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DR. ALI RAZA         Associate ProfessorHead of Department Ophthalmology Holy Family Hospital Rawalpindi
MICROBIAL KERATITIS
BACTERIAL KERATITISCOMMON PATHOGENS:Neisseria gonorrhoeaeCorynebacterium diphtheriaeListeria sp.Haemophilus sp.
BACTERIAL KERATITISOTHER PAHTOGENS: Produce keratitis only after loss of corneal epithelial integrity as in:Contact lens ...
BACTERIAL KERATITISOcular surface diseaseChronic dacryocistitisTopical steroidsSystemic immunosuppressive agents
BACTERIAL KERATITISCLINICAL FEATURES: Certain bacteria produce characteristic corneal response.1- Staph. aureus and Strep....
Large Corneal infiltration in bacterial keratitis
Severe staphylococcal keratitis
Staphylococcal keratitis
CLINICAL FEATURES:2- Pseudomonas:Mucopurulent exudate,liquefactive necrosisground-glass adjacent stroma
Pseudomonas keratitis withhypopyon
Advanced pseudomonas keratitis
CLINICAL FEATURES:3- Enterobacteriaeceae:Shallow ulcerationGrey-white pleomorphic suppurationStromal opalescenceCornea...
BACTERIAL KERATITISMANAGEMENT:                 Bacterial corneal ulcer is a sight- threatening condition demandingIdentif...
MANAGEMENT:                  Therapy is divided into:Sterilization phaseHealing phase
MANAGEMENT:1- CHOICE OF ANTIBIOTICS:Standard combined therapy with aminoglycosides and cephalosporins.Monotherapy with f...
MANAGEMENT:2- PREPARATION OF FORTIFIED ANTIBIOTICS: by combination with a compatible vehicle
MANAGEMENT:3- INSTILLATION OF TOPICAL ANTIBIOTICS:hourly intervals for first five days2 hourly if favourable responseGr...
MANAGEMENT:4- SYSTEMIC CIPROFLOXACIN:          When ulcer is close to limbus5- WHEN TO CHANGE ANTIBIOTICS:         If resi...
MANAGEMENT:6- CYCLOPLEGICS:      to prevent  Posterior synechiae  Pain7- STEROID THERAPY:      Controversial
Deposits of ciprofloxacin
MANAGEMENT:8- CAUSES OF FAILURE TO RESPOND:Wrong diagnosis by inappropriate culturesWrong treatment by inappropriate ant...
FUNGAL KERATITISKeratomycosisCLINICAL FEATURES:1- Filamentuous fungal keratitisAspergillus sp.Fusarium sp.2- Candida ker...
Fungal keratitis with hypopyon
filamentous fungal keratitis
Advanced filamentous fungalkeratitis
MANAGEMENT:Re-culture and corneal biopsyAntifungal therapyTherapeutic penetrating keratoplasty
OTHER TYPES OF KERATITISAcanthamoeba keratitisInterstitial keratitis     - luetic interstitial keratitis     - cogan syn...
Acanthamoeba keratitis
Interstitial keratitis
Infectious crystalline keratopathy
COMPLICATIONS OF KERATITIS
HERPES SIMPLEX KERATITISPRIMARY OCULAR INFECTION                    Occurs in children b/w ages of 6 months and 5 yrs    ...
HERPES SIMPLEX KERATITISDENDRITIC ULCER          Signs in chronological order:    - opaque cells in punctate or stellate ...
DENDRITIC ULCERAntiviral Therapy     - Acycloguanosine     - Trifluorothymidine     - Adenine arabinosideDebridement
OTHER VIRAL KERATITISStromal Necrotic KeratitisDisciform Keratitis
HERPES ZOSTER OPHTHALMICUSRash on eye lidsConjunctivitisEpiscleritisScleritisKeratitisAnterior Uveitis
CORNEAL ECTASIAS1- KERATOCONUS    - conical cornea    - central or paracentral stromal thinning    - apical protrusion    ...
2- KERATOGLOBUS      - rare condition      - oval keatoconus early on      - later protrusion and thinning of entire corne...
Thanks
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Keratitis

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Keratitis

  1. 1. DR. ALI RAZA Associate ProfessorHead of Department Ophthalmology Holy Family Hospital Rawalpindi
  2. 2. MICROBIAL KERATITIS
  3. 3. BACTERIAL KERATITISCOMMON PATHOGENS:Neisseria gonorrhoeaeCorynebacterium diphtheriaeListeria sp.Haemophilus sp.
  4. 4. BACTERIAL KERATITISOTHER PAHTOGENS: Produce keratitis only after loss of corneal epithelial integrity as in:Contact lens wear: Pseudomonas aeruginosa
  5. 5. BACTERIAL KERATITISOcular surface diseaseChronic dacryocistitisTopical steroidsSystemic immunosuppressive agents
  6. 6. BACTERIAL KERATITISCLINICAL FEATURES: Certain bacteria produce characteristic corneal response.1- Staph. aureus and Strep. pneumoniae:Oval, yellow-white, densely opaque stromal suppurationclear cornea
  7. 7. Large Corneal infiltration in bacterial keratitis
  8. 8. Severe staphylococcal keratitis
  9. 9. Staphylococcal keratitis
  10. 10. CLINICAL FEATURES:2- Pseudomonas:Mucopurulent exudate,liquefactive necrosisground-glass adjacent stroma
  11. 11. Pseudomonas keratitis withhypopyon
  12. 12. Advanced pseudomonas keratitis
  13. 13. CLINICAL FEATURES:3- Enterobacteriaeceae:Shallow ulcerationGrey-white pleomorphic suppurationStromal opalescenceCorneal rings
  14. 14. BACTERIAL KERATITISMANAGEMENT: Bacterial corneal ulcer is a sight- threatening condition demandingIdentification of causative organismEradicationHospitalization
  15. 15. MANAGEMENT: Therapy is divided into:Sterilization phaseHealing phase
  16. 16. MANAGEMENT:1- CHOICE OF ANTIBIOTICS:Standard combined therapy with aminoglycosides and cephalosporins.Monotherapy with fluoroquinolone
  17. 17. MANAGEMENT:2- PREPARATION OF FORTIFIED ANTIBIOTICS: by combination with a compatible vehicle
  18. 18. MANAGEMENT:3- INSTILLATION OF TOPICAL ANTIBIOTICS:hourly intervals for first five days2 hourly if favourable responseGradually taper and discontinue
  19. 19. MANAGEMENT:4- SYSTEMIC CIPROFLOXACIN: When ulcer is close to limbus5- WHEN TO CHANGE ANTIBIOTICS: If resistant pathogen
  20. 20. MANAGEMENT:6- CYCLOPLEGICS: to prevent Posterior synechiae Pain7- STEROID THERAPY: Controversial
  21. 21. Deposits of ciprofloxacin
  22. 22. MANAGEMENT:8- CAUSES OF FAILURE TO RESPOND:Wrong diagnosis by inappropriate culturesWrong treatment by inappropriate antibioticsDrug toxicity preventing corneal healing
  23. 23. FUNGAL KERATITISKeratomycosisCLINICAL FEATURES:1- Filamentuous fungal keratitisAspergillus sp.Fusarium sp.2- Candida keratitis
  24. 24. Fungal keratitis with hypopyon
  25. 25. filamentous fungal keratitis
  26. 26. Advanced filamentous fungalkeratitis
  27. 27. MANAGEMENT:Re-culture and corneal biopsyAntifungal therapyTherapeutic penetrating keratoplasty
  28. 28. OTHER TYPES OF KERATITISAcanthamoeba keratitisInterstitial keratitis - luetic interstitial keratitis - cogan syndromeInfectious crystalline keratopathy
  29. 29. Acanthamoeba keratitis
  30. 30. Interstitial keratitis
  31. 31. Infectious crystalline keratopathy
  32. 32. COMPLICATIONS OF KERATITIS
  33. 33. HERPES SIMPLEX KERATITISPRIMARY OCULAR INFECTION Occurs in children b/w ages of 6 months and 5 yrs 1- Blepharoconjunctivitis 2- Keratitis
  34. 34. HERPES SIMPLEX KERATITISDENDRITIC ULCER Signs in chronological order: - opaque cells in punctate or stellate pattern - linear branching ulcer stains with fluorescein - anterior stromal infiltrates - large epithelial defect (amoeboid configuration) - pseudodendrites in healing phase
  35. 35. DENDRITIC ULCERAntiviral Therapy - Acycloguanosine - Trifluorothymidine - Adenine arabinosideDebridement
  36. 36. OTHER VIRAL KERATITISStromal Necrotic KeratitisDisciform Keratitis
  37. 37. HERPES ZOSTER OPHTHALMICUSRash on eye lidsConjunctivitisEpiscleritisScleritisKeratitisAnterior Uveitis
  38. 38. CORNEAL ECTASIAS1- KERATOCONUS - conical cornea - central or paracentral stromal thinning - apical protrusion - irregular astigmatism - presents with impaired vision - oil droplet reflex - Munson sign
  39. 39. 2- KERATOGLOBUS - rare condition - oval keatoconus early on - later protrusion and thinning of entire cornea3- PELLUCID MARGINAL DEGENERATION
  40. 40. Thanks

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