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definition :

It is a disc shaped ulcer associated with :

-severe iridocyclitis .

-hupopyon formation .

Predisposing factors :

A)General : (due to decreased body resistanace)

1-Old age .

2-Diabetes .

3-AIDS .

4-Malnutrition . (vit A deficiency)

5-Immunosupressive drugs .

B)LOCAL:

1-Epithelial abrasions (by trauma, foreign body, contact lens,….).

2-lagophthalmos .

3-xerosis .

4-loss of corneal sensation .

Pathology :

As in corneal ulcer but :the ulcer has advancing and healing edges .

Healing edge :

  • Toward the limbus.
  • Sloping.
  • Epithelialized & vascularized.
  • Little filtration .

Advancing edge :

  • Towards the center .
  • Undermined .
  • No epithelialization .
  • No vascularization .
  • Dense infiltration .

clinical picture :

1-pain due to :

-irritation of n. endings by toxins & lid movement. -the accompanying iritis .

2-photophopia :

reflex lid closure in exposure to light .

3-lacrimation :

reflex stimulation of lacrimal gland .

4-blepharospasm :

reflex lid closure due to stimulation of n. endings .

5- diminution of vision :

due to necrosis & infiltration

and the accompanying iritis .

6- coloured haloes around light :

due to diffaction of light by corneal edema

  • Lid :

- edema due to anastmosis between ciliary

& lid vessels .

  • Conjunctiva :

-ciliary injection .

  • Cornea :

-loss of luster

-grey area of necrosis & infiltration .

- +ve fluorescin test .(green colour).

  • Signs of complications :

-A.Ch shows signs of accompanying iritis .

  • Ulcer :

- central , disc shaped and serpaginous ulcer (creeps deeply over the cornea )

.Ant. Chamber :

-hypopyon .

  • Descematocele is rare (due to post abscess formation ) .

  • Fistula is also rare (due to failure of epithelialization of the advancing edge ) .

  • Post abscess :

it is a cellular infoltration & necrosis occurs opposite the ulcer just ant to descemets membrane which may ulcerate posteriorly .

Hypopyon is :

it is a sterile pus

-site : at bottom of A.C .

-origin : from the inflamed ulcer .

-colour : yellowish .

-compostion : fibrin + iris pigment + PMNLs .

Treatment :

1-Usual treatment

A-Local treatmet .

B-General treatment . C-Causal treatment .

2-Surgical treatment

3-TTT of complication

Atrobine sulphate-Cyclopentolate 1%

Action:

paralysis of CPM and ciliary ms Leading to;

1-dilate thepupil so prevent ant.synechia.

2-decrease pain by relieving CPM andCiliar ms spasm .

3-it is vasodilator so increase antibodiesInside eye .

Frequency:

3 times daily .

  • Very essential to prevent lid movment

So Promotion of healing and epithlization

And Deacrease pain &photophobia .

  • Contraindicated in Conjunctivitis if discharge present so use dark glasses &

Bandage soft CL

2-Surgical TTT:

A) Cauterization :

-carbolic acid for pneumococci .

-zinc sulphate 20% for morax .

B)paracentesis :

if IOP is high .

Paracentesis:

If IOP increase by puncture of Ant.chamberAnd evacuation of its contents VIA limbusSO decrease IOP & wash out the toxins &New aqueous (rich in antibodies) fill The anterior chamber

ttt of Complications

1-severe 2ry iritis:

usual ttt &NSAID .

2-2ry giaucoma:

CAI & BB & Paracentesis .

3-corneal opacity:

-visual iridectomy (if vision improved after mydriatic) &

-Keratoplasty&

-coloured CL or tattooing(in Non seeing eye) .

4-PERFORATION (more common) :

-If small : (T-lens) or tissue adhesive glue

-If large : Amniotic membrane may be used to seal perforation & conj.flap & Therapeutic keratoplasty

THANK

YOU

N.B. :

Symptoms :

complications

  • Severe iridocyclitis

  • 2ry glaucoma .

  • Perforation is commom as :

-the ulcer tends to creep deeply & centrally.

-post. Abscess formation .

  • Corneal opacities

usually dense ( leucoma )

Fluorescin test :

  • Instill a drop of local anaesthesia .
  • Instill a drop of fluorescin in the conjunctiva (2%Fl Na in 2% NaHCO3).
  • Wait for a minute then wash with saline & examine .
  • Green staining is seen at the site of ulcer .

Signs :

Causative organisms :

1-Usual ttt

Typical hypopyon ulcer (80%) :

by pneumococci .

Atypical hypopyon ulcer (20%) :

-bacteria Morax-Axenfeld diplobacilli

- fungi Aspergillus .

local ttt :

1-Topical antibiotics

Causal TTT:

2-mydriatic:

Broad spectrum antibiotic

1-Eye drops:

every 5min/1h then 1h/24 Then according to response

2-Eye ointment:

only at night to prolong

Antibiotic action at night

3-Sub.conj.inj :

penicillin G

General TTT

Treatment of dacrocystitis

4-Hot fomentation

3-bandage

1- vasodilatation :

-to improve circulation ;Bring leucocytes&antibodies and washThe toxins

2- decrease pain by counter irritation

1-Systemic antibiotic : acc.to culture & Sensitivity tests .

2-vitamins :

- A (epithelium) .

– C (stroma) .

3-Bed rest .

4-Avoid straining .

Route of infection :

Common with Dacryocystitis .

(abrasions + Pneumococci + Dacryocystitis Hypopyon ulcer ) .

group : 421-430

HYPOPUON ULCER

under supervision of :

dr/ Ahmed Lotfy

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