KERATITIS

Function of the cornea :

as Window of the globe & refractive media:
clear & transparent with power + 42 D. as microorganisms barrier

Dr.H.Izar Aziz,SpM(K)

Loss of transparency caused

endothelial damage epithelial damage.

by :

Dr.H.Izar Aziz,SpM(K)

Keratitis : is

inflammation of cornea ,caused by microorganism infection antigen antibodies / allergic reaction.

Dr.H.Izar Aziz,SpM(K)

Epithelium covered by tear film :as a barrier microorganisms infection . (except N. Gonorrhoea) Descemets membrane as barrier for bacterial infection to COA .(but not for fungus)

Etiology of keratitis :
Exogenous : bacteria ,fungus , virus, parasite Endogenous : allergic reaction.
Dr.H.Izar Aziz,SpM(K) 5

 Bacteria :
-Pure Pathogen : Streptococcus pneumoniae, Pseudomonas aeroginosa

-Opportunistic bacteria : Staphylococcus,Moraxella, Serratia(as flora at conjunctiva

. Alcoholic/ B6 deficiency
.Topical steroid >>> . Corneal abrasion

Pathogen bacteria
Dr.H.Izar Aziz,SpM(K)

Corneal infection
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 Fungus (usually Virus

VHS VVZ

opportunistic)

Candida, Fusarium, Aspergillus

Parasite : Acanthamoeba in Contact lens user

Dr.H.Izar Aziz,SpM(K)

Symptoms & Signs

Subjective (patients
pain glare (photophobia) blur vision tearing (lacrimation)
history

Objective -

blepharospasme ciliary injection tearing (lacrimation) superficial infiltrate or corneal ulcer hypopyon- in advanced cases.
Dr.H.Izar Aziz,SpM(K)

loupe or slit lamp examination

Dr.H.Izar Aziz,SpM(K)

 Special examinations :
Flourescein test for corneal ulcer Seidel test for perforating cornea

Dr.H.Izar Aziz,SpM(K)

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Laboratory Studies

Etiologic diagnosis. Scraping from: infiltrate / edge of the ulcer fornices of conyunctiva Slide Staining : Gram ( for bacteria) Giemsa (for fungus )

Dr.H.Izar Aziz,SpM(K)

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Clinical course
Subepithelial /epithelial keratitis
Recover without scar
Recover with scar
Nebula Makula Leukoma

Become corneal ulcer

Perforating cornea, accompanied bulging of the cornea & iris prolaps

Recover with scar : Leukoma adherent staphyloma cornea
Phtysis bulbi

Advanced inflamation
-endophtalmitis -panophtalmitis recover
Extirpation of the globe

Corneal blindness

Permanent blindness

Abulbi 12

Clinical appearance of corneal ulcers

Serpeginous corneal ulcer.
Etiology : Pneumococcus acute, well circumscribed gray ulcer, tends to spread to center of cornea hypopyon is common (sterile)

Dr.H.Izar Aziz,SpM(K)

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Pseudomonas ulcer.

Etiology : Pseudomonas aerg. (present in Flourescein sol.) bluish-green exudate very acute ,spread rapidly to all direction ,because proteolytic enzyme destroy the corneal stroma

descemetocele

Dr.H.Izar Aziz,SpM(K)

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 Marginal Ulcer Fungal ulcer

Etiology : Staphylococcus affect limbal area history: agriculture trauma topical steroid usage >>>>

gray Infiltrate thick hypopyon & irregular surface satellite lesions - in endothelium

Dr.H.Izar Aziz,SpM(K)

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Herpes Simplex keratitis.

Etiology : VHS type I corneal sensibility <<< lesion : filament, punctate, dendritic, disciform

Dr.H.Izar Aziz,SpM(K)

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 Moorens Ulcer
Etiology : antigen antibodies reaction Progressive excavation of the limbus.

Dr.H.Izar Aziz,SpM(K)

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 Keratomalacia Etiology : Vitamin A deficiency advance stage of xerosis conjunctiva & cornea No ciliary injection

Dr.H.Izar Aziz,SpM(K)

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Treatment
atropine eye drops Anti microorganisms depend on laboratory finding (scraping & culture)
Antibiotic for bacteria Anti fungus for fungal infection Antiviral for viral infection

High dose Vit. A for keratomalacia Steroid for Moorens ulcer

eye bandage

Dr.H.Izar Aziz,SpM(K)

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 Prognosis depends on :
Corneal scar

depth & width of the ulcer

Dr.H.Izar Aziz,SpM(K)

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Nebula Makula Leukoma Leukoma adherent

Central ,-->corneal blindness -Periphery (No visual disturbance )

Dr.H.Izar Aziz,SpM(K)

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Prevention
Avoid corneal trauma Avoid overuse of topical steroid Cure external eye infection as soon as possible. Avoid trigger factor for relapsing H.simplex keratitis.

Dr.H.Izar Aziz,SpM(K)

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Have a nice day !

Dr.H.Izar Aziz,SpM(K)

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Reference Books
Vaughn D, Asbury T; General Ophthalmology, 15th edition, Appleton & Lange Miller S; Parsons Diseases of the eye, 17 th Edition, Churcill Livingstone, 1984 Kanski JJ, Clinical Ophthalmology, 4th edition,Oxford Butter Worth Heineman Ltd, 1999
Dr.H.Izar Aziz,SpM(K) 24