Marginal ulcerative keratitis

Introduction Ulcerative keratitis, also known as corneal ulcer, is mostly caused by external factors, that is, inflammation of the infectious virulence factor caused by external invasion of the corneal epithelial cell layer. Patients often complain of decreased vision, photophobia and foreign body sensation. At the edge of the cornea there is a turbid zone formed by leukocyte infiltration and ulceration, which can be stained with fluorescein green.

Cause

1. External causes: Most of the corneal infections caused by external causes have two conditions:

a. Damage and shedding of corneal epithelial cells.

b. Simultaneous infection. Infectious corneal ulcers are more likely to occur only if both conditions are available.

2. Internal cause: refers to an intrinsic disease from the whole body.

There is no blood vessel in the cornea, so acute infectious diseases are not easy to invade the cornea. However, the corneal tissue participates in the systemic immune response, although the degree of immune response is lower than that of other tissues, but because it has no blood vessels and the metabolism is slow, the change of this immune response lasts for a long time, and the cornea is in a long time. It is in a sensitive state, so that allergic diseases such as vesicular keratitis are prone to occur.

3. Caused by the spread of adjacent tissues: due to embryonic homology and anatomical continuity, the disease that spreads to the corneal epithelium mostly comes from the conjunctiva, such as severe conjunctivitis and superficial keratitis.

an examination

Related inspection

Fundus examination, fundus examination, tear secretion, immunoglobulin A, corneal lesion, scraping, tear electrolyte

Therefore, clinical examination of patients with marginal ulcerative keratitis:

First, physical examination

Taking a medical history gives us a first impression and revelation, and also guides us to a concept of the nature of the disease.

Second, laboratory inspection

Laboratory examinations must be summarized and analyzed based on objective data learned from medical history and physical examination, from which several diagnostic possibilities may be proposed, and further consideration should be given to those examinations to confirm the diagnosis. Such as: ophthalmoscopy, corneal lesions, corneal endothelial cell counters, Cochet and Bonnet's corneal sensory, corneal staining, tear secretion immunoglobulin, tear lysozyme, tear electrolytes and other inspection items.

Differential diagnosis

1, bacterial keratitis: the common bacteria causing this disease are pneumococci, staphylococcus, streptococcus, etc., due to the strong virulence of bacteria, rapid progress, often cause acute suppurative corneal ulcer, clinically known as "carrying Corneal ulcers; followed by corneal ulcers caused by Pseudomonas aeruginosa.

2, fungal keratitis: common pathogenic fungus is Aspergillus, followed by Fusarium. Because the early symptoms of this disease are mild, slow development, often misdiagnosed, after the formation of corneal ulcer, the surface of the ulcer is characterized by a toothpaste-like or tongue-like appearance.

3, allergic keratitis: caused by congenital and allergic factors, including bundle keratitis, deep keratitis, sclerosing keratitis, corneal parenchyma and so on.

4. Trauma and nutritional keratitis: including corneal epithelial exfoliation, corneal softening, paralytic keratitis and exposed keratitis.

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