Download Bacterial keratitis

Bacterial keratitis :
1 - contact lens used : specially extended
wear soft lenses, commonly organism
pseudomonas aeroginosa
2 - pre existing corneal disease: trauma ,
bullous keratopathy , exposure and diminished
corneal syndrome .
3 - chronic blepharo conjunctivitis , chronic
dacryocystitis, topical steroid therapy .
Presentation:
f.b.sensetion ,photophobia ,blurring of vision
,pain ,eye lid edema and discharge .
Singes:
Conjunctival injection ( red eye ), epithelial
defect ( ulcer) , stromal infiltrate , progressive
ulceration may lead to corneal perforation .
Treatment :
Broad spectrum AB.
1 - Dual therapy: combination of 2 fortified
ABS. , to cover gr +ve & gr _ ve inform of
amino glycosides & cephalosporin .
2 - monothrapy : flourqunolones like
ciprofloxacin or afloxacin .
2 - oral ciprofloxacin : 750 mg t.d may
indicated in juxtalimbal ulcer .
3 – Atropine: to prevent formation of
posterior synichia
4 – Steroid therapy: reduced necrosis & scar
formation
Disadvantage: increase risk of perforation and
exacerbate infection
Viral infection :
Herpes simplex keratitis (h.s.v.):
_ h.s.v. infect only human being , infection
common in up to 90 % of population .
_ most infecton are subclinical .
_ Primary ocular infection .
_ typically occur in children between age of 6
months & 5 years.
Singes:
Generalized symptoms of viral illness, skin
vesicles , typically involved lids & per orbital
aria, acute unilateral follicular conjunctivitis
Periocular LAP.
_ treatment: aimed to prevent keratitis with
acyclovir eye ointment 5 times a day for 5
wks.
EP. Keratitis :
Presentation : at any age with mild discomfort
………….. Blurring of vision
Sings:
In chronological order
_ Opaque ep. cells.
_central degeneration usual in dendrite ulcer ,
end of branches show swollen appearance ,
bed of ulcer stain with fluorescien & viral
loader cells with margin stain with rose
Bengal .
_ reduced corneal sensation.
_anterior stromal infiltatate appear under
ulcer
_progressive centrifugal enlargement may
lead to larger ep. Defect (geographical ulcer)
commonly induced by steroid