Corneal ulcer: Difference between revisions
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*Major cause of impaired vision and blindness worldwide | *Major cause of impaired vision and blindness worldwide | ||
*Break in epithelial layer allows infectious agents to gain access to the underlying stroma | *Break in epithelial layer allows infectious agents to gain access to the underlying stroma | ||
*Risk factors include: incomplete lid closure (e.g. secondary to Bell’s palsy) and soft contact | *Risk factors include: incomplete lid closure (e.g. secondary to [[Bell’s palsy]]) and soft [[contact lens]] use (especially sleeping in contacts) | ||
===Causes=== | ===Causes=== | ||
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*[[Viruses]] | *[[Viruses]] | ||
**[[Herpes simplex]] | **[[Herpes simplex]] | ||
**[[Varicella zoster]] | **[[Varicella-zoster]] | ||
*[[Fungi]] | *[[Fungi]] | ||
**[[Candida]] | **[[Candida]] | ||
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==Clinical Features== | ==Clinical Features== | ||
*Redness and swelling of lids and conjunctiva | *[[red eye|Redness]] and swelling of lids and conjunctiva | ||
*Ocular pain or foreign body sensation | *[[eye pain|Ocular pain]] or foreign body sensation | ||
*Decreased visual acuity (if located in central visual axis or uveal tract is inflamed) | *[[vision loss|Decreased visual acuity]] (if located in central visual axis or uveal tract is inflamed) | ||
*Photophobia | *Photophobia | ||
*Gray/white corneal lesion (will have fluorescein uptake) | |||
*Requires careful physical exam as 40% of lesions < 5mm | |||
*[[Hypopyon]] may be present | |||
*[[Iritis]] signs may be present (miotic pupil, consensual photophobia) | |||
===Complications=== | |||
*Corneal scarring | |||
*Corneal perforation | |||
*Anterior/posterior synechiae | |||
*[[Glaucoma]] | |||
*Cataracts | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
* | *Clinical | ||
==Management== | ==Management== | ||
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**Vigamox 1 drop qhour '''OR''' | **Vigamox 1 drop qhour '''OR''' | ||
**[[Ciprofloxacin]] 1 drop qhour | **[[Ciprofloxacin]] 1 drop qhour | ||
*Consider antiviral or | *Consider [[antiviral]] or [[antifungal]] if high suspicion for viral or fungal cause (rare) | ||
*Cycloplegic may help if iritis present | *[[Cycloplegic]] may help if iritis present | ||
**[[Cyclopentolate]] 1% | **[[Cyclopentolate]] 1% | ||
*Do not patch the eye | *Do not patch the eye | ||
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*Discharge with ophtho followup within 24-48 hours | *Discharge with ophtho followup within 24-48 hours | ||
==References== | ==References== | ||
Revision as of 16:33, 5 October 2019
Background
- Major cause of impaired vision and blindness worldwide
- Break in epithelial layer allows infectious agents to gain access to the underlying stroma
- Risk factors include: incomplete lid closure (e.g. secondary to Bell’s palsy) and soft contact lens use (especially sleeping in contacts)
Causes
Clinical Features
- Redness and swelling of lids and conjunctiva
- Ocular pain or foreign body sensation
- Decreased visual acuity (if located in central visual axis or uveal tract is inflamed)
- Photophobia
- Gray/white corneal lesion (will have fluorescein uptake)
- Requires careful physical exam as 40% of lesions < 5mm
- Hypopyon may be present
- Iritis signs may be present (miotic pupil, consensual photophobia)
Complications
- Corneal scarring
- Corneal perforation
- Anterior/posterior synechiae
- Glaucoma
- Cataracts
Differential Diagnosis
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Evaluation
- Clinical
Management
- Emergent ophtho consultation
- Topical antibiotics
- Vigamox 1 drop qhour OR
- Ciprofloxacin 1 drop qhour
- Consider antiviral or antifungal if high suspicion for viral or fungal cause (rare)
- Cycloplegic may help if iritis present
- Do not patch the eye
Disposition
- Discharge with ophtho followup within 24-48 hours