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    Expert tips for surgically managing corneal perforations


    Pseudomonas ulcer. Photo courtesy of Sonal Tuli, MDEstimates of the incidence of corneal ulcers seen in ophthalmology patients range from 1 in 1,000 to 1 in 10,000, she said.

    They are more common in warm humid places where bacteria and fungi grow more quickly. She said that explains why so many find their way to her Florida practice.

    “We definitely see tenfold more in the South,” she said. She often sees patients whose infections start with contaminated contact lenses. These ulcerations often cause significant tissue loss resulting in corneal perforations.

    Neurotrophic keratitis, peripheral ulcer keratitis, and Rosacea-related blepharokeratitis can lead to similar damage. In addition, pellucid marginal degeneration, Terrien’s marginal degeneration, keratoglobus, and Peters anomaly can also be the causes.

    As the eye becomes inflamed in response to breakdown of the epithelium, leukocytes produce proteases that cause tissue lysis.

    “The basic principle is that these are substances that chew up the cornea,” Dr. Tuli said. “They can be produced by bacteria, by our own leukocytes that are recruited to the eye to fight the infection, or could be produced by autoimmune processes.”

    Diseases such as rheumatoid arthritis can lead to cornea ulcers, she explained, because inflammatory mediators may emerge from the hairpin bends of limbal blood vessels in the eye, attacking tissues there much as they do in joints.

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