A Simple Guide to Corneal Ulcer

A Simple Guide to Corneal Ulcer
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What is Corneal ulcer?
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Corneal ulcer is a inflammatory disease of the surface of the cornea which causes local destruction of the superficial layer of the cornea resulting in ulcers.

Corneal ulcers can be infectious(due to infection) or non infectious(due to injury or autoimmune disease)


Who is affected by corneal ulcer?
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Corneal ulcers may be present more frequently in patients with :
Vitamin A deficiency

autoimmune disease

neurological disorders like facial palsy

What is the Cause of corneal ulcer?
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The causes of Corneal ulcers can divided into 2 type:
Infections:
1. Bacterial infection such as Streptococci, Staphhylococci, pneumococci, pseudomonas

2. Viral infections such as herpes simplex, herpes zoster,

3. Fungal infection

Non-infection:
1.Injury due to hard contact lens, abrasions from trauma, accidental scratch

2.autoimmune disease

3.Systemic disease

What are the Symptoms and signs of corneal ulcer?
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Symptoms varies from mild to severe:

1.Severe pain in the eye or around the eye and eyebrow especially with infectious causes. Non-infectious causes may not give rise to pain.

2.Red eye - increased blood flow through inflamed eye shows up the blood vessels

3.Tearing -excess tears from inflammation

4.Discharge -may be pus discharge from eyes especially in the morning

5.Light sensitivity - sensitive to bright lights

Signs:

1.White spot on the cornea, that depending on the severity of the ulcer, may not be visible with the naked eye

2.increased dilated blood vessels present due to inflammation


How do you make the Diagnosis of corneal ulcer?
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The presence of a corneal ulcer can be seen using a slit lamp microscope.
Sometimes a dye fluorescein may be dropped into the eye making it more visible and easier to detect.

What investigation are necessary in Corneal ulcer?
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If the patient is suspected to have infection(pus discharge from the eyes), a tissue culture of the corneal cells(gently scraped from the ulcer) may be necessary to determine the type of micro-organism infecting the eye.


What are the complications of corneal ulcer?
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The complication is always the risk of :

1.Severe infection of the eye especially with pseudomonas infection causing infection of the anterior chamber of the eye and then spreading to the rest of eye resulting in loss of an eye.

2.Scarring of the corneal ulcer resulting in partial loss of vision

What is the treatment of corneal ulcer?
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Treatment depends on the type of corneal ulcer:

Infection:
1.Bacterial infection requires more intense treatment with oral antibiotics and antibiotic eye drops (given every 15 minutes)

2.Viral infections are usually treated with acyclovir tablets orally and acyclovir eye cream

3.Fungal infections are less common but are usually treated with antifungal medicine and eye drops.

In all infection cases, corticosteroid medications are not given.
Painkillers such as paracetamol can be given for pain

Non-infection:
1.Corticosteroid eye drops are usually given to reduce the inflammation

2.Antibiotic are also given to prevent infections of the ulcer.

In all cases the eye should be covered with eye pad until the epithelium of the ulcer heals about 10-14 days.

What is the prognosis of corneal ulcer?
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The prognosis depends on the severity of the disease

Most cases can be healed if detected early.

There may be minimum scarring of the cornea with possible loss of some vision.

Rarely the eye may be lost if there is severe infection and no treatment.


What are preventive measures in corneal ulcer?
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1. A nutritious diet with vitamin supplements can strengthen the body resistance against illness.

2.Avoid the use of infected contact lens lotion

3.A soft lens are more prone to eye infection. Always wash the hands before using any contact lens.

4.Avoid rubbing the eyes with dirty hands or tissues

5.A healthy lifestyle with less stress and mild exercise is always good for the body.

A Simple Guide to Crohn's Disease

A Simple Guide to Crohn's Disease
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What is Crohn's Disease?
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Crohn's Disease(Regional Enteritis) is a chronic inflammatory disease of the gastrointestinal tract which affects the layers of the lining of the whole gastrointestinal tract from mouth to anus.

It was originally called regional ileitis because the ileum was typically affected but has been extended to regional enteritis because the whole layer of the lining of the gastrointestinal tract can be affected from the mouth to anus.

Who is affected by Crohn's Disease?
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Crohn's Disease is more common in Jews than non-Jews and in whites than non-whites

It occurs equally in men and women and can be found in families.

Crohn's Disease can be found in all ages but are more common in the 20-30 years age group.

What is the Cause of Crohn's Disease?
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The exact cause of Crohn's Disease is not known.

It has been suggested that an autoimmune disease is the main cause of Crohn's Disease.

A protein produced by the immune system, called anti-tumor necrosis factor (TNF) may be a possible cause of the body's reaction in the lining of the gastrointestinal tract resulting in inflammation.

Infectious causes has also been blamed.


What are the Symptoms and signs of Crohn's Disease?
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Symptoms varies from mild to severe:

1.severe abdominal pain, especially in the right iliac fossa

2.diarrhea

3.Rectal Bleeding

4.fever

5.weight loss

6.loss of appetite

7.joint pain

Signs:

1.Abdominal distension and tenderness
Abdominal mass may be felt in the right iliac fossa

2.Rectal examination may show blood in the stool

3.pallor due to anemia

4.skin lesions


How do you make the Diagnosis of Crohn's Disease?
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1.A history of abdominal pain , diarrhea and bloody stools

2.The physical exam consists of
a.palpation of the abdomen for tenderness and right iliac fossa mass

b.digital rectal exam to detect blood.

3.stool may be tested for blood

4.blood tests(Hb, WBC, ESR, blood culture) are done for evidence of infection.

5.X-rays of the abdomen, barium meal and barium enema may be done to show evidence of extent of inflammation and narrowing of segment of intestine

6.Colonoscopy is also done to confirm extent of colon involvement.
A biopsy of inflamed lining may be done for microscopic examination.

7.A small camera which can be swallowed and passed out in the stools can take photos of the entire gastrointestinal tract.


What are the complications of Crohn's Disease?
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Bowel complications:

1.Strictures of intestine leading to blockage

2.Fistula especially in the rectal region

3.Fissures in the anal region

4.hemorrhage

Non-bowel complications:

1.Bones: arthritis, sacroiliatis
osteoporosis

2.Eyes: uveitis, iritis

3.mouth ulcers

4.Skin: eczema

5.Nutrition: malabsorption and vitamin deficiency

What is the treatment of Ulcerative Colitis?
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Treatment is symptomatic to relieve discomfort, correct nutritional deficiencies, and control inflammation of the gastrointestinal tract.

Medications:

1.Anti-diarheal and bulk forming agents

2.Anti-spasmotic medication for spasm of the colon

3.Anti-inflammation drugs like Sulfasalazine (immunosuppressant) given indefintely.
Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, may be used by people who cannot take sulfasalazine.

4.Oral corticosteroids in high doses at first, followed by reduction of dosage.
These are for short term use only because of the side effects.

5.azathioprine and 6-mercapto-purine (6-MP) can also reduce inflammation by suppressing the immune system

6.Infliximab (Remicade). This drug helps by blocking the body's inflammation response

7.Antibiotics like ampicillin, septrim, flagyl, cephalosporin, tetracycline helps to treat bacterial infections in strictures, fistulas.

8.Correction of anemia and nutritional deficiencies is important to enhance the immune system

9.Replacement of fluids and electrolytes are important in cases of dehydration especially in children.

10.Regular hemoglobin, blood counts and liver function tests

Surgery:

Surgery is required:

1.if medications cannot control the symptoms or progression of the disease
2.to treat complications such as blockage, perforation, abscess, or bleeding in the intestine.

Resection of the inflammed segment of the intestine is removed and may relieve symptoms but is not a cure.
There has been instances where recurrence occur in the the segment next to the resected intestine.

In more severe cases a total colectomy with ileostomy( a stoma is left in the abdomen for disposal of faeces) is done.

Emergency surgery may be done for perforation, peritonitis, or continued bleeding.


What is the prognosis of Crohn's Disease?
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The prognosis depends on the severity of the disease

Three quarters of patients with Crohn's Disease will require surgery sooner or later.

There will be temporary relief of symptoms but recurrences are common.

In many cases with proper treatment, patients are able to lead a normal life.

What are preventive measures in Crohn's Disease?
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A nutritious diet with vitamin supplements can strengthen the body resistance against illness.

Certain foods such as spicy food, milk products and alcohol which may spark off an attack of abdominal discomfort and diarrhea should be avoided.

Stress can also trigger off episodes of Crohn's disease.

A healthy lifestyle with meditation and mild exercise can always help to prevent triggering off an attack of Crohn's Disease.