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HYPOPYON ULCER

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by

mohamed sharaf

on 24 March 2013

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Transcript of HYPOPYON ULCER

clinical picture : Treatment : ttt of Complications 2-Surgical TTT: Signs : Fluorescin test : Symptoms : definition : Causative organisms : Predisposing factors : It is a disc shaped ulcer associated with :
-severe iridocyclitis .
-hupopyon formation . 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 . Typical hypopyon ulcer (80%) :
by pneumococci .
Atypical hypopyon ulcer (20%) :
-bacteria Morax-Axenfeld diplobacilli
- fungi Aspergillus . 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 . 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 . 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 A) Cauterization :
-carbolic acid for pneumococci .
-zinc sulphate 20% for morax .


B)paracentesis :
if IOP is high . Route of infection : Common with Dacryocystitis .
(abrasions + Pneumococci + Dacryocystitis Hypopyon ulcer ) . 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 . complications Severe iridocyclitis

2ry glaucoma .

Perforation is commom as :
-the ulcer tends to creep deeply & centrally.
-post. Abscess formation .

Corneal opacities
usually dense ( leucoma ) N.B. : 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 . 1-Usual treatment
A-Local treatmet .
B-General treatment . C-Causal treatment .
2-Surgical treatment
3-TTT of complication local ttt : Causal TTT: General TTT 1-Usual ttt 1-Topical antibiotics 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 2-mydriatic: 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 . 3-bandage 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 4-Hot fomentation 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 . Treatment of dacrocystitis 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 THANK
YOU HYPOPUON ULCER group : 421-430 under supervision of :
dr/ Ahmed Lotfy
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