What is this condition?

A major cause of blindness worldwide, corneal ulcers produce scar­ring or perforation of the cornea. They occur in the central or marginal areas of the cornea, but marginal ulcers are the most common form. A person may have one or several ulcers, of varied size and shape. Prompt treatment (within hours of onset) can prevent visual impairment.

What causes it?

A corneal ulcer generally results from infections by protozoa, bacteria, viruses, or fungi. Other causes include trauma, exposure, vitamin A deficiency, toxins, and allergens.

What are its symptoms?

Typically, a corneal ulcer causes pain (aggravated by blinking) and sensitivity to light, followed by increased tearing. Eventually, a central corneal ulcer blurs vision markedly. Bacterial ulcers may produce a pus-filled discharge.

How is it diagnosed?

A history of trauma or use of contact lenses and a penlight exam that reveals an irregular corneal surface suggest a corneal ulcer. Fluoresce-in dye, instilled in the conjunctival sac, stains the outline of the ulcer and confirms the diagnosis. Cultures of corneal scraping may identify the causative bacterium or fungus.

How is it treated?

Treatment aims to relieve pain and eliminate the underlying cause of the ulcer, as follows:

• Pseudomonas aeruginosa: the antibiotics Aerosporin and Garamycin, given topically and by subconjunctival injection, or Geocillin and Tobrex given intravenously. Since this type of corneal ulcer spreads so rapidly, it can cause corneal perforation and loss of vision within 48 hours. Immediate treatment and isolation of hospitalized patients are required. Eye coverings are never used when treating bacterial corneal ulcers .
• herpes simplex type 1 virus: hourly topical application of Herplex or Vira-A Ophthalmic. Corneal ulcers resulting from a viral infection often recur .
• varicella-zoster virus: a topical sulfonamide ointment applied 3 to 4 times daily to prevent secondary infection. These lesions are typically painful, so the person also receives pain relievers .
• fungi: instillation of Natacyn eyedrops for Fusarium, Cephalosporoium, and Candida
• vitamin A deficiency: correction of dietary deficiency or malabsorption of vitamin A
• neurotropic ulcers or exposure keratitis: frequent instillation of artificial tears or lubricating ointments and use of a plastic bubble eye shield.

Prompt treatment is essential for all forms of corneal ulcer to prevent complications and permanent vision problems or blindness.

What do Doctors call this Condition - Keratitis

What is this Condition?

Inflammation of the cornea (the transparent covering of the eye) may be acute or chronic and superficial or deep. Superficial inflammation is fairly common and may develop at any age. The prognosis is good with treatment. Without treatment, recurrent inflammation of the cornea may lead to blindness.

What Causes it?

Inflammation of the cornea usually results from infection by herpes simplex virus type 1 (known as dendritic inflammation of the cornea). It may also result from exposure caused by the person’s inability to close the eyelids, or from congenital syphilis (known as interstitial inflammation of the cornea). Less commonly, it stems from bacterial or fungal infections.

What are its Symptoms?

Usually occurring in one eye, inflammation of the cornea produces cloudy areas in the corneal tissue, mild irritation, tearing, and sensitivity to light. An infection in the center of the cornea may produce blurred vision. When inflammation results from exposure, it usually affects the lower portion of the cornea.

How is it Diagnosed?

The doctor will perform a slit-lamp exam to confirm inflammation of the cornea. To determine if the inflammation results from herpes virus infection, the doctor will stain the eye with a fluorescein-impregnated strip, which produces one or more small, dendritic (branchlike) lesions. Touching the cornea with cotton reveals reduced corneal sensation.

Vision testing may show slightly decreased acuity. The person’s history may reveal a recent infection of the upper respiratory tract accompanied by cold sores.

How is it Treated?

Acute inflammation caused by the herpes virus is treated with Herplex eyedrops and ointment or Vira-A Ophthalmic ointment; recurrent herpetic inflammations are treated with Viroptic solution. A broad-spectrum antibiotic may prevent secondary bacterial infection. Chronic dendritic inflammation may respond more quickly to Vira-A. Long-term topical therapy may be necessary. (Corticosteroid therapy should not be used in dendritic inflammation or any other viral or fungal disease of the cornea.) Treatment of fungal inflammation consists of Natacyn.

Inflammation due to exposure requires application of moisturizing ointment to the exposed cornea and a plastic bubble eye shield or eye patch. Treatment of severe corneal scarring may include a cornea transplant.

What are these Conditions?

Extraocular motor nerve palsies are dysfunctions of the third, fourth, and sixth cranial nerves, which are involved with movement and focusing of the eyes.

What Causes them?

The most common causes of extraocular motor nerve palsies are diabetic neuropathy and pressure from an aneurysm or a brain tumor. Other causes vary, depending on which cranial nerve is involved.

What are their Symptoms?

The most characteristic symptom is double vision of recent onset. Typically, the person with third nerve palsy exhibits drooping eyelid. an eye that looks outward, dilated pupils, and an inability to adjust to light.

The person with fourth nerve palsy has double vision and cannot rotate the eye downward or upward; wryneck may develop from repeatedly tilting the head to the affected side to compensate for double vision.

Sixth nerve palsy causes one eye to turn; the eye cannot abduct beyond the midline. To compensate for double vision, the person turns the head to the unaffected side and develops wryneck.

How are they Diagnosed?

The doctor will perform a complete neuro-ophthalmologic exam and obtain a thorough history. Differential diagnosis of third, fourth, or sixth nerve palsy depends on the specific motor defect. For all extraocular motor nerve palsies, skull X-rays and a computed tomography scan (called a CAT scan) rule out tumors. The person is also evaluated for an aneurysm or diabetes. If sixth nerve palsy results from infection, cultures identifY the causative organism and determine the choice of an antibiotic.

How are they Treated?

Treatment depends on the underlying cause. Neurosurgery is necessary if the cause is a brain tumor or an aneurysm. For infection, massive doses of antibiotics may be appropriate. After treatment of the primary condition, the person may need to perform exercises that stretch the neck muscles.