Corneal ulcer: Difference between revisions

Revision as of 08:33, 12 April 2019

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

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, Consenual photophobia)

Management

Emergent ophtho consultation
Topical antibiotics
- Vigamox 1 drop qhour OR
- Ciprofloxacin 1 drop qhour
Consider antiviral or anti-fungal if high suspicion for viral or fungal cause (rare)
Cycloplegic may help if iritis present
- Cyclopentolate 1%
Do not patch the eye

Disposition

Discharge with ophtho followup within 24-48 hours

Complications

Corneal scarring
Corneal perforation
Anterior/posterior synechiae
Glaucoma
Cataracts

References

Authors:

@@ Line 1: / Line 1: @@
-==Diagnosis==
+==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==
+*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, Consenual photophobia)
+==Management==
+*Emergent ophtho consultation
+*Topical antibiotics
+**Vigamox 1 drop qhour '''OR'''
+**[[Ciprofloxacin]] 1 drop qhour
+*Consider antiviral or anti-fungal if high suspicion for viral or fungal cause (rare)
+*Cycloplegic may help if iritis present
+**[[Cyclopentolate]] 1%
+*Do not patch the eye
+==Disposition==
+*Discharge with ophtho followup within 24-48 hours
+==Complications==
+*Corneal scarring
+*Corneal perforation
+*Anterior/posterior synechiae
+*Glaucoma
+*Cataracts
+==References==
+<references/>
+[[Category:Ophthalmology]]