eye

1. DR. ALI RAZA
Associate Professor
Head of Department Ophthalmology
Holy Family Hospital Rawalpindi

3. MICROBIAL KERATITIS

4. BACTERIAL KERATITIS
COMMON PATHOGENS:
Neisseria gonorrhoeae
Corynebacterium diphtheriae
Listeria sp.
Haemophilus sp.

5. BACTERIAL KERATITIS
OTHER PAHTOGENS:
Produce keratitis only after loss of corneal epithelial
integrity as in:
Contact lens wear:
Pseudomonas aeruginosa

6. BACTERIAL KERATITIS
Ocular surface disease
Chronic dacryocistitis
Topical steroids
Systemic immunosuppressive agents

7. BACTERIAL KERATITIS
CLINICAL FEATURES:
Certain bacteria produce characteristic corneal
response.
1- Staph. aureus and Strep. pneumoniae:
Oval, yellow-white, densely opaque stromal
suppuration
clear cornea

8. Large Corneal infiltration in
bacterial keratitis

9. Severe staphylococcal keratitis

10. Staphylococcal keratitis

11. CLINICAL FEATURES:
2- Pseudomonas:
Mucopurulent exudate,
liquefactive necrosis
ground-glass adjacent stroma

12. Pseudomonas keratitis with
hypopyon

13. Advanced pseudomonas keratitis

15. CLINICAL FEATURES:
3- Enterobacteriaeceae:
Shallow ulceration
Grey-white pleomorphic suppuration
Stromal opalescence
Corneal rings

16. BACTERIAL KERATITIS
MANAGEMENT:
Bacterial corneal ulcer is a sight-
threatening condition demanding
Identification of causative organism
Eradication
Hospitalization

17. MANAGEMENT:
Therapy is divided into:
Sterilization phase
Healing phase

18. MANAGEMENT:
1- CHOICE OF ANTIBIOTICS:
Standard combined therapy with aminoglycosides
and cephalosporins.
Monotherapy with fluoroquinolone

19. MANAGEMENT:
2- PREPARATION OF FORTIFIED ANTIBIOTICS:
by combination with a compatible vehicle

20. MANAGEMENT:
3- INSTILLATION OF TOPICAL ANTIBIOTICS:
hourly intervals for first five days
2 hourly if favourable response
Gradually taper and discontinue

21. MANAGEMENT:
4- SYSTEMIC CIPROFLOXACIN:
When ulcer is close to limbus
5- WHEN TO CHANGE ANTIBIOTICS:
If resistant pathogen

22. MANAGEMENT:
6- CYCLOPLEGICS:
to prevent
Posterior synechiae
Pain
7- STEROID THERAPY:
Controversial

23. Deposits of ciprofloxacin

24. MANAGEMENT:
8- CAUSES OF FAILURE TO RESPOND:
Wrong diagnosis by inappropriate cultures
Wrong treatment by inappropriate antibiotics
Drug toxicity preventing corneal healing

25. FUNGAL KERATITIS
Keratomycosis
CLINICAL FEATURES:
1- Filamentuous fungal keratitis
Aspergillus sp.
Fusarium sp.
2- Candida keratitis

26. Fungal keratitis with hypopyon

27. filamentous fungal keratitis

28. Advanced filamentous fungal
keratitis

29. MANAGEMENT:
Re-culture and corneal biopsy
Antifungal therapy
Therapeutic penetrating keratoplasty

30. OTHER TYPES OF KERATITIS
Acanthamoeba keratitis
Interstitial keratitis
- luetic interstitial keratitis
- cogan syndrome
Infectious crystalline keratopathy

31. Acanthamoeba keratitis

32. Interstitial keratitis

33. Infectious crystalline keratopathy

34. COMPLICATIONS OF KERATITIS

41. HERPES SIMPLEX KERATITIS
PRIMARY OCULAR INFECTION
Occurs in children b/w ages of 6
months and 5 yrs
1- Blepharoconjunctivitis
2- Keratitis

42. 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

43. DENDRITIC ULCER
Antiviral Therapy
- Acycloguanosine
- Trifluorothymidine
- Adenine arabinoside
Debridement

46. OTHER VIRAL KERATITIS
Stromal Necrotic Keratitis
Disciform Keratitis

47. HERPES ZOSTER OPHTHALMICUS
Rash on eye lids
Conjunctivitis
Episcleritis
Scleritis
Keratitis
Anterior Uveitis

48. CORNEAL ECTASIAS
1- KERATOCONUS
- conical cornea
- central or paracentral stromal thinning
- apical protrusion
- irregular astigmatism
- presents with impaired vision
- oil droplet reflex
- Munson sign

52. 2- KERATOGLOBUS
- rare condition
- oval keatoconus early on
- later protrusion and thinning of entire cornea
3- PELLUCID MARGINAL DEGENERATION

54. Thanks