Corneal ulcer: Difference between revisions

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__NOTOC__
{{Infobox_Disease
{{Infobox_Disease
| Name            = Corneal ulcer
| Name            = Corneal ulcer
  | Image          = Eyes corneal ulcer.jpg
  | Image          = Eyes corneal ulcer.jpg
  | Caption        = Corneal ulcer. Marked generalized inflammation related to bacterial infection in this immunocompromised host. The cornea itself has become opaque secondary to this process. <br> (Image courtesy of Charlie Goldberg, M.D.)  
  | Caption        = Corneal ulcer. Marked generalized inflammation related to bacterial infection in this immunocompromised host. The cornea itself has become opaque secondary to this process.<br>(Image courtesy of Charlie Goldberg, M.D.)  
| DiseasesDB    =
| ICD10          = {{ICD10|H|16|0|h|15}}
| ICD9          = {{ICD9|370.00}}
| ICDO          =
| OMIM          =
| MedlinePlus    = 001032
| MedlinePlus_mult=MedlinePlus2|001017
| eMedicineSubj  =
| eMedicineTopic =
| MeshID        =
}}
}}
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
{{Corneal ulcer}}


{{Corneal ulcer}}
{{CMG}}
{{CMG}}
__NOTOC__
{{Editor Join}}


{{SK}} Ulcerative keratitis; eye sore


==[[Corneal ulcer overview|Overview]]==
==[[Corneal ulcer overview|Overview]]==


==[[Corneal ulcer historical perspective|Historical Perspective]]==
==[[Corneal ulcer classification|Classification]]==


==[[Corneal ulcer pathophysiology|Pathophysiology]]==
==[[Corneal ulcer pathophysiology|Pathophysiology]]==


==[[Corneal ulcer epidemiology and demographics|Epidemiology & Demographics]]==
==[[Corneal ulcer causes|Causes]]==


==[[Corneal ulcer risk factors|Risk Factors]]==
==[[Corneal ulcer differential diagnosis|Differentiating Corneal Ulcer from other Diseases]]==


==[[Corneal ulcer screening|Screening]]==
==[[Corneal ulcer epidemiology and demographics|Epidemiology and Demographics]]==


==[[Corneal ulcer causes|Causes]]==
==[[Corneal ulcer risk factors|Risk Factors]]==
 
==[[Corneal ulcer differential diagnosis|Differentiating Corneal ulcer]]==


==[[Corneal ulcer natural history|Complications & Prognosis]]==
==[[Corneal ulcer natural history|Natural History, Complications and Prognosis]]==


==Diagnosis==
==Diagnosis==
[[Corneal ulcer history and symptoms|History and Symptoms]] | [[Corneal ulcer physical examination|Physical Examination]] | [[Corneal ulcer staging|Staging]] | [[Corneal ulcer laboratory tests|Laboratory tests]] | [[Corneal ulcer electrocardiogram|Electrocardiogram]]  | [[Corneal ulcer x ray|X Rays]] | [[Corneal ulcer CT|CT]] | [[Corneal ulcer MRI|MRI]] [[Corneal ulcer echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Corneal ulcer other imaging findings|Other images]] | [[Corneal ulcer other diagnostic studies|Alternative diagnostics]]
[[Corneal ulcer history and symptoms|History and Symptoms]] | [[Corneal ulcer physical examination|Physical Examination]] | [[Corneal ulcer laboratory findings|Laboratory Findings]] | [[Corneal ulcer other diagnostic studies|Other Diagnostic Studies]]


==Treatment==
==Treatment==
[[Corneal ulcer medical therapy|Medical therapy]] | [[Corneal ulcer surgery|Surgical options]] | [[Corneal ulcer primary prevention|Primary prevention]]  | [[Corneal ulcer secondary prevention|Secondary prevention]] | [[Corneal ulcer cost-effectiveness of therapy|Financial costs]] | [[Corneal ulcer future or investigational therapies|Future therapies]]
[[Corneal ulcer medical therapy|Medical Therapy]] | [[Corneal ulcer surgery|Surgery]] | [[Corneal ulcer primary prevention|Primary Prevention]] | [[Corneal ulcer cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Corneal ulcer future or investigational therapies|Future or Investigational Therapies]]
 
==Superficial and deep corneal ulcers==
 
 
 
 
===Treatment===
Proper diagnosis is essential for optimal treatment. Bacterial corneal ulcer require intensive fortified antibiotic therapy to treat the infection. Fungal corneal ulcers require intensive application of topical anti-fungal agents. Viral corneal ulceration caused by herpes virus may antivirals like topical acyclovir oint instilled at least five times a day. Alongside, supportive therapy like pain medications are given, including topical cycloplegics like [[atropine]] or [[homatropine]] to dilate the pupil and thereby stop spasms of the [[ciliary muscle]]. Superficial ulcers may heal in less than a week. Deep ulcers and descemetoceles may require conjunctival grafts or conjunctival flaps, soft [[contact lens]]es, or [[cornea transplant|corneal transplant]]. Proper nutrition, including protein intake and Vitamin C are usually advised. In cases of Keratomalacia, where the corneal ulceration is due to a deficiency of Vitamin A, supplementation of the Vitamin A by oral or intramuscular route is given. Drugs that are usually contraindicated in corneal ulcer are topical [[corticosteroid]]s and [[anesthetics]] - these should not be used on any type of corneal ulcer because they prevent healing, may lead to superinfection with fungi and other bacteria and will often make the condition much worse.
 
==Refractory corneal ulcers==
{{main|Recurrent corneal erosion}}
Refractory corneal ulcers are superficial ulcers that heal poorly and tend to recur.  They are also known as '''indolent ulcers''' or '''Boxer ulcers'''.  They are believed to be caused by a defect in the basement membrane and a lack of [[hemidesmosome|hemidesmosomal]] attachments.  They are recognized by undermined epithelium that surrounds the ulcer and easily peels back. Refractory corneal ulcers are most commonly seen in diabetics and often occur in the other eye later.  They are similar to Cogan's cystic dystrophy.
 
===Treatment===
Topical fortified antibiotics are used at hourly intervals to treat infectious corneal ulcers.  Cycloplegic eye drops are applied to give rest to the eye.Pain medications are given as needed. Loose epithelium and ulcer base can be scraped off and sent for culture sensitiviy studies to find out the pathogenic organism. This helps in choosing appropriate antibiotics. Complete healing takes anywhere from about few weeks to few months.
 
Refractory corneal ulcers can take a long time to heal, sometimes months.  In case of progressive or non-healing ulcers, surgical intervention by an  Ophthalmologist with corneal transplantation may be required to save the eye. In all corneal ulcers it is important to rule out predisposing factors like [[Diabetes Mellitus]] and Immunodeficiency.


==Melting ulcers==
==Case Studies==
Melting ulcers are a type of corneal ulcer involving progressive loss of stroma in a dissolving fashion.  This is most commonly seen in ''[[Pseudomonas]]'' infection, but it can be caused by other types of [[bacteria]] or [[fungus|fungi]].  These infectious agents produce [[protease]]s and [[collagenase]]s which break down the corneal stroma.  Complete loss of the stroma can occur within 24 hours. Treatment includes antibiotics and collagenase inhibitors such as [[acetylcysteine]]. Surgery in the form of corneal transplantation (penetrating keratoplasty) is usually necessary to save the eye.
[[Corneal ulcer case study one|Case #1]]


==See also==
==Related Chapters==
*[[Corneal abrasion]]
*[[Corneal abrasion]]
*[[Keratitis]]
*[[Keratitis]]
==References==
{{reflist|2}}


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Latest revision as of 21:08, 29 July 2020

Corneal ulcer
Corneal ulcer. Marked generalized inflammation related to bacterial infection in this immunocompromised host. The cornea itself has become opaque secondary to this process.
(Image courtesy of Charlie Goldberg, M.D.)

For patient information click here

Corneal ulcer Microchapters

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Overview

Classification

Pathophysiology

Causes

Differentiating Corneal Ulcer from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Ulcerative keratitis; eye sore

Overview

Classification

Pathophysiology

Causes

Differentiating Corneal Ulcer from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters

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