Corneal Ulcer

Subject: Medical and Surgical Nursing II (Theory)

Overview

A thin coating called the cornea covers the front of the eye. An ulcer is a break that has an open sore on the skin. It doesn't heal, thus it starts to resemble a crater-like wound. A corneal ulcer results from damage to the eye's front film that doesn't heal. That eye's eyesight is severely impaired. A corneal ulcer is defined as an open sore that can be seen or manifest itself around the cornea of the eyes, or when the film at the front of the eye is damaged and does not heal, which can have a substantial negative influence on vision. Each animal and person can suffer from this circumstance. Corneal irritation, lacrimation, photophobia, swollen eyelids, a feeling of a foreign body in the eye, and circumcorneal vessel congestion are some of the clinical characteristics of the cornea. Through history-taking, inquire about the patient's trauma history, the disease's mode of onset, its duration, and the severity of its symptoms. The precise treatment—immediate care is required to stop corneal scarring or blindness.Systemic analgesic and anti-inflammatory medications, like ibrufen and paracetamol, reduce oedema while relieving pain. Under local anesthesia, mechanical debridement of the ulcer to remove necrosed material is performed by scarping the ulcer's floor with a spatula.

Corneal Ulcer

A thin coating called the cornea covers the front of the eye. An ulcer is a break that has an open sore on the skin. It doesn't heal, thus it starts to resemble a crater-like wound. A corneal ulcer results from damage to the eye's front film that doesn't heal. That eye's vision is severely impaired.

A corneal ulcer is defined as an open sore that can be seen or appear around the eyes, or the front film of the eye may be damaged and not heal, which can have a significant impact on vision. Each animal and person can suffer from this circumstance.

Etiology

  • Predisposing factor
  • Corneal trauma: foreign body plants, contact lens
  • Entropion, ectropion
  • Trichiasis
  • Blepharitis
  • Chronic dacryocystitis
  • Xeropthalmia
  • Measles, DM, TB
  • Immunosuppressed condition
  • Etiology agent
    • Pyogenic bacteria- pseudomonas, staphylococcus, streptococcus
    • Viruses- herpes simplex
    • Fungus- candida, aspergillus
    • Amoeba- acamthamoeba

Pathology

  • tiny foreign bodies, misdirected cilia, concretions, and minor trauma in contact lens wearers or others that cause corneal abrasion
  • Drying of the epithelium as in xerosis and exposure keratitis
  • Epithelial necrosis, such as in keratomalacia
  • Epithelial desquamation, as in keratomalacia
  • Corneal scarring appears

Clinical Features

  • inflammation of the cornea
  • Lacrimation
  • Photophobia
  • Lids swell Feeling of a foreign body
  • distorted vision
  • eye redness brought on by circumcorneal vessel obstruction.
  • Pain brought on by the chemical and mechanical effects of toxins

Diagnosis and Investigation

  • Through history taking, inquire about the patient's exposure to trauma, the disease's method of development, its length, and the severity of its symptoms.
  • examination of the eyes
  • Examining the lids, conjunctiva, and cornea under diffuse light for significant lesions and feeling tests
  • After staining the corneal ulcer with a freshly made, 2% aqueous solution of fluorescein dye, a biomicroscopic examination was performed to note the corneal ulcer's location, size, shape, depth, margin, floor, and vascularization.
  • Corneal scraping for the C/S test to determine the pathogens.

Treatment

  • The specific treatment- prompt treatment is necessary to prevent corneal scarring or blindness.
    • Gentamycin eye drops combined with cephazoline eye drops were used topically every hour for the first few days, then every two hours.
    • Applying antibiotic eye ointment is best done at night.
    • Gentamicin 40 mg and 125 mg of cephazoline should also be injected subconjunctivally once day for five days in cases of sloughing corneal ulcers.
    • Atropine sulphate injections should be administered to widen the pupils, which promotes ulcer healing and lessens pain. Systematic antibiotics should be administered as prescribed by a doctor.
  • Non-specific treatment
    • Systemic analgesia and anti-inflammatory drugs such as paracetamol and ibrufen relieve pain and decrease edema
    • Vitamins ( A, B complex and c) helps in early healing and ulcer.
  • Physical and general measures
    • Localized hot treatment provides relief, lessens discomfort, and dilates blood vessels.
    • The ulcer can be healed with a pad and bandage (if associated acute conjunctivitis and copious discharge it should be avoided)
    • Use dark or green sunglasses to shield your eyes from the irritant effects of intense light.
    • Rest, a healthy diet, and fresh air may be calming.

Surgical Treatment for Non-healing Corneal Ulcer

  • Mechanical debridement of ulcer to remove necrosed material by scraping floor of ulcer with a spatula under local anesthesia may hasten the healing
  • If the ulcer is deep and perforation of cornea appears possible a surgical conjunctival flap may be created to cover and seal the ulcer.
  • The corneal opacity which is left behind after successful management of corneal ulcer can be treated with corneal transplantation.

Nursing Consideration

  • if at all feasible, isolation of the patient.
  • Focus on maintaining decent personal hygiene.
  • to maintain clean bedding.
  • correct hand washing.
  • nail and hair trimming.
  • placement of hairs and nails.
  • application of oral medicine in accordance with a doctor's prescription.
  • psychological assistance for the patient's family.

Complication

  • Corneal scarring
  • Corneal perforation
  • Blindness
  • Iritis
  • Intraocular infection
  • Visual impairment
  • Secondary glaucoma
Things to remember
  • In front of the eye, there is a film called the cornea. A break results in an ulcer, which is an open sore on the skin.
  • It doesn't heal, and a crater-like wound starts to form as a result. A corneal ulcer develops when the eye's front film is harmed and doesn't heal.
  • That eye's vision is seriously compromised.
  • The term "corneal ulcer" refers to an open sore that can be seen or feel around the cornea from the eyes, or the movie in the entrance movie is damaged and doesn't heal, and it can have a significant impact on vision.
  • Both people and animals can suffer from this circumstance.
  • Clinical characteristics of the cornea include corneal irritation, lacrimation, photophobia, swelling of the eyelids, and a feeling of a foreign body
  • Corneal irritation, lacrimation, photophobia, swollen eyelids, a feeling of a foreign body, and redness of the eyes as a result of circumcorneal vascular congestion are some of the clinical characteristics of the cornea.
  • By taking a patient's history, you may learn about their trauma history, disease duration, mode of onset, and the severity of their symptoms.
  • The precise treatment—immediate care is required to stop corneal scarring or blindness.
  • Anti-inflammatory medications including ibrufen and paracetamol, as well as systemic analgesia, reduce swelling and alleviate pain.
  • Under local anesthetic, mechanical debridement of the ulcer to remove necrosed material by scarping the ulcer's floor with a spatula may speed healing.
Questions and Answers

The cornea is the transparent film that covers the front of the eye. An ulcer is a surface open sore caused by a break. It does not heal and thus forms a crater-like wound. A corneal ulcer occurs when the front film of the eye becomes damaged and fails to heal. That eye's vision is severely impaired.

Corneal ulcer is defined as an open sore that can be seen or appear around the cornea from the eyes, or the film in the entrance movie is damaged and does not heal, which can have a significant impact on vision. This situation can affect both animals and humans.

Cause

  • Predisposing factor
  • Corneal trauma: foreign body plants, contact lens
  • Entropion , ectropion
  • Trichiasis
  • Blepharitis
  • Chronic dacrocystities
  • Xeropthalmia
  • Measles, DM , TB
  • Immunosuppressed condition

 

Etiology agent

  1. Pyogenic bacteria- pseudomonas, staphylococcus, streptococcus
  2. Viruses- herpex simplex
  3. Fungus- candida, aspergillus
  4. Amoeba- acamthamoeba

Treatment

1.The specific treatment- prompt treatment is necessary to prevent corneal scarring or blindness.

  • Topical drops- Gentamycin eye drops with cephazoline eye drops every 1 hrly for 1st few days then reduced to 2 hrly.
  • Antibiotic eye ointment should be applied at night.
  • Subconjunctival injection of gentamycin 40mg and cephazoline 125 mg once a day for 5 days should also br given in sloughing corneal ulcer.
  • Instillation of atropine sulphate in order to dilate the pupils( and puts the ciliary body and iris at rest promotes healing of the ulcer and decrease pain)
  • Systematic antibiotics should be given according to doctors ordered.

2.Non specific treatment

  • Systemic analgesic and anti inflammatory drugs such as paracetamol and ibrufen relieve pain and decreases oedema
  • Vitamins ( A, B complex and c) helps in early healing and ulcer.

 

3.Physical and general measures

  • Hot formentation- local application of heat gives comfort, reduce pain and causes vasodilation.
  • Pad and bandage helps to heal the ulcer (if associated acute conjunctivitis and copious discharge it should be avoided)
  • Green shade or dark goggles should be used to protect the eye from irritation effects strong light.
  • Rest good diet and fresh air may have a soothing effects.

 

4.Surgical treatment for non healing corneal ulcer

  • Mechanical debridement of ulcer to remove necrosed material by scarping floor of ulcer with a spatula under local anaesthesia may hasten the healing
  • If the ulcer is deep and perforation of cornea appears possible a surgical conjunctival flap may be created to cover and seal the ulcer.
  • The corneal opacity which is left behind after successful management of corneal ulcer can be treated with corneal transplantation.

 

 

Nursing consideration

  • Isolation of the patient if possible.
  • Emphasis the good personal hygiene.
  • To keep beds clean.
  • Proper hand wash.
  • Trimming of nails and hairs.
  • Instillation of nails and hairs.
  • Instillation of topical eye drops oral medication according to doctors order.
  • Psychological support to the patient and family members.

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