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Etiology

Predisposing factors

General factors :decrease in body resistance

1-Old Age

2-Diabetes meleitus

3-AIDS

4-vitamen A deficiency

5-immunosupresive drugs

Local factors: lesion in cornea

1-corneal foreign body(most common cause)

2-Abrasion :loss of barrier function of cornea

3-loss of corneal sensitivity

4 - rupture of corneal bullae in bullous keratitis

5- occupational relation was found between ulcer and

a)agricultural workers

b)coal miners

c)rail-road workers

6-xerosis

Causitive Organisms

Many Organisms are identified but pneumococci is the most common

Typical hypopyon ulcer 80%

Caused by pneomococci (grame negative diplpcocci)

Atypical hypopyon ulcer 20%

Morax-axenfeld bacillus (10%)

Staph aurius, psedommonas,fungi ,streptococus haemolyticus 10%

  • Progressive infilteration.
  • Active ulceration.
  • Regression.
  • Cicatrization.

1-Severe stitching pain (eye socked pain) :

a-irritation of exposed nerves by toxins ,

lid movement

b-accompanying iritis

2-photophobia.

3-lacrimation: due to reflex stimulation of

trigeminal nerve.

4-Diminution of vision:

Due to vascularisatin ,infiltration of cornea

5-coloured haloes around light :

Due to corneal oedema

6-Blepharospasm.

7-Red eye.

An inverse hypopyon needs to be differentiated from a standard hypopyon.

a)Topical broad spectrum antibiotics. Initial therapy(before results of culture and sensitivity are available)

Fluroquinolones or combination of aminoglycoside garamycin or tobramycin &cephalosporine.

b)Systemic antibiotics are usually not required.

may be given in fulminating cases with

perforation and when sclera is also involved.

a) Cycloplegic drug: atropine eye ointment or drops . Other cycloplegic homatropine eye drops.

  • reduce pain from ciliary spasm & to prevent the

formation of posterior synechiae from secondary

iridocyclitis.

  • Atropine also increases the blood

supply to anterior uvea by relieving pressure

on the anterior ciliary arteries& so brings

more antibodies in the aqueous humour.

  • It also reduces exudation by decreasing hyperaemia

and vascular permeability

Hypopyon Ulcer

Seidle test

Hypopyon Ulcer

The advancing stage---edge is undermined;proceeded by intense infiltration

The healing stage ----edge is covered by epithelium ;vascularized;not undermined and surrounded by less infiltration

In Acute hypopyon ulcer we notice;

Common due to

a)the ulcfr tends to go deep

b)posterior abscess formation---this occurs opposite to the ulcer just anterior to descement s membrane in the form of cellular infiltration

perforation

SINGS OF HYPOPYON ULCER

2-ciliary injection of conjunctiva

+ve fluoreceine test

Greyish infiltration -ulceration

shows

The cornea

Loss of luster

1-Edema of the eye lids

origin- inflamed iris

Composition-polymorphs+fibrin+iris pigment

Showhypopyon(hypopyon-it is sterile pus which is colour and tends to settle at the buttom of the A.C has an upper straight level)

Antreior chamber

frt

Inflamed (secondary iritis) and the pupil constricted- posterior synechiae are common

iris

Symptoms

values: decrease IOP –Wash out of toxins in the aqueos –New aqueos rich in antibodies fill the AC.

Treatment of resistant Cases

After Failure of ttt by antibiotics for about 3 weeks !!

1-Cauterization :Carbolic acid for pneumococci – Zinc sulphate 20% for Morax.

2- Paracentesis :

it is a puncture of the anterior chamber and evacuation of its contents (by a paracentesis needle within the limbus at lower temporal quadrant)

in 2ry glucoma

3-Conjunctival flap:

A flap of conjunctiva is dissected and used to cover the ulcer.

in perforation.

4-Therapeutic Keratoplasty:

Once the favourable response is obtained, they substituted by available eye-drops, e.g. : Ciprofloxacin (0.3%) eye drops, orOfloxacin (0.3%) Gatifloxacin (0.3%)

1. The specific treatment :

(b) Systemic analgesics and anti-inflammatory .

(c) Vitamins (A, B-complex and C) help in early healing of ulcer.

(a) Hot fomentation. gives comfort, reduces pain and causes vasodilatation.

(b) Dark glasses to prevent photophobia.

(c) Rest, good diet and fresh air .

2-Non specific treatment:

3-General measures:

Penetrating Keratoplasty

Deep Lamellar Endothelial Keratoplasty

Descment Membrane Endothelial Keratoplasty

Differential Diagnosis

  • causitive organism.
  • Age.
  • Ulcer.

Typical & Atypical hypopyon :

Hypopyon ulcer with fungal corneal ulcer

Hypopyon Ulcer with Bacterial corneal disease

Treatment

1. Specific treatment for the cause.

2. Non-specific supportive therapy.

3. Physical and general measures.

Pathology

Stages:

Eitiology.

Pathology.

Differntial Diagnosis.

Clinical picture.

Complications.

Treatment.

Signs of improvement.

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