Case 8: Corneal Ulcer - The 10 Essentials to Do 

A. CONGENITAL: i. Congenital trigeminal anesthesia. ii. Corneal dystrophies B. ACQUIRED: i. Diabetes mellitus: reduces sensitivity. ii. Herpes simplex keratitis. iii. Leprosy. iv. Adie’s tonic pupil v. Myasthenia gravis. vi. Toxic corneal hypoesthesia: C. PHYSIOLOGICAL: i. Iris color-lighters the iris color, more the sensitivity. ii. Gender-more sensitive in males than females. iii. Eyelid closure: decreases sensitivity. This is due to depressed acetylcholine levels with lid close. This is the reason for low corneal sensitivity in morning after a night’s sleep. D. PHARMACOLOGICAL: i. Surface anesthetics like 4% lignocaine, 0.5% proparacaine. ii. Beta blockers-temporary decrease. iii. Sodium sulfacetamide-30% solution decreases sensitivity. iv. Atropine-decreases sensitivity after 10 minutes of instillation. This is due to decreased acetylcholine. E. HORMONAL: i. Preovulatory reduction in corneal sensations due to estrogen rise. ii. Decreased corneal sensitivity during pregnancy. F. MECHANICAL: i. Contact lens: decreases corneal sensitivity. This may be attributed to the decrease in oxygen pressure at epithelial level. G. SURGICAL: i. Limbal incisions ii. Corneal grafts iii. Refractive surgeries: LASIK decreases sensations. iv. Other procedures: Photocoagulation and retinal detachment surgeries. v. Trigeminal denervation

@@pranesh thank you sir , what is the answer for 2nd question??

The second Q more or less reflects the 1st. Any corneal lesion should induce pain but if the corneal nerves are bad in quantity/ quality the pt cannot perceive the sensation.

To give an answer, I feel the viral keratitis and systemic diseases like DM will cause pt not to perceive the pain despite the lesion

@@pranesh thank you sir 🙏🙏

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