Sunday, May 14, 2017

Corneal Ulcer - Clinical features And Management

A corneal ulcer is an inflammatory and ulcerative keratitis.

Common infectious etiologies include

  • bacteria (Staphylococcus, Streptococcus, Pseudomonas) and 
  • viruses (herpes simplex, adenovirus). 
  • Rare causes of corneal ulcers include fungal infections and Acanthamoeba, a ubiquitous protozoan associated with contaminated contact lens solutions.

- Bacterial corneal ulcers are commonly associated with extended-wear contact lenses.
- Fungal infections may also arise from trauma involving vegetable matter such as a tree branch.  - - - -Acanthamoeba infections may also occur from swimming in lakes, especially while wearing contact lenses.

Corneal Ulcer. A small circular corneal infiltrate is seen adjacent to the white flash photography reflection. Diffuse conjunctival hyperemia with a nasal ciliary flush is seen.

Clinical Features:Patients present with pain, photophobia, decreased vision, discharge, and a foreign body sensation.
Ocular findings include a corneal infiltrate, typically a round white spot, with conjunctival hyperemia, meiosis, and chemosis.
 Slitlamp biomicroscopy may demonstrate an epithelial defect with fluorescein uptake. Anterior chamber findings can include cells and flare, keratic precipitates, and a hypopyon.


Management

  • Corneal ulcers are an ophthalmologic emergency requiring emergent ophthalmology consultation. 
  • Stains and cultures should be obtained as expeditiously as possible. 
  • Intensive topical treatment using fortified antibiotics is the most effective treatment route, initially given every 30 to 60 minutes.
  • For mild cases, a single fluoroquinolone agent may suffice.
  • For more severe cases, dual therapy using a cephalosporin or vancomycin combined with an aminoglycoside is recommended.
  • Clinical improvement is usually noted after 2 to 3 days.
  • Systemic antibiotics are used in cases where the sclera is involved (Pseudomonas) or if there is a high risk of concurrent systemic disease (Neisseria, Haemophilus). 
  • Cycloplegics are recommended if there is an accompanying iritis. 
  • Steroids and eye patching are contraindicated. 
  • A contact lens wearer must discontinue contact lens wear.

Points To Remember
1. A corneal ulcer is an ophthalmologic emergency.
2. Extended-wear contact lens use is a risk factor for corneal ulcer.
3. Pseudomonas aeruginosa, associated with thick yellow green or blue-green mucopurulent tenacious exudate, is capable of destroying the cornea within 6 to 12 hours.

2 comments:

  1. For years, I have read and seen the advertisements in the mass media about all of the penis enhancement pills and thought that they were all scams or gimmicks. All of the medical sites that I have visited stated that none of the herbal supplements would ever help increase the size of a penis. I got very depressed when I read this, because unfortunately I was not naturally blessed with a penis that was big enough to arouse my sexual partner or past partners. I am a man that is past my sexual primetime and my sexual performance has a lot to be desired. I decided to try Doctoc Akhigbe herbal medicine after all the reading and researching that I have done.I saw a testimony " Joe" about doctror Akhigbe Herbal Medicine Since there is a Money Back Guarantee, I give him a trial what did I have to lose? I couldn't believe the results I was seeing after drinking the Natural  Herbal Medicine  and Herbal Soap to be rubign my penis! he sent to me through DHL courier delivery service . Within about 2 weeks I had a noticeable increase in the girth of my penis. Then after a coupleof aditional week it started to grow in length and I was amazed and very excited.before I finish the drink and the soap my penis had grown an additional two inches. I've had a considerable improvement with my sex life and these pills are certainly worth every penny I spent on them! I want to thank Dr Akhigbe for the time and effort they have spent on helping people in my situation.I know many are out there who are suffering this problem and they need help, email him.    drrealakhigbe@gmail.com.    He also cure other diseases like: Painful or Irregular Menstruation. HIV/Aids. Breast Enlargement. Diabetics. Vaginal Infections. Vaginal Discharge. Itching Of the Private Part. Breast Infection. Discharge from Breast. Breast Pain & Itching. Lower Abdominal Pain. No Periods or Periods Suddenly Stop. Women Sexual Problems. High Blood Pressure Chronic Disease. Pain during Sex inside the Pelvis. Pain during Urination. Pelvic Inflammatory Disease, (PID). Dripping Of Sperm from the Vagina As Well As for Low sperm count. Parkinson disease. Lupus.  Cancer.  Tuberculosis.  Zero sperm count.  Asthma.  Quick Ejaculation. Corneal Ulcer, Gallstone, Terminal Illnesses, Premature Ejaculation. Herpes. Joint Pain. Stroke. Weak Erection.  Erysipelas, Thyroid, Discharge from Penis. HPV.  Hepatitis A and B. STD. Staphylococcus + Gonorrhea + Syphilis. Heart Disease.  Pile-Hemorrhoid.rheumatism, thyroid, Autism, Penis enlargement,  Waist & Back Pain.  Male Infertility and Female Infertility. For your cure email him now:   drrealakhigbe@gmail.com    or Contact his numbe:  +2349010754824.

    ReplyDelete
  2. For years, I have read and seen the advertisements in the mass media about all of the penis enhancement pills and thought that they were all scams or gimmicks. All of the medical sites that I have visited stated that none of the herbal supplements would ever help increase the size of a penis. I got very depressed when I read this, because unfortunately I was not naturally blessed with a penis that was big enough to arouse my sexual partner or past partners. I am a man that is past my sexual primetime and my sexual performance has a lot to be desired. I decided to try Doctoc Akhigbe herbal medicine after all the reading and researching that I have done.I saw a testimony " Joe" about doctror Akhigbe Herbal Medicine Since there is a Money Back Guarantee, I give him a trial what did I have to lose? I couldn't believe the results I was seeing after drinking the Natural  Herbal Medicine  and Herbal Soap to be rubign my penis! he sent to me through DHL courier delivery service . Within about 2 weeks I had a noticeable increase in the girth of my penis. Then after a coupleof aditional week it started to grow in length and I was amazed and very excited.before I finish the drink and the soap my penis had grown an additional two inches. I've had a considerable improvement with my sex life and these pills are certainly worth every penny I spent on them! I want to thank Dr Akhigbe for the time and effort they have spent on helping people in my situation.I know many are out there who are suffering this problem and they need help, email him.    drrealakhigbe@gmail.com.    He also cure other diseases like: Painful or Irregular Menstruation. HIV/Aids. Breast Enlargement. Diabetics. Vaginal Infections. Vaginal Discharge. Itching Of the Private Part. Breast Infection. Discharge from Breast. Breast Pain & Itching. Lower Abdominal Pain. No Periods or Periods Suddenly Stop. Women Sexual Problems. High Blood Pressure Chronic Disease. Pain during Sex inside the Pelvis. Pain during Urination. Pelvic Inflammatory Disease, (PID). Dripping Of Sperm from the Vagina As Well As for Low sperm count. Parkinson disease. Lupus.  Cancer.  Tuberculosis.  Zero sperm count.  Asthma.  Quick Ejaculation. Corneal Ulcer, Gallstone, Terminal Illnesses, Premature Ejaculation. Herpes. Joint Pain. Stroke. Weak Erection.  Erysipelas, Thyroid, Discharge from Penis. HPV.  Hepatitis A and B. STD. Staphylococcus + Gonorrhea + Syphilis. Heart Disease.  Pile-Hemorrhoid.rheumatism, thyroid, Autism, Penis enlargement,  Waist & Back Pain.  Male Infertility and Female Infertility. For your cure email him now:   drrealakhigbe@gmail.com    or Contact his numbe:  +2349010754824.

    ReplyDelete