This document discusses bacterial corneal ulcers. It notes common causes like corneal epithelial damage, prolonged steroid use, and contact lens wear. It describes the stages of a corneal ulcer from progressive infiltration and ulceration to regression and cicatrisation. Signs and symptoms include pain, photophobia, and blurred vision. Treatment involves antibiotics, atropine, steroids, and cauterization or surgery for complicated cases. Organisms commonly involved include Pneumococcus, Pseudomonas, and Staphylococcus.

1. BACTERIAL CORNEAL
ULCER
Labeeb Pc

3. Corneal epithelial damage
Prolonged use of steroids
Wearing contact lenses
Poor local hygiene

4. Corneal Epithelial Damage
 Corneal Abrasion
 Epithelial drying
 Necrosis - keratomalacia
 Desquamation – bullous keratopathy
 Trophic changes – neurotrophic keratitis

5. TRICHIASIS

6. ENTROPION

7. LAGOPHTHALMOS

8. Sources Of Infection
Exogenous
Ocular tissue

9. Causative organisms
 Invade normal epithelium –
N.gonorrhoeae & C. diphtheriae

12. Stage of progressive
infiltration & ulceration
 Saucer shaped ulcer
 Walls project above normal surface
 Grey zone of infiltration
 Hypopion
 Progress laterally or deeper

13. Stage of regression
A line of demarcation.
Necrotic material shed off
Begins to heal
Vascularisation

14. Stage of cicatrisation
 If epithelium only – no scar
 Nebular – Bowman’s membrane &
superficial stroma
 Macular – upto half of stroma
 Leucomatous – more than half of stroma
 Corneal Facets

16. Corneal Opacities
Nebular Macular Leucomat
ous
Adherent
Leucoma

17. Nebular
Macular

18. Leucomatous

19. Adherent Leucoma

21.  Pain & fb sensation
 Lacrimation
 Photophobia
 Blurred vision
 Blepharospasm
 Redness of eyes

23. Circum corneal
congestion

25.  Swelling of lids
 Conjunctiva – chemosis, CCC
 Corneal ulcer –
 Margins – swollen, over hanging
 Floor - necrotic material
 Stromal edema around

26.  AC – hypopion - mobile
 Iris – slightly muddy
 Pupil – small

29. Ectatic
Cicatrix

30. Descemetocele

31.  Ectatic cicatrix
 Descemetocele
 Toxic Iridocyclitis
 Inflammatory glaucoma

32. Corneal perforation
 Prolapse of iris
 Adherent Leucoma

33. Pseudocornea

34. Anterior Staphyloma

35. Anterior Subcapsular
cataract
Anterior
Synechia

36.  Corneal fistula
 Secondary glaucoma
 Spontaneous expulsion of lens & vitreous
 Intraocular hemorrhage , Expulsive
Hemorrhage
 Endophthalmitis or Panophthalmitis

38.  Routine blood examination
 Lid & Adnexa Examination
 Corneal Scraping – kimura spatula
 Corneal biopsy
 Culture of contact lens & solution

39. 
TREATMENT

40. Treatment of Uncomplicated Ulcers
1. Antibiotics
Fortified Cephazolin 5%, fortified Tobramycin
1.3%
Fortified Vancomycin 0.3%, Fluroquinolones
2. Atropine
3. Steroids

41. 4. Cauterisation – carbolic acid, trichloroacetic a
5. Rigid gas permeable contact lenses
6. Dense corneal scars with visual potential-
Lamellar keratoplasty, full thickness graft
7. Without visual potential –
Cosmetic contact lenses, tattooing.

42. 8. Analgesics
9. Hot Fomentation
10. Dark Goggles
11. Rest, good diet, fresh air

43. Perforated ulcer
1. Avoid straining
2. Tissue adhesive –
 N-butyl 2-ethyl cyanoacrylate
3. Bandage soft contact lenses
4. Therapeutic keratoplasty , Dacrocystorhinostomy
5. Conjuctival flap, amniotic membr transplant
6. Antiglaucoma

44. Marginal Catarrhal Ulcer
 Near limbus
 Old pupil
 Hypersnsitivity to staphylococcal toxins

45. 
HYPOPION ULCER

46.  Pneumococcus – Ulcus Serpens
 Pseudomonas, Staphylococcus, Gonococci,
Streptococcus, Moraxella
 C/c Dacrocystitis
 Sterile , mobile, rapidly absorbed

47. Ulcus serpens
 Greyish white or
yellowish disc like.
 Opacity greater at the edges
 One edge – infiltration , other - cicatrization
 Cornea – lustreless
 Violent iritis and aqueous is cloudy