CORNEAL ULCER(microbial keratitis)
The term keratitis / microbial keratitis are used to describe all suppurative infections of the cornea.They are characterized by the presence of white or yellowish infiltrates in the corneal storma, with or without overlaying corneal epithelial defect and it’s associated  with signs of inflammation.
The cornea has certain defensive mechanisms required because of it’s constant exposure to microbes and environmental influences:
  • Reflex eye closing 
  • Flushing effect of tear fluid
  • Epithelium can regenerate quickly and completely .   Any breach in any of these mechanisms may result in certain pathogens succeeding in breaching the corneal defenses through superficial injuries or minor epithelial defects, then the bradytrophic corneal tissue will respond  to the specific pathogen with a characteristic keratitis.
PATHOGENESIS OF CORNEAL ULCER
Corneal ulcers may be caused by :
  • Viruses
  • Bacteria 
  • Acanthoamoeba
  • Fungi
Once the bradytophic corneal tissue is invaded by microbes through superficial corneal lesion/trauma a typical chain of events will ensue: A corneal lesion will render pathogens to colonize the corneal stroma.(Eye becomes Red)➡️ Antibodies will infiltrate the site(cornea will opacify with infiltrate)➡️ Inflammation in the anterior chamber will result in pus (whitish fluid) in the anterior chamber called hypopion.

ClINICAL SIGN:

  1. Central corneal opacity 
  2. Conjunctival inflammation and dicharge makes the become red
  3. Reduced corneal sensation 
  4. Corneal epithelial defect( confirmed with fluorescein )- shape and size
  5. Corneal inflammatory infiltrate 
  6. Thinning or perforations of the cornea.
DIAGNOSIS/TREATMENT 
Treatment and diagnostic regimen is cause(pathogen) specific , therefore it’s necessary at least 2mm corneal scrape sample is ordered for a laboratory analysis in order to identify the specific pathogen responsible for the ulcer and treat as such.
TREATMENT PROPHYLAXIS 
It is imperative to start with antibacterial (antibiotics) until laboratory request proves otherwise. This is because about 90% of all ulcers are caused by bacteria.
  • Your Doctors can start with an hourly dosage of  ciprofloxacin ,Gentamycin or ofloxacin eye drops .
  • In cases of suspected fungus infection: Amphoterisin-B 0.15% or Natamycin 5% hourly dosage can be administered 
  • Corneal ulcers may present with severe pain; adjunct treatment like Atropine 1% ,oral analgesics like paracetamol,and anti glaucoma medication may be given to patients pain,prevent synechiae, and the high intraocular pressures that comes with eye inflammations.
NOTE: Never administer topical corticosteroids on the eye in cases of corneal ulcers. If topical steroids are dropped on the eye they ulcer may heal leaving a permanent corneal scar on the eye resulting in permanent blindness due to corneal opacity.
Always seek the council of your Doctor before applying any eye drop on your eye.
More on the various types of ulcers will be discussed in later episodes of the corneal ulcer series.

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