#26. Superficial purulent keratitis.

Question 1

What is Keratitis?

Answer 1

• INFLAMMATION of the CORNEA

Question 2

What are the TYPES of Keratitis?

Answer 2

1) SUPERFICIAL
a. Purulent = Bacterial / Fungal
b. Non-Purulent = Viral / Allergic

2) DEEP

Question 3

Which BACTERIA cause Corneal Inflammations?

Answer 3

• S. epidermidis
• S. aureus
• S. pneumoniae
• Coliforms
• Pseudomonas
• Haemophilus

Question 4

What is the PATHOGENESIS of SUPERFICIAL PURUENT KERATITIS?

Answer 4

1) Bacteria Host INFECTS the Cornea - Some are found on Lid Margin as part of NORMAL FLORA

2) Conjunctiva + Cornea are PROTECTED AGAINST INFX :

• Blinking
• Washing away DEBRIS, via Tear Flow
• Entrapment of FOREIGN PARTICLES by MUCUS
• ANTI-BACTERIAL Properties of Tears
• BARRIER FUNCTION of Corneal EPITHELIUM

Question 5

What are the CAUSES of BACTERIAL KERATITIS?

Answer 5

• KERATOCONJUNCTIVITIS SICCA = Dry Eye
• BREACH in Corneal EPITHELIUM = From Surgery / Trauma
• Wearing Contact Lenses
• PROLONGED Use of TOPICAL STEROIDS

Question 6

What are the SYMPTOMS & SIGNS of SUPERIFICAL PURULENT KERATITIS?

Answer 6

• Pain (UNLESS under Anaesthesia)
• Purulent DISCHARGE
• Ciliary INJECTION
• Visual Loss
• Photophobia
• HYPOPHON
• WHITE Corneal OPACITY

Question 7

What is the TREATMENT for SUPERIFICAL PURULENT KERATITIS?

Answer 7

• SCRAPES TAKEN from BASE of ULCER for Gram Staining / Culture
• Px treated with INTENSIVE TOPICAL Antibiotics = DUAL THERAPY via Combined Preparations
  (CEFUROZIME = Gram +ve)
  (GENTAMYCIN = Gram -ve)
• Use FLUROQUINOLONES = Ciprofloxacin / Ofloxacin
• INITIALLY TREATED with TISSUE ADHESIVES (Cyanoacrylate Glue) and THEN, a CORNEAL GRAFT