Corneal ulcer: a study of 110 cases

ABSTRACT

One hundred ten cases of corneal ulcer and abscesses have been analyzedThe role of predisposing factors in the causation of the infection cannot overemphasized. Noteworthy are the corneal traumatas and local ocular diseases which are either ignored by the patients or are inadequately managedCorneal ulcers are predominantly bacterial. Fungi should be suspected in cases that are not responding favorably to anti-bacterial therapy. The role of previously considered non-pathogenic organisms in corneal infection should be recognized. How to deal with sterile corneal ulcer is a problemFor the purpose of isolating the etiologic organisms, specimens for microbiological studies should be taken from the corneal lesions and should include the advancing borders of the ulcer. A sterile Bard-Parker knife is most efficient for this purpose. Conjunctival exudates are insufficient for the purpose. When the organisms isolated by smear or culture is inconclusive, corneal biopsy may be done especially in suspected mycotic infectionsCorneal ulcers are generally treated arbitrarily without benefit of culture and sensitivity studies. This procedure is not without danger. The cost entailed by the procedure is highly warranted in infection that may cause blindnessFailure of the infection to respond favorably to medical treatment is generally due to either that the antibiotic is ineffective against the organism or that the drug is administered in insufficient concentrationsPrevention is still the best management of corneal ulcer. This is so because even adequate therapy does not prevent development of corneal scarring that causes visual impairment. Prophylactic antibiotics, not steroids, must always be given immediately following corneal injuries and the treatment should be closely supervised. Existing local ocular conditions that may be complicated with corneal ulceration should be correctedEffective therapy of corneal ulcers should not only eradicate the infection but also prevent or minimize the degree of corneal scarring and the attendant complications that make corneal transplantation an extremely unrewarding procedure. For medical treatment to be effective, not only that the organism is identified and the appropriate antibiotics chosen but also that the latter is administered in sufficient concentrations. (Summary and conclusions)