANAGEMENT: 6- CYCLOPLEGICS: to prevent Posterior synechiae Pain 7- STEROID THERAPY: Controversial
- 24. MANAGEMENT: 8- CAUSES OF FAILURE TO RESPOND: Wrong diagnosis by inappropriate cultures Wrong treatment by inappropriate antibiotics Drug toxicity preventing corneal healing
- 25. FUNGAL KERATITIS Keratomycosis CLINICAL FEATURES: 1- Filamentuous fungal keratitis Aspergillus sp. Fusarium sp. 2- Candida keratitis
- 26. Fungal keratitis with hypopyon
- 29. MANAGEMENT: Re-culture and corneal biopsy Antifungal therapy Therapeutic penetrating keratoplasty
- 30. OTHER TYPES OF KERATITIS Acanthamoeba keratitis Interstitial keratitis - luetic interstitial keratitis - cogan syndrome Infectious crystalline keratopathy
- 41. HERPES SIMPLEX KERATITIS PRIMARY OCULAR INFECTION Occurs in children b/w ages of 6 months and 5 yrs 1- Blepharoconjunctivitis 2- Keratitis
- 42. HERPES SIMPLEX KERATITIS DENDRITIC ULCER Signs in chronological order: - opaque cells in punctate or stellate pattern - linear branching ulcer stains with fluorescein - anterior stromal infiltrates - large epithelial defect (amoeboid configuration) - pseudodendrites in healing phase
- 43. DENDRITIC ULCER Antiviral Therapy - Acycloguanosine - Trifluorothymidine - Adenine arabinoside Debridement
- 46. OTHER VIRAL KERATITIS Stromal Necrotic Keratitis Disciform Keratitis
- 47. HERPES ZOSTER OPHTHALMICUS Rash on eye lids Conjunctivitis Episcleritis Scleritis Keratitis Anterior Uveitis
- 48. CORNEAL ECTASIAS 1- KERATOCONUS - conical cornea - central or paracentral stromal thinning - apical protrusion - irregular astigmatism - presents with impaired vision - oil droplet reflex - Munson sign
- 52. 2- KERATOGLOBUS - rare condition - oval keatoconus early on - later protrusion and thinning of entire cornea 3- PELLUCID MARGINAL DEGENERATION
- 54. Thanks