RAMJIPANDEY

1. WORK UP CASE OF KERATITIS
PRESENTER-RAMJI PANDEY
(CONSULTANT
OPTOMETRIST)

2. Workup protocol in keratitis
• History
• Visual acuity
• Gross external examination
• slit lamp examination
• Care should be taken
• IOP
• Syringing
• Dilate the eyes for retinal evaluation
• Microbiology report

3. DEMOGRAPHIC DATA
M#R: xxxxx
Name: yyyyy
Age: 28
Sex: Female
D/O: 9/2/1987
Occupation: House Wife

4. Chief Complain
• Major Symptoms- Pain, watering, pricking
sensation, Decrease of vision, redness, pus
formation since 2 week after ocular injury by
sugar cane leaf.

5. Past History
H/O of ocular by injury with sugarcane leaf
since 2 weeks ago
No H/O of recent oph.consultant @ Bijnor with
Dr. Jay Prakash
Family history :- Nil
Surgeries/lasers procedure/ Allergies/ Systemic
disease/ Past surgeries / current treatment:-Nil
current treatment: using some eye drops

6. UVA OD OS
Distance :- 20/20 CF@CF (PL+VE,PR ACCURATE)
NI
Near :- N6 N60
with Hindi chart at 30 cm.
Retinoscopy (dry) :- plano DEFER
Acceptance Dist. :- DEFER
Near :-
IOP & time 12 Dig(N)
(mm of Hg @2:03pm)

7. OD OS
Lid Flat Eedema
Conjunctiva Quiet Congestion
Cornea Clear Stromal infiltrate
with epi defect
Anterior chamber PACD>1/4CT/Quiet PACD>1/4CT
Hypopyon 1mm
Pupil R/R/R r/m/f
Lens
iop
Clear
12
Clear
DIG(N)

8. Signs
• Feathery margins
• Immune ring
• Satellite lesions
• Endothelial plaque
• Hypopyon

9. CON..
 SIGNS(SPECIFIC)
• Infiltrate
• Feathery margins
• Gray/brown pigmentation
• Elevated edges
• Rough texture
• Satellite lesions
• Fixed hypopyon
Cornea, 3rd Edition
By Jay H. Krachmer, MD, Mark J. Mannis, MD, FACS and Edward J. Holland, MD

10. Con..
FEATHERY MARGINS BROWN PIGMENTATION ELEVATED EDGES
ROUGH TEXTURE STATELLITE LESIONS FIXED HYPOPYON
CORNEAL ULCERS Diagnosis and Managemen Namrata Sharma MD DNB MNAMS

11. INVESTIGATION
 SYSTEMIC INVESTIGATION-
• Blood Sugar
 OCULAR INVESTIGATION-
• Intra ocular pressure
• Slit Lamp Photo
• B-Scan
• Syringing
 MICROBIOLOGICAL INVESTIGATION
• Corneal scraping
CORNEAL ULCERS Diagnosis and Management Namrata SharmaMD DNB MNAMS

12. Investigation
 CULTURE MEDIA-
• 2 slides
• Blood agar
• Chocolate agar
• Sabouraud's dextrose agar(SDA)
• Brain-heart Infusion (BHI)
• Thioglycollate broth.
•
CORNEAL ULCERS Diagnosis and Management Namrata SharmaMD DNB MNAMS

13. Plan of treatment
• Medical Therapy- as per organism comes in
smear report and culture report
• Follow the patient to see

14. HERPES SIMPLEX KERATITIS

15. Workup protocol in viral keratitis
• History
• Visual acuity
• External examination
• Slit lamp examination
• Corneal sensation
• Rose Bengal satin
• Care should be taken
• IOP

16. DEMOGRAPHIC DATA
M#R: xxxxx
Name: yyyyy
Age: 28
Sex: Female
D/O: 9/2/1987
Occupation: House Wife

17. Chief Complain
• Major Symptoms- Pain, watering, pricking
sensation, Decrease of vision, redness, since 1
week after fever .

18. Past History
H/O Fever since 1 weeks ago
No H/O of recent oph.consultant dr pk pandey
where diagnosis left eye hsv keratitis
Family history :- Nil
Surgeries/lasers procedure/ Allergies/ Systemic
disease/ Past surgeries / current treatment:-Nil
current treatment: using some eye drops

19. UVA OD OS
Distance :- 20/20 20/40 NI
Near :- N6 N8
with Hindi chart at 30 cm.
Retinoscopy (dry) :- plano DEFER
Acceptance Dist. :- DEFER
Near :-
IOP & time 12 Dig(N)
(mm of Hg @2:03pm)

20. OD OS
Lid Flat Eedema
Conjunctiva Quiet Congestion
Cornea Clear Mild Stromal/
stanning+ve
dendritic pattern
Anterior chamber PACD>1/4CT/Quiet PACD>1/4C
Pupil R/R/R R/R/R
Lens
iop
Clear
12
Clear
DIG(N)

21. signs
• HSV keratitis is the presence of multiple small
branching epithelial dendrites on the surface of
the cornea, punctuate epithelial keratitis .
•
21

22. Clinical feature
• The bed of the ulcer stains with fluorescein,
while the swollen corneal epithelium at the
edge of the ulcer typically stains with rose
bengal.
• Several dendrites may also coalesce to form a
geographic epithelial ulcer.
• mild stromal edema and subepithelial
infiltration..

23. Symptoms
• The symptoms of herpes keratitis may include:
• Pain
• Redness
• Blurred vision
• Tearing
• Sensitivity to light

24. HERPES SIMPLEX KERATITIS
• HSV Keratitis is not only infectious keratitis it is also
immunologic diseases that can affect all levels of the cornea .

25. CLASIFICATION OF HSV KERATITIS
 Infectious epithelial keratitis
• Cornea vesicles
• Dendritic keratitis
• Geographic keratitis
• Marginal keratitis
• Neurotrophic keratopathy
 Stromal keratitis
• Necrotizing stromal keratitis
• Immune stromal (interstitial) keratitis
 Endotheliitis
• Disciform
• Diffuse
• Linear

26. Cornea vesicles /Punctate epithelial
keratitis
• This keratitis by swelling of the epithelium cells from intra
cellular replication of HSV.
• Initial epithelial of HSK are small vesicle that are generally
described as punctate epithelial.
• Sign - Lesion are minute
raised and vesicle.

27. CON..
 Dendritic ulcer- The features of a dendritic ulcer include a
branching, linear lesion and swollen epithelial borders that
contain live virus.
• This lesion represents a true ulcer in that it extends through the
basement membrane.

28. DIAGNOSTIC,CLINICAL TEST TEST
• Cornea sensation
• Rose Bengal satin
https://wherpes-simplex-virus-keratitis-treatment-guideline

29. Do’s
• Take measurement of epithelium defect and
infiltrate in every visit.
• Before putting the anesthetic drop should
check corneal sensitivity
• Always draw the diagram
• Always look for AC reaction- Measurement of
hypopyon
• Take IOP digitally
• Seidel test

30. Don’t
• Not checked IOP by GAT
• If perforation- defer Digitally
• Defer refraction if patient very symptomatic
• Dilatation- In COVID OPD- Not neccessery (
or as ophthal advice)

31. THANK YOU