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Monday, December 17, 2012

USING STEROIDS IN BACTERIAL CORNEAL ULCERS

This study in Ophthalmic Epidemiology concludes that the adjunctive use of topical steroids in bacterial corneal ulcers improves visual outcome.  Personally I wait until the ulcer is mostly healed before considering the use of topical steroids to minimize scarring.

1 comment:

  1. Hey there! This is a good read. I will be looking forward to visit your page again and for your other posts as well. Thank you for sharing your thoughts about corneal ulcer. I'm glad to stop by your site and know more about corneal ulcer. Keep it up!
    Viral keratitis causes corneal ulceration. It is caused most commonly by Herpes simplex, Herpes Zoster and Adenoviruses. Also it can be caused by coronaviruses & many other viruses. Herpes virus cause a dendritic ulcer, which can recur and relapse over the lifetime of an individual.
    Although corneal epithelium, conjunctival epithelium, and corneal fibroblasts are all capable of producing matrix metalloproteinases, including classical collagenase, abundant evidence indicates that the preeminent source of degradative enzymes which produce corneal stromal destruction in cases of corneal ulceration are delivered to the site of the corneal ulceration by neutrophils. Routine histopathologic studies and ultrastructural studies show that, regardless of the initiating stimulus for corneal ulceration, neutrophils are routinely present, in abundant numbers, and they all exhibit the ultrastructural characteristics of "activated" neutrophils. By contrast, the origin of these neutrophils, similarly, is generally underappreciated: the preocular tear film. The neutrophils have access to the damaged cornea primarily through the tears, and exclusion of the tears from the area of corneal degradation instantly arrests the ulcerative process. This was shown nearly 20 years ago in various experiments employing glued on hard contact lenses and the use of surgical adhesive itself, which provides its benefits to the ulcerating corneal not because of some sort of structural support, but rather because of a mechanical barrier to neutrophils from the preocular tear film. Indeed, histopathologic studies of such glued corneas shows essentially an acellular stroma in the affected stromal regions, whether the problem has been created by alkali burning, infectious keratopathy, an autoimmune process, or thermal burns.

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