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KERATITIS

H. IZAR AZIZ

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(

Loss of transparency caused

endothelial damage
epithelial damage.

Dr.H.Izar Aziz,SpM(

by :

Keratitis : is

inflammation of cornea ,caused by


microorganism infection
antigen antibodies / allergic reaction.

Dr.H.Izar Aziz,SpM(

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(

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

Corneal infection

Dr.H.Izar Aziz,SpM(

Fungus (usually

opportunistic)

Candida, Fusarium, Aspergillus

Virus
VHS
VVZ

Parasite : Acanthamoeba
in Contact lens user

Dr.H.Izar Aziz,SpM(

Symptoms & Signs


Subjective (patients

pain
glare (photophobia)
blur vision
tearing (lacrimation)

Objective

history

loupe or slit lamp examination

blepharospasme
ciliary injection
tearing (lacrimation)
superficial infiltrate or corneal ulcer
hypopyon- in advanced cases.

Dr.H.Izar Aziz,SpM(

Dr.H.Izar Aziz,SpM(

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

Dr.H.Izar Aziz,SpM(

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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(

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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

Advanced
inflamation
-endophtalmitis
-panophtalmitis
recover

Phtysis bulbi

Corneal blindness

Permanent blindness

Extirpation
of the globe

Abulbi

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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(

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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(

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Marginal Ulcer

Etiology : Staphylococcus
affect limbal area

Fungal ulcer

history: agriculture trauma


topical steroid usage >>>>

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

Dr.H.Izar Aziz,SpM(

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Herpes Simplex keratitis.

Etiology : VHS type I


corneal sensibility <<<
lesion : filament, punctate, dendritic, disciform

Dr.H.Izar Aziz,SpM(

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

Dr.H.Izar Aziz,SpM(

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

Dr.H.Izar Aziz,SpM(

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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(

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Prognosis depends on :

depth & width of the ulcer


Corneal scar

Dr.H.Izar Aziz,SpM(

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Nebula
Makula
Leukoma
Leukoma adherent

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

Dr.H.Izar Aziz,SpM(

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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(

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Have a nice
day !

Dr.H.Izar Aziz,SpM(

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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(

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