Initial treatment for perforated corneal ulcer is: March 2009

Ans. B: Tissue adhesive glue Bacterial corneal ulcer requires intensive foified antibiotic therapy to treat the infection. Fungal corneal ulcers require intensive application of topical anti-fungal agents. Viral corneal ulceration caused by herpes virus may respond to antivirals like topical acyclovir ointment instilled at least five times a day. Alongside, suppoive therapy like pain medications are given, including topical cycloplegics like atropine or homatropine to dilate the pupil and thereby stop spasms of the ciliary muscle. All forced expiration like blowing the nose, coughing etc. must be avoided. Proper nutrition, including protein intake and Vitamin C are usually advised. In cases of Keratomalacia, where the corneal ulceration is due to a deficiency of Vitamin A, supplementation of the Vitamin A by oral or intramuscular route is given. Drugs that are usually contraindicated in corneal ulcer are topical coicosteroids and anesthetics - these should not be used on any type of corneal ulcer because they prevent healing, may lead to superinfection with fungi and other bacteria Fuher option is the use of a tissue adhesive such as N-butyl 2-ethyl cyanoacrylate monomer which is applied to the area of perforation after careful debridement. Drying of the adhesive may take few minutes after which anterior chamber may reform. Following this, a continuous-wear soft contact lens can be applied or a definite surgical procedure such as therapeutic penetrating keratoplasty or conjunctival flap undeaken. Superficial ulcers may heal in less than a week.