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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
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%
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.
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.
formation of posterior synechiae from secondary
iridocyclitis.
supply to anterior uvea by relieving pressure
on the anterior ciliary arteries& so brings
more antibodies in the aqueous humour.
and vascular permeability
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
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
+ve fluoreceine test
Greyish infiltration -ulceration
shows
Loss of luster
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)
frt
Inflamed (secondary iritis) and the pupil constricted- posterior synechiae are common
values: decrease IOP –Wash out of toxins in the aqueos –New aqueos rich in antibodies fill the AC.
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%)
(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 .
Hypopyon ulcer with fungal corneal ulcer
Hypopyon Ulcer with Bacterial corneal disease