MANAGEMENT OF

PERFORATED COR NE AL
UL CE R
Under Supervision Of :
Dr. Mahmoud Yousif
DEFINITION
• Corneal ulcer is discontuity of the
anterior corneal surface.
CAUSATIVE AGENT
• Bacterial : staph.,Strept.,Pneumococci
• Viral : H.S.Virus
• Fungi : Candida albican
• Protozoal : Acanthamoeba
• Chlamydial : Chlamydia trachomatis
Bacterial culture
DIAGNOSIS
• Slit lamp
revealing the ulcer on the cornea.
DIAGNOSIS
• fluorescein stain
helps in defining the margins of the corneal
ulcer, and can reveal additional details of the
surrounding epithelium
DIAGNOSIS
• Rose-Bengal dye :
used for supra-vital staining purposes,
but it may be very irritating to the eyes.
DIAGNOSIS
DIAGNOSIS
COMPLICATIONS
COMPLICATIONS
COMPLICATIONS
COMPLICATIONS
COMPLICATIONS
COMPLICATIONS
1-MEDICAL TREATMENT
• Local treatment :
2. Atropine sulphate
3. Bandage
4. Antibiotics
5. Hot fomentation
1-MEDICAL TREATMENT
• General treatment :
2. Systemic Antibiotics
3. Vitamins
4. Rest in bed
5. Avoid straining : By laxatives and anti
tussives
2-SURGICAL TREATMENT
1. Conjunctival flaps or graft
Principle:
All types of conjunctival flaps consist of thin
conjunctival tissue transposed onto the
cornea to cover the lesion.
Value:
Conjunctival flaps provide corneal support,
fibrovascular tissue to fill corneal defects, and
bring blood supply
3-SURGICAL TREATMENT
• Conjunctival flaps or graft
2-SURGICAL TREATMENT
• Amniotic membrane grafts
Principle:
Separate amniotic membranes were
transplanted as material to fill the stromal
layer (amniotic membrane filling), as a
basement membrane (amniotic membrane
graft), and as a wound cover (amniotic
membrane patch
2-SURGICAL TREATMENT
• Amniotic membrane grafts
2-SURGICAL TREATMENT
1. Penetrating Keratoplasty :
Objectives
Corneal perforation can be potentially blinding unless
the integrity of the globe is restored quickly.
Although penetrating keratoplasty (PK) may achieve
this, it carries a high risk of endothelial rejection in
inflamed eyes
2-SURGICAL TREATMENT
1. Penetrating Keratoplasty :
2-SURGICAL TREATMENT
4. Deep lamellar keratoplasty
Objectives :
an alternative option to PK in inflamed
eyes owing to its potential for a lower
incidence of rejection
2-SURGICAL TREATMENT
4. Deep lamellar keratoplasty
2-SURGICAL TREATMENT
1. Human Fibrin Glue
Princible:
similar to those of the coagulation cascade,
with final formation of a fibrin clot
3-SURGICAL TREATMENT
• Human Fibrin Glue
3-CAUSAL TREATMENT
1. Treat the predisposing factors :
e.g.: - Epilation of rubbing lashes
- Removal of P.T.D.s
- Control D.M.
5. Treat the precipitating Factors :
e.g.:- blepharitits
- conjunctivivtis
- Chronic dacryocystits
‫‪Presented By :‬‬
‫‪ -608‬مروة وجيه طه فرج‬ ‫‪ -602‬مروة محمد أحمد مليحة‬
‫‪ -609‬مريم ماهر حليم‬ ‫‪ -603‬مروة محمد شتا‬
‫‪ -610‬مريم نشأت المحلوي‬ ‫‪ -604‬مروة محمد صبحي‬
‫‪ -611‬مريهان عبد العليم‬ ‫‪ -605‬مروة محمود الطويل‬
‫‪ -612‬مسلم ابراهيم نعيم‬ ‫‪ -606‬مروة مصطفى الشوح‬
‫‪ -607‬مروة مصطفى زكي حراز ‪ -613‬مشيرة اسماعيل‬
‫‪ -614‬مصطفى أحمد أحمد‬
‫عبدالقادروالى‬