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Management of Corneal ulcer (Treatment of impending perforation (No strain…
Management of Corneal ulcer
Thourough history Taking
General Physical Examination
Ocular Examination
Regurgitation test
Biomicroscopic examination after staining of Corneal ulcer with fluorescent dye
Laboratory investigation
Routine
DLC,TLC,ESR, Hb, Urine
Microbiological
Gram & Geimsa stain
10% KOH Wet preparation
Calcofluor white stain for fungal filaments
Blood agar
Sabourad dextrose agar medium
Treatment of uncomplicated ulcer
Specific treatment
Topical antibiotics
Initial therapy before results of culture & sensitivity
5% Fortified cefazoline
&
1.3% Fortified tobramycin
5% Fortified Vancomycin
&
FQ eye drops
Subsequent therapy as per culture & sensitivity report
Systemic antibiotics in fulminating cases with perforation
Ciprofloxacin / Aminoglycoside
Nonspecific
Cycloplegic (1% Atropine ointment)
To reduce pain from ciliary spasm
To prevent formation of posterior synechiae
Brings more antibodies in aqueous through increasing blood supply
Paracetamol / Ibuprofen
Vitamins A, B-complex & C
General measures
HOT FOMENTATION
Dark Goggles
Treatment of non healing Ulcer
Removal of any known cause
Local Causes
⬆️IOP , Vascularization of ulcer
Misdirected cilia
Concretions
Dacryocystitis
Lagophthalmos
Systemic causes :
DM
Anaemia
Malnutrition
Mechanical debridement
Cauterisation
Bandage soft contact lenses
Peritomy of perilimbal Conjunctival vessels
Treatment of impending perforation
No strain & Strict bed rest
Pressure bandage
Lowering of IOP by simultaneous acetazolamide orally , IV Mannitol , Oral glycerol , Timolo eyedrops & Paracentasis of aqueous from AC
Tissue adhesive glue (Cyanoacrylate)
Conjunctival flap
Penetrating therapeutic keratoplasty (Tectonic Keratoplasty)