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Keratitis - Coggle Diagram
Keratitis
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Etiology
Infections
Fungal - Aspergillous, Fusarium, Candida
Bacterial - Pseudomonas, Staphylococci, Streptococci,
Viral - Herpes simplex virus (HSV), Herpes zoster virus (HZV), Adenovirus
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Pathophysiology
Fungal keratitis has also been associated with fungal endophthalmitis. In these circumstances, fungal organisms spread from the posterior segment to the corneal stroma via the Descemet membrane. Another alternative is entrance through corneoscleral trabeculae into the cornea's network of channels. Fungal keratitis is uncommon in Western advanced countries. Fungal infections are highly common in impoverished countries. The leading cause is farm-related injuries. Fungi cannot pass through the undamaged corneal epithelium. To penetrate the cornea, they must have sustained a penetrating damage or have a prior epithelial defect. Once inside the cornea, they can grow and spread across the corneal channels.
Many bacteria have many adhesins on fimbriated and non-fimbriated features that may help them adhere to host corneal cells. In the early stages, the epithelium and stroma in the area of damage and infection expand and necrotize. The starting ulcer is surrounded by acute inflammatory cells (mostly neutrophils), which cause stromal lamellar necrosis. Diffusion of inflammatory chemicals (including cytokines) from the posterior chamber causes an outpouring of inflammatory cells into the anterior chamber, potentially leading to a hypopyon. Various bacterial toxins and enzymes (including elastase and alkaline protease) may be created during corneal infection, aiding in the degradation of corneal constituents.
Primary HSV-1 infection primarily affects the trigeminal nerve's mucocutaneous distribution. Although it is usually asymptomatic, an upper respiratory tract infection without a clear cause may appear. Following the initial infection, the virus travels along the nerve axon to the cell body found in the trigeminal ganglion after spreading from the infected epithelial cells to neighboring sensory nerve ends. The virus DNA enters a neuron's nucleus there and remains there forever in a dormant form.
CMx
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Bacterial - mucopurulent, :arrow_up: pain, :arrow_down: red
Viral - watery eye, :arrow_down:pain, :arrow_up: red
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Management
Medical
Vital sign - Bp, Temp., pulse rate, O2, Resp. rate, pain score
Phys. exam - visual acuity, visual field
Hx - Social history, Chief complaint, Past medical history
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Pharmacology
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Occ/Gutt Ofloxacin - adult: 10 drops BD x 2/52, Child: 5 drops BD x 1/52
Tablet Erythromycin Ethylsuccinate - Adult: 400mg QDS / 800mg BD, Child: 30 - 50mg/kg in divided doses
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