Serpiginous corneal ulcers

1. SERPIGINOUS CORNEAL
ULCERS

2. CONTENT
• ANATOMY OF THE CORNEA.
• WHAT KEEPING THE CORNEA TRANSPARENT.
• CORNEAL ULCER
• SERPIGINOUS CORNEAL ULCERS:
• HYPOPYON
• MOORHEN’S
• PHLYCTENULAR (FASCICULAR)

3. ANATOMY OF THE CORNEA.
GROSS ANATOMY
• Anterior transparent 1/6 of the outer coat of the eye ball
• Avascular
• Diameter : Vertical 11 mm & horizontal 12 mm
• Thickness : 0.67 peripherally & 0.52 mm at the center
• R.I : 1.37
• Refractory power : 42 diopter
• Radius of curvature : anterior 7.8 mm & posterior 6.8 mm

4. MINUTE ANATOMY

5. NERVE SUPPLY

6. TRANSPARENCY OF CORNEA

7. Corneal
ulcers
superficial
Interstitial
Deep
Primary
Secondar
y
infecte
d
Non
infecte
d
hypopyon
mooren’s
Fascicula

8. PATHOLOGY
Stage of infiltration
Stage of ulceration
Stage of healing

9. SYMPTOMS
Pain photophobia
lacrimation
Diminution of vision

10. SIGNS
Diminish
ed visual
acuity
Lid
edema
Constrict
ed pupil
Iridocyclit
is
Hypopyo
n or
plasmoid
aqueous
Chemosis
&
Ciliary
injection
Blepharospa
sm
IOP
Grayish infiltration &loss of luster &
+ve fluorescein stain

11. COMPLICATIONS
•NON PERFORATION (EARLY & LATE)
•PERFORATION (EARLY & LATE)

12. Early
Non perforated
ulcer
Secondary glaucoma descemetocele secondary
iridocyclitis

13. LATE
NON PERFORATED
ULCER
Corneal opacity
Macula
……nebula
Keratectesia pseudo pterygium fac

14. EARLY
PERFORATED
ULCER
Anterior synechia hyphema
luxation of lens
Iris prolapse
infection

15. LATE
PERFORATED
ULCER
Anterior staphyloma corneal fistula ant.
Polar cataract
Leucoma adherent
atrophia bulbi

16. TREATMENT
• TREATMENT OF UNCOMPLICATED ULCER (LOCAL
&SYSTEMIC )
• TREATMENT OF COMPLICATIONS

17. LOCAL
TREATMENT OF
UNCOMPLICATED
ULCER

18. SYSTEMIC
TREATMENT OF
UNCOMPLICATED
ULCER

19. • GLAUCOMA
• DESCEMETOCELE
• PERFORATION
• LEUCOMA
• NEBULA
• PERFORATION
TREATMENT OF
COMPLICATED
ULCER

20. HYPOPYON ULCER

21. DEFINITION
1RY INFECTIVE ACUTE SEVER
SUPERFICIAL SUPPURATIVE
KERATITIS ASSOCIATED WITH
SEVER IRIDOCYCLITIS AND
HYPOPYON

22. ETIOLOGY
•CAUSATIVE AGENTS
PNEUMOCOCCI (80%)
MORAX-AXENFIELD (10%)
STREPTOCOCCI, STAPHYLOCOCCI, PSEUDOMONAS & FUNGI (10%)
•PREDISPOSING FACTORS
TRAUMA
XEROSIS
ALTERED OCULAR DEFENSE MECHANISMS

23. CLINICAL PICTURES

24. SPECIFIC SIGNS
• * THE ULCER HAS 2 EDGES: -
• - THE CENTRAL EDGE PROGRESSIVE. IT IS CONCAVE AND UNDERMINED.
• - THE PERIPHERAL EDGE THE HEALING EDGE. IT IS CONVEX, SCARRED AND
VASCULAR.
• - HYPOPYON WHICH IS STERILE PUS IN ANTERIOR CHAMBER. IT IS FORMED OF
FIBRIN AND INFLAMMATORY CELLS PRODUCED BY THE SEVERE TOXIC
IRIDOCYCLITIS

25. COMPLICATIONS
* The ulcer is deep with
posterior abscess formation. So
that it commonly perforates and
descemetocele is never formed.

26. TREATMENT
+ Ttt of complications

27. MOORHEN’S ULCER

28. DEFINITION
MOORHEN'S ULCER (MU) IS A RARE AND PAINFUL
PRIMARY CHRONIC SERPIGINOUS ULCER WHICH
OCCURS IN THE ABSENCE OF ANY ASSOCIATED
SCLERITIS , AND ANY DETECTABLE SYSTEMIC
DISEASE.

29. CLINICAL FEATURES

30. CLINICAL FEATURES
A. THE ULCER MARGINAL GREYISH INFILTRATION AT LIMBUS
THEN FORM CRESCENT SHAPED ULCER
EDGES ARE A. CENTRAL B. PERIPHERAL
B. THE CORNEA THIN
C. PERORATION RARE

31. MANAGEMENT
• TOPICAL STEROIDS
• CONJUNCTIVAL RESECTION
• IMMUNOSUPPRESSIVE CHEMOTHERAPY
• ADDITIONAL SURGICAL PROCEDURES
• SUPERFICIAL LAMELLAR KERATECTOMY
• REHABILITATION

32. FASCICULAR KERATITIS

33. DEFINITION
•A CORNEAL ULCER RESULTING FROM
PHLYCTENULES THAT SPREAD FROM LIMBUS
TO THE CENTER OF CORNEA ACCOMPANIED
BY FASCICLE OF BLOOD VESSELS.

34. ETIOLOGY
ALLERGY TO AN ENDOGENOUS TOXIN:
A. TUBERCULO-PROTEIN
B. INTESTINAL PARASITES
C. SEPTIC FOCI

35. CLINICAL PICTURE
The ulcer starts near the limbus then creeps ( serpiginous )
centrally over the cornea followed by a leash of parallel blood
vessels

36. TREATMENT
GENERAL
1. REMOVE SEPTIC FOCUS
2. ANTI TB DRUGS
3. ANTI HELMINTHS DRUGS
LOCAL
1. CORTICOSTEROID
2. ATROPINE
TREATMENT OF COMPLICATIONS
1. FASCICULAR ULCER (CHEMICAL CAUTERY BY CARBOLIC ACID)
2. FASCICULAR BLOOD VESSELS (ELECTRIC CAUTERY)