Corneal ulcer: Difference between revisions

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==Background==
==Background==
[[File:Corneal ulcer.jpg|thumb|Corneal ulcer without infection]]
*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 lenses use (especially sleeping in contacts)
===Causes===
*[[Bacteria]]
**[[Pseudomonas]]
**[[Strep pneumo]]
**[[Staph]]
**[[Moraxella]]
*[[Viruses]]
**[[Herpes simplex]]
**[[Varicella zoster]]
*[[Fungi]]
**[[Candida]]
**[[Aspergillus]]
**[[Penicillium]]
**[[Cephalosporium]]


==Clinical Features==
==Clinical Features==
*Redness and swelling of lids and conjunctivae
*Redness and swelling of lids and conjunctiva
*Ocular pain or foreign body sensation
*Ocular pain or foreign body sensation
*Decreased visual acuity (if located in central visual axis or uveal tract is inflamed)
*Decreased visual acuity (if located in central visual axis or uveal tract is inflamed)
*Photophobia


==Diagnosis==
==Differential Diagnosis==
#Slit-Lamp Exam
{{Unilateral red eye DDX}}
##Gray/white lesion
##Hypopyon may be present
##Iritis signs may be present:
###Miotic pupil
###Consenual photophobia


==DDX==
==Evaluation==
#Bacteria
*Gray/white corneal lesion (will have fluorescein uptake)
##Pseudomonas
*Requires careful physical exam as 40% of lesions < 5mm
##Strep pneumo
*Hypopyon may be present
##Staph
*Iritis signs may be present (miotic pupil, Consenual photophobia)
##Moraxella
#Viruses
##Herpes simplex
##Varicella zoster
#Fungi
##Candida
##Aspergillus
##Penicillium
##Cephalosporium


==Treatment==
==Management==
#Emergent ophtho consultation
*Emergent ophtho consultation
#Topical abx
*Topical antibiotics
##Ciprofloxacin or ofloxacin otic, 1 drop qhr in affected eye
**Vigamox 1 drop qhour '''OR'''
##Antiviral or anti-fungal if high suspicion for viral or fungal cause
**[[Ciprofloxacin]] 1 drop qhour
#Cycloplegic
*Consider antiviral or anti-fungal if high suspicion for viral or fungal cause (rare)
##Helps w/ pain from accompanying iritis
*Cycloplegic may help if iritis present
##Cyclopentolate 1%
**[[Cyclopentolate]] 1%
#Do not patch the eye
*Do not patch the eye


==Disposition==
==Disposition==
Refer to ophtho within 12-24hr
*Discharge with ophtho followup within 24-48 hours


==Complications==
==Complications==
#Corneal scarring
*Corneal scarring
#Corneal perforation
*Corneal perforation
#Ant/posterior synechiae
*Anterior/posterior synechiae
#Glaucoma
*Glaucoma
#Cataracts
*Cataracts


==Source==
==References==
Tintinalli
<references/>


[[Category:Ophtho]]
[[Category:Ophthalmology]]

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

^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
  • Consider antiviral or anti-fungal 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

Complications

  • Corneal scarring
  • Corneal perforation
  • Anterior/posterior synechiae
  • Glaucoma
  • Cataracts

References