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Hypopyon Ulcer

Bacterial Ulcerative Keratitis

Rawan El Deeb

on 11 January 2013

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Transcript of Hypopyon Ulcer

Hypopyon Ulcer Eitiology.
Differntial Diagnosis.
Clinical picture.
Signs of improvement. Hypopyon Ulcer Causitive Organisms Many Organisms are identified but pneumococci is the most common Treatment of resistant Cases Differential Diagnosis Typical & Atypical hypopyon : Progressive infilteration.
Active ulceration.
Cicatrization. Treatment 1. Specific treatment for the cause.

2. Non-specific supportive therapy.

3. Physical and general measures. Etiology Predisposing factors causitive organism.
Ulcer. Hypopyon Ulcer with Bacterial corneal disease Hypopyon ulcer with fungal corneal ulcer An inverse hypopyon needs to be differentiated from a standard hypopyon. Pathology Stages: General factors :decrease in body resistance
1-Old Age
2-Diabetes meleitus
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% Symptoms 1-Severe stitching pain (eye socked pain) :
a-irritation of exposed nerves by toxins ,
lid movement
b-accompanying iritis
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
7-Red eye. 1. The specific treatment : a)Topical broad spectrum antibiotics. Initial therapy(before results of culture and sensitivity are available) Fluroquinolones or combination of aminoglycoside garamycin or tobramycin &cephalosporine. 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 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. 2-Non specific treatment: reduce pain from ciliary spasm & to prevent the
formation of posterior synechiae from secondary
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 (b) Systemic analgesics and anti-inflammatory .
(c) Vitamins (A, B-complex and C) help in early healing of ulcer. 3-General measures: (a) Hot fomentation. gives comfort, reduces pain and causes vasodilatation.
(b) Dark glasses to prevent photophobia.
(c) Rest, good diet and fresh air . 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: values: decrease IOP –Wash out of toxins in the aqueos –New aqueos rich in antibodies fill the AC. Deep Lamellar Endothelial Keratoplasty Penetrating Keratoplasty Descment Membrane Endothelial Keratoplasty frt SINGS OF HYPOPYON ULCER 1-Edema of the eye lids 2-ciliary injection of conjunctiva +ve fluoreceine test Greyish infiltration -ulceration Loss of luster shows The cornea Composition-polymorphs+fibrin+iris pigment origin- inflamed iris 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 Inflamed (secondary iritis) and the pupil constricted- posterior synechiae are common iris 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; Seidle test 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
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