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 | *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== | ||
{{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== | ==Disposition== | ||
*Discharge with ophtho followup within 24-48 hours | |||
==Complications== | ==Complications== | ||
*Corneal scarring | |||
*Corneal perforation | |||
*Anterior/posterior synechiae | |||
*Glaucoma | |||
*Cataracts | |||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Ophthalmology]] |
Revision as of 08:33, 12 April 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 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
- 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
- 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
- Do not patch the eye
Disposition
- Discharge with ophtho followup within 24-48 hours
Complications
- Corneal scarring
- Corneal perforation
- Anterior/posterior synechiae
- Glaucoma
- Cataracts