الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
A corneal ulcer, or ulcerative keratitis, is a wound or sore on the cornea. the clear part of the eye that covers the iris and pupil. Corneal ulcers sometimes form when the surface of the cornea is damaged or compromised. A corneal ulcer may cause a variety of symptoms including eye redness, pain, squinting, tearing, discharge and reduced vision. Corneal ulcers have many causes, but most are caused by infection.
So,in this study, corneal ulcers were studied to detect the incidence of different types of corneal ulcers ” its predisposing factors, etiological diagnosis, treatment and treatment outcome”.
69 patients were examined for visual acuity , slit lamp biomicroscopy and ophthalmoscopic examination. Landolt C chart was used to measure the visual acuity, indirect ophthalmoscope was used for fundus examination , slit lamp biomicroscopy was used to examin the cornea and the ulcer.
The predisposing factors were trauma in 33 patients (47,8%), corneal scar in 3 patients (4,3%), blepharitis in 3 patients (4,3%), dry eye in 17 (24,6%), contact lens wear in 8 patients (11,6%), lagophthalmos in 3 patients (4,3%), diabetes mellitus and epithelial dystrophy in 2 patients (2,9%).
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In 33 patients where trauma was the predisposing factor; traumatic agents varies between: stones in 10 patients (14,5%), fingernail in 9 patients (13%), tree branch in 7 patients (10,1%), metallic forign body in 4 patients (5,8%), vegitable matter in 2 cases (2,9%), animal matter in one case (1,4%). In other 36 patients trauma was not the predisposing factor so that there was not traumatic agent.
Out of 69 suspected cases of corneal ulcers 20 (29%) were traumatic ulcers, 14 (20,3%) were viral, 9 (13%) were pure bacterial, 6 (8,7%) were fungal, 2 (2,9%) were bacterial with descematocele, 2 (2,9%) were bacterial with fungal, 2 (2,9%)were bacterial with viral, 2 (2,9%) were bacterial with hypopyon ,2 (2,9%) were melting ulcers, 2 (2,9%)were moreen ulcers, 2 (2,9%)were exposure ulcers, 2 (2,9%) were indolent ulcers, 2 (2,9%) were acanthameba ulcer, 1 (1,4%) was atheromatous ulcers, 1 (1,4%) was Traumatic with fungal ulcer .
Majority of the bacterial ulcers were caused by staphylococcus areus (11,6%) and candida (7,2%) was the leading cause of fungal ulcers, herpes simplex virus was the only cause of viral corneal ulcers.
Over all culture was positive in 34 (49,3%) of cases and was negative in 10 (14,5%) of cases and not needed to be done in 25 (36,2%) of all cases.
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In culture positive cases organisms were staph. Areus in (11,6%), candida in (7,2%), herpes simplex virus in (5,8%), staph- epidermis in (2,9%), asparagilus in (2,9%), staph. Pyogens in (2,9%), psudomonus in (1,4%), herpes simplex with strept pyogens in (1,4%), herpes simplex with staph areus in (1,4%), acanthameba in (1,4%), strept. Viridians with candida in (1,4%), candida with staph. Pyogens in (1,4%), strept pyogens in (1,4%) of all cases.
Greater number of patients had sought medical help at our hospital with duration less than 3 weeks and only (38%) of patients with duration more than 3 weeks.
In the 69 patients 37 (53,6%) treated with antibiotics only, 5 (7,2%) treated with antibiotics and steroids , 9 (13%)treated with antibiotics and antifungal agents, 16 ( 23,2%) treated with antibiotics and antiviral agents 2 (2,9%)treated with antibiotics and antiacanthameba agents.
All patients were started on medical therapy initially, however (21,7%) of the patient required surgical intervention as shown in table”14” in the form of: amniotic membrane graft in (1,4%) , debridment in (7,2%), edge excision in (1,4%), scraping in (1,4%), bandage contact lens in (10,1%) of all patients.
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Over all treatment outcome in corneal ulcers patients is shown in table ”10”, healing of ulcers in (62,3%), nebula in (23,2%), non adherent leucoma in (11,6%), no response ”worsening” in (2,9%) of 69 patients. Corneal healed ulcers was achieved in (62,3%) of cases.
A multicenter study with more follow up periods on larger number of eyes is recommended to draw out the incidence of different types of corneal ulcers, proper examination techniques are recommended.