CORNEAL ULCER

 CORNEAL ULCER

All right so today we are dealing yet

very important topic and that is the

corneal ulcers frequently we get this

problem that how to differentiate

between the different ulcers when it is

bacterial.

when it is viral where it is

fungal what are the most prominent

features and how to decide the treatment

of choice so all right we'll be starting

with first the most common also and that

is the bacterial answer the ulcer is the most common as we

know now what is the most important

cause of this answer as you know the

most important cause of this also is the

epithelial erosion. whenever there is a

patil erosion due to any of the reason

secondary bacterial infection is very

commonly occurring and the most common

bacteria is actually the staph aureus.

Staph aureus is most common in the world

streptococcus pneumoniae so we have most

common in the word as well as we have

most common in pakistan as well as the most

common factor which is actually

responsible for the corneal ulcer is the

epithelial erosion now because most of

the bacteria are not able to invade the

intact epithelium that is why epithelial

erosion is actually the most common

cause of the secondary bacterial

infection but I will say that some

bacteria are much virulence and those

bacteria which are virulent enough which

are aggressive enough which can invade

the intact epithelium they have the risk

of causing corneal ulcers even when

there is conjunctivitis so for example

if I talk about gonococcus guna gokul

conjunctivitis which is most commonly

the purulent conjunctivitis whenever a

patient this systemic type of gonococcal

conjunctivitis which has systemic

features also like we have urethritis. we

have arthritis in all these cases there

is always a risk of the bacterial

infection in the cornea also there is a

risk of corneal involvement also because

it can invade the intact corneal

epithelium now let us see a list which

can invade the intact corneal epithelium

the first important is the Corney

bacterium tip 3 the first important

bacteria is the Corney bacterium def 3

the second one second is the nazaria go

nori nazaria go nori the third important

is the nazaria meningitidis nazaria

meningitidis then the fourth one is the

Listeria food is the Listeria and fifth

is the H influenza and finally we have

the Shigella now this is again I

important mcq all those bacteria which

can invade the internal epithelium are

these and apart from this they will

always cause corneal ulcers whenever

there is epithelial erosion all right

now because there is lot of vascular

ization which is present in the

bacterial corneal ulcer a very important

complaint of this patients these

patients is the pain in fact I can say

that pain is the most dominant feature

as well as most prominent feature of

those patients who are having the

bacterial corneal ulcer and both is due

to the vascularization because it is so

red like why it is so painful both of

them is occurring due to the

vascularization lot of vascularization

reading lot of pain and lot of

congestion

now these bacteria when they are

invading and they are going inside in

the different layers of the cornea as

they reach inside they can also cause

the uveitis uveitis means are ido site

light

when the inflammation is going to the

deeper layers there is active ulceration

from the superficial layers to the

deeper layers this keratitis which could

have started from conjunctivitis also so

this conjunctivitis then keratitis

is going to the deeper layers also it is

involving the iris and ciliary body it

is causing a reduce eye cleitus and that

is why photophobia

photophobia is again a very important

symptom of these patients plus the

inflammatory cells now these

inflammatory cells when they're

collected inside the anterior chamber

because of their happiness the accidents

will always settle at the bottom now

whenever the exudates are settling at

the bottom.