KERATITIS

Function of the cornea :

as Window of the globe & refractive
media:
• clear & transparent with power + 42 D.
• as microorganisms barrier
Loss of transparency caused by :
• endothelial damage
• epithelial damage.
Keratitis : is
inflammation of cornea ,caused by
microorganism infection
antigen antibodies / allergic reaction.
Epithelium covered by tear film :as a
barrier microorganisms infection .
(except N. Gonorrhoea)
• Descemet’s membrane as barrier for
bacterial infection to COA .(but not for
fungus)

• Etiology of keratitis :
– Exogenous : bacteria ,fungus , virus,
parasite
– Endogenous : allergic reaction.
• 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

• Fungus (usually opportunistic)
• Candida, Fusarium, Aspergillus
• Virus
– VHS
– VVZ
• Parasite : Acanthamoeba
in Contact lens user
 Symptoms & Signs
• Subjective (patient’s history )
– pain
– glare (photophobia)
– blur vision
– tearing (lacrimation)

• Objective - loupe or slit lamp examination

– blepharospasme
– ciliary injection
– tearing (lacrimation)
– superficial infiltrate or corneal ulcer
– hypopyon- in advanced cases.
• Special examinations :
– Flourescein test for corneal ulcer
– Seidel test for perforating cornea
Laboratory Studies
Etiologic diagnosis.
Scraping from:
infiltrate / edge of the ulcer
fornices of conyunctiva
Slide Staining :
Gram ( for bacteria)
Giemsa (for fungus )
 Clinical course
Subepithelial /epithelial
keratitis

Recover Become
without scar corneal ulcer

Perforating cornea, Advanced

Recover
accompanied bulging of the inflamation
with scar
cornea & iris prolaps -endophtalmitis
Nebula Recover with scar : -panophtalmitis
Makula Leukoma adherent
Leukoma staphyloma cornea recover Extirpation
of the
globe
Phtysis bulbi

Corneal blindness Abulbi

Permanent blindness 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)
•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
• 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
Herpes Simplex keratitis.
Etiology : VHS type I
corneal sensibility <<<
lesion : filament, punctate, dendritic, disciform
• Mooren’s Ulcer
– Etiology : antigen antibodies reaction
– Progressive excavation of the limbus.
• Keratomalacia
Etiology : Vitamin A deficiency
advance stage of xerosis conjunctiva & cornea
No ciliary injection
 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 Mooren’s ulcer
• eye bandage
• Prognosis depends on :
– depth & width of the ulcer

Corneal scar
Nebula Central ,-->corneal
Makula blindness
Leukoma -Periphery (No visual
Leukoma adherent disturbance )

Dr.H.Izar Aziz,SpM(K) 21
 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.
Have a nice
day !
 Reference Books
• Vaughn D, Asbury T; General Ophthalmology,
15th edition, Appleton & Lange
• Miller S; Parson’s Diseases of the eye, 17 th
Edition, Churcill Livingstone, 1984
• Kanski JJ, Clinical Ophthalmology, 4th
edition,Oxford Butter Worth Heineman Ltd,
1999