CORNEAL ULCER

Question 1

Etiology

Answer 1

Strepococcus Pneumoniae
Staphylococcus sp.
Pseudomonas Aeruginosa w/ contacts lenses

Herpes Simplex
Varicella Zoster

Candida
Aspergillus
Penicillium

Amoebic

Question 2

History & Physical

Answer 2

Severe Pain

Watery discharge if central or iritis

Redness

Photophobia

Decreased Visual Acuity

Round or irregular ulcer with white hazy base extending into stroma

Slit Lamp:
staining corneal defect with a surrounding white hazy infiltrate
Flare & cells
Assoicated iritis
Hypopyon

Question 3

Risk Factors

Answer 3

It is rare to develop a corneal ulcer WITHOUT risk factors

Contact Lense (33%)

Blepharitis (19.7%)

Eye Trauma (13%)

Immunocompromise
(6.8%)

Bell’s Palsy (Dry Eyes)

Desquemation

Question 4

Risk Factors with Contact Lense Wearers

Answer 4

Extended use

Poor Hygiene (hand, lense)

Reuse

Freshwater swimming

Gardening / Organic contamination of eye

Question 5

Management

Answer 5

Ciprofloxacin 0.3% solution
2 drops per affected eye q 15 min for 6 hrs
THEN
2 drops per affected eye q 30 min for 18 hrs
THEN
2 drops per affected eye q 2 hrs for 1 day
THEN
2 drops per affected eye q 4 hrs for 12 days

Associated Anterior Uveitis:
Cyclogyl (Cyclopentolate) 1%
1 drop tid

Consult opthalmology 12-24 hrs

Question 6

Treatment Contraindications

Answer 6

Eye Patching
Steroid Drops

Question 7

Complications

Answer 7

Blindness

Perforation