cornea class 3
TRANSCRIPT
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Fungal corneal ulcer
History : Injury with
vegetable matter Aspergillus, Fusarium, Candida
Symptoms
•Pain
•Redness
•Tearing
•Photophobia
•Defective vision
•Blepherospasm
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signsSigns out of proportion
to symptomsDry, raisedFeathery marginsImmune ringSatellite lesionsEndothelial plaque
HypopyonFixedConvexNon sterile
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Management
Diagnosis Treatment
History
Microbiological investigationsKOH, Calcofluor
white, Giemsa
Sabouraud’s dextrose agar
Specific treatment Topical
NatamycinAmphotericin B
SystemicKetoconazole
NO CORTICOSTEROID
Therapeutic Keratoplasty
Non specific treatment
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Acanthamoeba Keratitis
Free living amoeboid protozoanTrophozoites and cystsUbiquitous in natureFound in air, soil & all water sources.
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Acanthamoeba Keratitis• Symptoms out of proportion to signs
• More in contact lens wearers , swimming pool, soil contamination
• Epithelium initially intact• Stromal infiltrate, dendrite like infiltrate.• Ring infiltrate• Radial keratoneuritis• Limbitis
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Management • Calcofluor white – cysts
• Culture – • non nutrient agar enriched with E
coli
• Specific• Propamidine isothionate
0.1 % ( Brolene )
• Polyhexamethylene biguanide (PHMB)
• Neomycin• Fluconazole, Micanazole• NO CORTICOSTEROIDS
• Therapeutic Keratoplasty• Non specific treatment
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Herpetic KeratitisHerpes Simplex – 1 : above the waist Primary HSV - 6 months to 5years - and self limiting
Acute follicular keratoconjunctivitis
Blepharitis
Corneal lesions
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Herpetic Keratitis
Corneal lesions Epithelial lesions Dendritic ulcer Amoeboid ulcer geographic ulcer
Stromal(necrotising and non necrotising)
Endothelial
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Dendritic ulcerSuperficial punctate erosions
Infiltrates spread in all direction- coalesce
Large shallow ulcers with crenated edges.
Increase in length ,send out lateral branches and are knobbed at the ends
Giving rise to dendritic form configuration
Linear branching Ulcer stains with Fluorescein
Reduced corneal sensation
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Rose bengal stain
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Management Investigations TreatmentImmunoflurescence and
culture of epithelial scrapings.
Antivirals
Acyclovir 3% 5 times/ day
Triflurothymidine IDU 0.1% drops
Antibiotic eye drops
DebridementCycloplegics
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Stromal keratitis Disciform keratitis
Necrotising ulcerative keratitis Interstitial keratitis
SclerokeratitisEndotheleitisIndolent & trophic ulcerationUveitis
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Reactivated infection of the endothelium and
keratocytes
Past history of dendritic ulcer
Disc shaped corneal dedep lesionOedema
Immune ring KPS
Anterior uveitisIOP may be high
Old lesions – faint opacities
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Treatment of disciform keratitisTopical Antivirals e.g acyclovir
Steroids under the cover of anti viral drops.
Tapered over weeks eg. 4x to 6x a day over 2weeks and then to taper.
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Herpes ZosterChicken pox- Varicella Zoster virusVirus dormant in Gasserian
ganglion
Immunity depressed
Infection activates and virus travels down the branches of ophthalmic division of trigeminal nerve(supra orbital aupre and infra trochlear)
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Herpes zoster ophthalmicusOphthalmic division of the trigeminal nerveAcute phase
Prodromal phase- Influenza like illness Neuralgia
Ocular lesions – vesicles over the lids eyelids ,conjunctivitis, episcleritis,
scleritis, keratitis,anterior uveitis,retinal vasculitis,optic neuritis, cranial nerve palsy.
Hutchinson's sign –involvement of the tip of the nose is associated with ocular involvement.
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Rash Maculapapular rash
VesiclesPustules
CrustOedema
Along distr. Of nerveDoes not cross midline
Ocular Complications
IridocyclitisKeratitis
Sec. Glaucoma
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Treatment Oral Acyclovir 800mg 5 times/day for 10 days Topical acyclovir
ointmentTopical antibioticsIn case of iridocyclitis
add topical steroids and cycloplegics