Corneal ulcer: Difference between revisions

Revision as of 20:45, 30 September 2017

Background

Corneal ulcer without infection

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 lenses 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

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

^Emergent diagnoses ^^Critical diagnoses

Evaluation

Slit-lamp exam
- Gray/white lesion
- Requires careful physical exam as 40% of lesions < 5mm
- Hypopyon may be present
- Iritis signs may be present:
  - Miotic pupil
  - Consenual photophobia

Management

Emergent ophtho consultation
Topical antibiotics
- Ciprofloxacin or ofloxacin otic, 1 drop qhr in affected eye
- Antiviral or anti-fungal if high suspicion for viral or fungal cause
Cycloplegic
- Helps with pain from accompanying iritis
- Cyclopentolate 1%
Do not patch the eye

Disposition

Refer to ophtho within 12-24hr

Complications

Corneal scarring
Corneal perforation
Ant/posterior synechiae
Glaucoma
Cataracts

References

Authors:

@@ Line 1: / Line 1: @@
-==Corneal Ulcer==
+==Background==
-# Gray/white area
+[[File:Corneal ulcer.jpg|thumb|Corneal ulcer without infection]]
-# Worsening symptoms
+*Major cause of impaired vision and blindness worldwide
-# +/- discharge
+*Break in epithelial layer allows infectious agents to gain access to the underlying stroma
-# >1dy
+*Risk factors include:  incomplete lid closure (e.g. secondary to Bell’s palsy) and soft contact lenses use (especially sleeping in contacts)
-[[Category:Ophtho]]
+===Causes===
+*[[Bacteria]]
+**[[Pseudomonas]]
+**[[Strep pneumo]]
+**[[Staph]]
+**[[Moraxella]]
+*[[Viruses]]
+**[[Herpes simplex]]
+**[[Varicella zoster]]
+*[[Fungi]]
+**[[Candida]]
+**[[Aspergillus]]
+**[[Penicillium]]
+**[[Cephalosporium]]
+==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
+==Differential Diagnosis==
+{{Unilateral red eye DDX}}
+==Evaluation==
+*[[Slit-lamp exam]]
+**Gray/white lesion
+**Requires careful physical exam as 40% of lesions < 5mm
+**Hypopyon may be present
+**Iritis signs may be present:
+***Miotic pupil
+***Consenual photophobia
+==Management==
+*Emergent ophtho consultation
+*Topical antibiotics
+**[[Ciprofloxacin]] or ofloxacin otic, 1 drop qhr in affected eye
+**Antiviral or anti-fungal if high suspicion for viral or fungal cause
+*Cycloplegic
+**Helps with pain from accompanying iritis
+**[[Cyclopentolate]] 1%
+*Do not patch the eye
+==Disposition==
+Refer to ophtho within 12-24hr
+==Complications==
+*Corneal scarring
+*Corneal perforation
+*Ant/posterior synechiae
+*Glaucoma
+*Cataracts
+==References==
+<references/>
+[[Category:Ophthalmology]]