CORNEAL ULCER

• A corneal ulcer may be defined as a discontinuation of the normal epithelial surface of cornea associated with necrosis of the surrounding corneal tissue
• Pathologically, it is characterised by oedema and cellular infiltration
• Inflammation of the cornea (keratitis) is characterised by corneal oedema, cellular infiltration and ciliary congestion

Etiological classification

• Infective keratitis
• Allergic keratitis
• Trophic keratitis
• Keratitis associated with diseases of the skin and mucous membrane
• Keratitis associated with systemic collagen vascular disorders
• Traumatic keratitis
• Idiopathic keratitis

• Chemical irritation
• An object in the eye, such as sand or dust
• Something striking the eye, such as a tree branch
• Radiation injury from the sun, sun lamps, welding, or sun reflected on snow (snow blindness)
• Complications of contact lens wear

Symptoms

• Pain and foreign body sensation
• Watering from the eye occurs due to reflex hyper lacrimation
• Photophobia
• Blurred vision results from the corneal haze
• Redness of eyes occurs due to congestion of circum corneal vessels

Signs

• Swelling of lids.
• Blepharospasm may be moderate to severe
• Conjunctival hyperaemia and ciliary congestion
• Corneal ulcer

Thorough history taking to elicit mode of onset

Ocular examination -

• Diffuse light examination for gross lesions of lids, conjunctiva and cornea including testing for sensations
• Regurgitation test and syringing to rule out lacrimal sac infection
• Bio microscopic examination after staining of corneal ulcer with 2% freshly prepared aqueous solution of fluorescing in dye or sterilised fluoresce in impregnated filter paper strip

• Topical antibiotics
• Systemic antibiotics
• Cycloplegic drugs. Preferably 1% atropine eye ointment or drops should be used
• To reduce pain from ciliary spasm and
• To prevent the formation of posterior synechiae from secondary iridocyclitis

Physical and general measures

• Hot fomentation -Local application of heat gives comfort, reduces pain and causes vasodilatation
• Dark goggles may be used to prevent photophobia
• Rest, good diet and fresh air may have a soothing effect

Ayurvedic Treatment

Internal medicines

• Panchatikthaka kashaya
• Guduchyadi kashaya
• Kaisora guggulu
• Padoladi gritha
• Triphala gritha
• Thikthaka gritha

Procedures

• Netra dhara - Darvi+ Yasti+ Lodra kashaya
• Jaloukavacharana - forehead
• Virechana - Avipathi choorna
• Nasya - Ksheerabala avarthi
• Anjana - Jateemukuladi varti+ honey , Mudganjana + honey
• Aschotana – Durva gritha
• Lekhana Anjana - After inflammation subsides
• Jeevaneeya Putapaka x 1 day