corneal epithelial defect and corneal ulcer

Question 1

what is a corneal ulcer?

Answer 1

A corneal ulcer implies to an epithelial defect with accompanying inflammation and necrosis of
corneal tissue due to invasion by bacteria, fungi, viruses, or Acanthamoeba

Question 2

define corneal epithelial defect

Answer 2

In the absence of
infection, an area of cornea without epithelium should be termed an epithelial defect the
commonest cause of which is from mechanical abrasion.

Question 3

sx of corneal epithelial defect/ulcer

Answer 3

conjunctival hyperaemia, photophobia, pain, and watering.

Question 4

how to detect

Answer 4

Epithelial defects are detected by slit lamp examination with fluorescein instillation, and should
be recorded meticulously with measured dimensions. Diagnosis is often clinical but suspected
infection should also prompt clinicians to take a scrape of the infected corneal tissue for
microscopy, culture and sensitivities.

Question 5

how to manage corneal ulcer?

Answer 5

A corneal ulcer in a contact-lens wearing patient has to be scraped and then aggressively treated
for presumed bacterial infection (e.g. pseudomonas) and reviewed within 48 hours to ensure
clinical improvement.

Question 6

mx

Answer 6

Treatment is with antibiotics such as chloramphenicol eye drops (or levofloxacin eye drops for
contact lens wearers).

Question 7

mx of viral ulceration?

Answer 7

Viral ulceration needs to be treated with a course of topical antiviral gel such as ganciclovir
(Virgan). Systemic antiviral treatment is not indicated in immunocompetent patients