MODULE OPTHALMOLOGY

Corneal Ulcer
GROUP 7
WULAN-FADZELY-ARIF AMRI-SAFUAN ARIFNADIAH-INSYIRA-FATIMAH-ANDI ABSHARINA

CASE 2
A 45 year old female patient was diagnosed with Corneal Ulcer ( OD ) based
on findings :
History : A chief complaint of painful red eye on the right eye, occurred
suddenly since 3 days earlier. There was a decreased of vision, profound
discharge and tearing. There is a history of trauma of the eye, the right
eye was come into contact with sand 4 days prior to visit. There are no
history of systemic diseases.
- Physical findings : General state : Mild / Good nutrition /
Conscious
o Vital signs : BP = 110/70; Pulse = 96x/menit; Breathe= 20x/menit; Temp
= 37oC
- Ophthalmology findings :
o Visual Acuity : VOD 2/60, uncorrected; VOS : 6/6
o Intraocular Pressure : TOD : Tn TOS : Tn ( palpation )

 Anterior segment

CORNEAL
ULCER
ANATOMY &
PHYSIOLOGY
OF EYE

TREATMEN
T

PROGNOSIS

METABOLISM
OF CORNEA

PATHO
MECHANISM
OF CM

COMPLICATION

DEFINITION

CM

DD

ETIOLOGY

PATHO
GENESIS

Anatomy & Physiology of Cornea

Cornea:

Barrier
Transparent
Avascular
Refractive media
Innervated by N. V (1)
Metabolism of the cornea: corneal layer that
actively metabolize - epithelium & endothelium.
Corneal tear film is given nutrition by aqueous
humor and blood vessels around the limbus.
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CORNEAL ULCER

Definition

The cornea is the clear tissue at the front of the

eye.

Corneal ulcer : Erosion or open sore in the outer

layer of the cornea.

It is often caused by infection.

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Etiology
Corneal ulcers are most commonly caused by an infection:

Bacteria
Fungal

Streptococcus
Staphylococcus
Pneumonia

Candida
Aspergillus

Virus

Herpes Simplex

Protozoa

Acanthamoeba
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Corneal ulcers or infections may also be caused

by:

Eyelids that do not close all the way, such as

with Bell's palsy
Foreign bodies in the eye
Scratches (abrasions) on the eye surface
Severely dry eyes
Severe allergic eye disease
Various inflammatory disorders
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Clinical Manifestations

Hypopion
Blepharospasm
Ciliary injection
Lacrimation
Redness of the eye
Photophobia
Pain
Blurred vision
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Pathomechanism of Clinical Manifestations

Blepharosp
asm!

Hypopion
Peradangan
pada iris dan
badan siliar

Penurunan
permeabilitas
dari blood
aqueous barrier

Peningkatan
protein, fibrin
dan sel radang
dalam cairan
aqueous

Hipopion!

Pus bersifat lebih

berat dari cairan
aqueous

Pus mengendap
di bagian bilik
mata depan

Photophobia
Pterygum (penebalan fibrovaskuler di konjungtiva) terjadi sampai kornea

Permukaan superfisial stroma dan membran Bowman pada kornea rusak

Iritasi dari N. trigeminus

Refleks dilatasi vaskuler iris menyebabkan serabut saraf pada nervus ciliary
ke ventroposterior medial talamus.

Impuls dibawa ke somatosensori

Photophobia!

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Diagnosis

Examination of scrapings from the ulcer

Fluorescein stain of the cornea
Pupillary reflex response
Refraction test
Slit-lamp examination
Tests for dry eye
Visual acuity

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Treatment

Cycloplegic : atropine 1%
(to reduce ache of a corneal ulcer and to reduce the formation
of posterior synechiae )

Antibiotic : moxifloxacin 0.5% or gatifloxacin 0.3 to 0.5% for

small ulcers
tobramycin 15 mg/mL and cefazolin 50 mg/mL, for more
significant ulcer
Bacteria: penicilin, cephalosporin, aminoglycoside
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Prognosis

Bad due to the ulcer located in the middle of pupil

This ulcer will permenantly located there
It will cause decrease of vision

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Complication

Glaukoma sekunder
Toxic iridiocyclitis
Descemetocele
Perforation
Corneal scarring : nebula, macula, leukoma

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Differential diagnosis
Sign and symptoms

Corneal Ulcer
et causal
fungus

Endolpthalmitis Corneal Ulcer et

causal virus

Uveitis

Pain and redness on

the eye
Since 3 days earlier

5 days

Decreased vision

Profound discarge

Tearing

Palpebra edema

Palpebra conjunctiva
(hyperemic)

Hypopion

Ulcer on eye

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