Clinical features:

Ø  Source of infection can be exogenous or endogenous (from other ocular structures)

Ø  Patient presents with history of trauma to the eye with pain and redness.

Ø  Concomitant photophobia, discharge and dimness of vision can also be present.

Ø  On examination, conjunctival and circumcorneal vessels may be engorged and inflamed with localized epithelium disintegrated and cast off.

Ø  Ulcer is saucer shaped, walls project above the normal corneal surface.

Ø  Surrounding area shows grey discoloration (cloudiness) suggestive of the progressive stage of the ulcer-microscopic tissue examination reveals leucocytic infiltration.

Ø  In severe cases there is pronounced anterior chamber reaction, often with hypopyon.

Investigations:

Ø  Conjunctival swab and ulcer scrapings can be tested with Gram stain, KOH preparation and culture to determine the etiology.

Ø  Routine investigations like complete blood count, blood sugar, urine examination should be done. Septic foci should be found.

Non- pharmacological treatment:

l  Maintain proper ocular hygiene by cleaning discharge twice a day.

l  Removal of contributory factors like trichiasis, foreign body etc.

l  The eye can be covered with a pad, unless the discharge is copious. In such case, shield the eye with dark goggles.

l  Prevention and treatment of complications – secondary glaucoma.

Pharmacological treatment:

1.       Control of infection with antibiotics-Start with empirical broad spectrum antibiotics, which can be changed according to sensitivity report

2.       Use atropine 1% eye drops or ointment for controlling iridocyclitis, to relieve ciliary spasm and to prevent synechia formation.

3.       Other measures like scraping and cauterization.

4.       If the ulcer progresses in spite of the pharmacological treatment, the removal of the necrotic material may be hastened by scraping or ulcer may be cauterized with 100% carbolic acid, 10% trichloracetic acid 10% or 5% povidone iodine.

5.       In case of non resolving ulcers, surgical methods like vasculoplasty, conjuctival hooding and patch graft, tectonic penetrating keratoplasty and tarsorraphy can be considered.

Patient education:

u  Use dark goggles and avoid close contact with other persons for two weeks.

u  Restrict work and school for patients with significant exposure to others.

u  Frequent handwashing.