What is the role of slit-lamp exam in the assessment of corneal ulcer and ulcerative keratitis?

Updated: Aug 05, 2019
  • Author: Jesse Borke, MD, FACEP, FAAEM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Slit lamp examination should follow gross examination in all suspected cases.

Clinical features suggestive of bacterial keratitis include suppurative stromal infiltrate (particularly >1 mm) with indistinct edges, edema, and white cell infiltration in surrounding stroma. An epithelial defect is typically present. An anterior chamber reaction is often seen. [8] The ulcer often is round or oval, and the border is generally demarcated sharply, with the base appearing ragged and gray. Slit lamp examination may reveal findings of iritis, and hypopyon may be present. Hypopyon is an accumulation of inflammatory cells in the anterior chamber that produces a layered meniscus in the inferior anterior chamber.

Slit-lamp examination should include assessment of the following: [8]

  • Corneal epithelium, including defects and punctate keratopathy, edema
  • Corneal stroma, including ulceration, thinning, perforation, and infiltrate (location [central, peripheral, perineural, surgical, or traumatic wound], density, size, shape [ring], number [satellite], depth, character of infiltrate margin [suppuration, necrosis, feathery, soft, crystalline], color), edema
  • Corneal endothelium
  • Corneal (or scleral) foreign bodies
  • Signs of corneal dystrophies (eg, epithelial basement membrane dystrophy)
  • Previous corneal inflammation (thinning, scarring, or neovascularization)
  • Signs of previous corneal or refractive surgery
  • Anterior chamber for depth and the presence of inflammation, including cell and flare, hypopyon, hyphema

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