A 55 yrs female presents with c/o severe pain & f.b sensation , redness & watering in Lt eye since last 3 to 4 days. Thre is no h/o trauma or f.b in the eye or any Rx taken .There was some d/ v vn in eye. Pt was found to have lid edema , normal pupil , & ? Epithelial lesion in Central cornea. Antibiotic eye drops & cycloplegic & Nsaids & dark glasses were prescribed & pt was called on next day. On the next day lid edema increased & Central corneal epithelial defect with folds in descemet's membrane were found . Please explain the evolution of the pathology & Rx.

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This is corneal epithelial defect. Also check corneal sensation .Do flourescein staining. Tulle out herpes simplex. Rule out lagophthalmos and check no sugar for diabetes. Don't give NSAID. They are epitheliotoxic . Eye pad helps in nohealing erosion. Add antibiotic ointment as well. Give oral Bit A and C. Off course that you have exerted the lid to look for offending causes.

Spelling mistakes. Read Rule for Tulle, blood for no, nonhealing in place of nohealing Vit A for Bit A and everted for exerted. Thanks
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This pt was prescribed Antibiotic eye drops after healing of epithelial defect ,& 4 days later ,she came for f/ up . Her Lt eye was found to be completely Normal & She was cured.

Causes of epithelial defect with stromal edema can be: Trauma/ vigorous rubbing Raised IOP Severe dry eye Viral keratoconjunctivitis sequelae, etc

One important miss: keratitis medicamentosa
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Keratoconjunctivitis

Keratoconjunctivitis

This pt's central cornea was found to be almost normal when pt presented for the first time. There were definitely no dendritic keratitis like or disciform keratitis like lesions or epithelial bullae. There were 4 to 5, isolated minute pinpoint sized doubtful infiltrating spots slightly inferonasal to pupil. The picture was almost Suggestiive of severe acute conjunctivitis . On the next day pt came with corneal epithelial defect in central cornea , but all doubtful Infiltrating points had disappeared. After instilling antibiotics drops & cycloplegic & timolol ,eye patch was applied , & oral Nsaids continued. On the next day ,the epithelial defect began to heal & in just 2 days there was complete epithelial healing with pt relieved of pain & f.b sensation. Thereafter , patch was removed ,& again pt was prescribed to continue topical antibiotics drops..

So you mean it was keratoconjunctivitis?
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@Dr. Ratnesh Kumar @Dr. Ramchandra Kaushik @Dr. Arun Rajan @Dr. Samrin Sarwar @Dr. Vaibhev Mittal @Dr. Neha Mehrotra @Dr. Manbir Singh @Dr. Brijesh Gupta @Dr. Sneha Prabhu @Dr. Rashmi Barve Please make opinion . Thanks.

@Dr. E Ahmed Please make an opinion. Thanks.
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First stain with fluorocin & look for pattern of staining.If it is dendritic,start Acivir or Virson gel along with oral acyclovir.But since there is severe pain & lid edema(which is very unusual in Herpes Simplex),it goes more in favour of bacterial ulcer.Treat with topical antibiotic, cycloplegic & oral anti inflamatory drugs.

Place a bcl fr hastened healing.luk fr hidden fb under d conj.some pts vl nt reveal d history properly. Dds cud b chemical injury, acute ACG wid ruptured bullae leading to ep defect, low iop can cause dm folds, epithelial dendrites leading to geographic ulcer

Respected mam , Bandage c.l r used to promote healing as a last resort after all conventional measures have failed. Why to use them first of all ? None of the causes u mentioned , r present in this case.
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Going through the case report and age of the patient suspicion of DM should be there.If possible a NCT is advised, though there is no ciliary congestion.Also test corneal sensation. I am curious to know about this case of yours.With best wishes.

There is cilliary congestion , sir , but because of reflex of light in the picture eye appears to be white. I have mentioned presence of redness in findings. What , I m really interested to know is , what were the preceding events for the development of corneal epithelial defect. Thanks.
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