• drawing the ulcer
• source of the infection
• eyelids
• scraping and culturing the ulcer
• the organism
• treatment

• mostly the eye lids
• infection introduced from contact lens
• underlying Sjogrens/very dry eyes..examine teeth...excess decay = caries = Sjogrens
• if the ulcer is resistant to treatment see Eye 2012
  

The organism has often spread from the eyelids. This is particularly likely in chronic blepharitis.

the thickened lid in blepharitis
(normal left, blepharitis right)

Look for the meibomian glands on the inside of the eyelid. Express the glands. Glands may be reduced and scarred or keratinised in blepharitis.photo  See

blocked meibomian glands

• must wear a glove
• number 11 blade
• scrape the ulcer
• place the entire blade in a culture bottle and put top on.
• BHI :  brain heart infusion broth (bacteria and fungus)
• this culture medium usually lasts 3 months, and can be kept ready in the clinic
• PCR..will be helpful soon
  

• 25% pseudomonas
• 20% staph aureus
• 10% pneumococcus (very dangerous)
• 15% enterococci
  

• half hourly drops
• admit...36-48 hours of half-hourly drop is impractical at home, and does not work
• once you know organism no need for more than one drug (usually)
• fungal infections...inject drug into cornea
• pneumococcus ..penicillin / chloramphenicol
• pseudomonas (in the UK) usually ciprofloxacin sensitive..ointment..half hourly
• staph aureous...fuithalmic/penicillin/Teicoplenin
• combination..rifampicin aids amphotericin
• gentamicin and ciproflaxacin..not together (antagonistic)
• no steroid for 2 weeks
• acanthomoeba....chlorhexidine for 4 weeks