Corneal Ulcer

Authors: Liza B. Byrd, Nathan Martin

Journal: StatPearls
May 13, 2019
Link: https://www.ncbi.nlm.nih.gov/books/NBK539689/
Duvan Alexis Linares Arenas

Objective
This article has like objective recognize the corneal ulcers fast and differentiate each of the
etiologies, starting an effective treatment and organize an evaluation Ophthalmological
urgent.
Thematic Analysis
A characteristic that to have to very present is that the corneal ulcer is a pathology so
dangerous that can perforate even be mortal for patient. In spite of any treatment the
complications become very difficult to management. Between these be corneal
perforation, cataract, secondary glaucoma, that become to be corneal transplant. The 12 .
2% of all corneal transplant are of bacterial corneal ulcer.
Is very important now, understand and know the mechanism different that generate this
pathology. The most usual is the bacterial corneal ulcer, this cause a rupture in the
epithelium a central level, generate a wound delimitated for the bacterial invasion. Also,
this himself has purulent secretion of color yellow. It is related with use contact lenses for
agents as Pseudomonas aeruginosa and Staphylococcus aureus. In others cases begin for
ocular trauma and surgery.
To difference the bacteria, the virus as the herpes simplex, cause a corneal wound with a
pattern of dendritic, very pain, no to delimited. Only the 5 to 10 % are of etiology fungal,
whose lesion is paracentral but of fast developed, ever associated to vegetal trauma for
candida or Aspergillus. And other differential diagnostic between the contact lenses users
is the corneal ulcer for Acanthamoeba, that is present into water. The corneal ulcer
peripheral is more related with autoimmune disease, for example rheumatoid arthritis or
Wegener granulomatosis.
To level Epidemiological, the corneal ulcer is causative of one million of urgencies in EE.
UU, affecting more to the contact lens users. Exists a rate tall of bacterial corneal ulcer in
women between 25 to 34 years. The cases of infection for herpes simplex are minors, 5 to
20 cases for 10000 in different countries. The corneal ulcer fungal is the most common in
field workers for vegetal trauma. The corneal ulcer peripheric has an incidence of 3 cases
for one million.
The slit lamp evaluation is so important in the differential diagnosis of each type of corneal
ulcer. Signs as corneal infiltrate punctual or type dendritic, edema, hyperemia and report
of pain, and also the interrogation or history are crucial for generate the differential
treatment.
The treatment has to be clear for each of etiologies. In the bacterial corneal ulcer must
use topical antibiotic of the category of Fluoroquinolones. For example, the first option is
Moxifloxacin 0.5 %, following with other options as Gatifloxacin and Ciprofloxacin. In the
treatment for corneal ulcer for Herpes simplex there are two principal options, Trifluridine
and acyclovir, but we can complement with antiviral systemic. In the cases of etiologies
fungal the principal topical is the Natamycin accompanied of Amphotericin systemic. In
the case of Acanthamoeba keratitis, make epithelial debridement and use antiamoebic
therapy, for example chlorhexidine and poligexametilen.

Corneal ulcer. Image courtesy S Bhimji MD

Conclusion
Consequently, the differential diagnosis is key in the management of each corneal ulcer,
the first 24 hours are very primordial for avoid visual and ocular lost. Something that also
is important, is the patient education. The good cleanse and management the contact
lenses, avoid all corneal damage and permit that the visual care advance. we have to have
known all medicament and dosification exactly with the final purpose of know attend this
urgency.
Contribution to Professional Practice
This is my first case of bacterial corneal ulcer that I see, for me is very interesting and i
could use all knowledge acquired during my career, for this the contribution is can
differentiate and diagnosis faster the pathologies that affect the visual and ocular health.
Contribute to The Practice Scenario
In my practice scenario texts as this help to actualize me in each topic relevant in the zone
that working. This text is needed for comply with petitions of the patients and help they of
a form integral.