Download MBBS Ophthalmology PPT 29 Diseases Of The Cornea 3 Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Ophthalmology PPT 29 Diseases Of The Cornea 3 Lecture Notes


DISEASES OF THE CORNEA

Department of Ophthalmology



IMMUNE MEDIATED KERATITIS

n Phlyctenular keratitis

n Marginal ulcer( catarrhal ulcer)

n Asso. with acne rosacea

n Asso with systemic collagen vascular disease

n Chronic serpiginous(Mooren) ulcer

n Interstitial keratitis

n Disciform keratitis
INTERSTITIAL KERATITIS

n Non ulcerative deep stromal keratitis

n Infective or allergic in origin

n Causes: Syphilis congenital 90%,

acquired 10%

Tuberculosis

Cogan's syndrome

Leprosy

Sarcoidosis

? Local Ag ?Ab reaction



n Progressive stage

n Florid stage

n Stage of regression

Bilateral
Keratitis is secondary to uveitis
Treatmemt

n Systemic : penicillin

n Local: lubricants
steroids
cycloplegics

MARGINAL(CATARRHAL) ULCER

n Form of peripheral ulcerative keratitis

n Immune response to staphylococcal toxins,

Moraxella, Haemophilus

n Old age

n Shallow, slightly infiltrated

n Typically located at the points of contact of lids

with cornea i.e 4,7,10 and 2 o' clock

n Clear zone b/w lesion & limbus

n Vascularization + in recurrent cases

n Treatment Antibiotic+ steroids


ROSACEA KERATITIS

n Ds. of sebaceous glands of

skin

n Women > men

n Facial eruptions in butterfly

configuration

n Keratits in 5-10% cases

ROSACEA KERATITIS

n Infiltrates + small corneal ulcers near limbus

n Prominent vascularization

n Blepharoconjunctivitis

n Frequent recurrences

n Local treatment - low dose steroids

n Systemic therapy- Tetracycline 3-6 months
Doxycycline


KERATITIS IN RHEUMATOID

ARTHRITIS

n Sclerosing keratitis

n Perpheral corneal thinning( contact lens

cornea)

n Acute stromal keratitis

n Acute corneal melting

SHIELD ULCER IN VKC


MOOREN'S ULCER

n Form of inflammatory peripheral ulcerative

keratitis

n Two forms Limited form/ Benign

Progressive/Virulent

? Etiology Autoimmune

Ischaemic necrosis

Enzymes produced by conj.

Degenerative

MOOREN'S ULCER
n Severe pain

n Signs Superficial infiltration

Shallow ulceration

Overhanging edge

Vascularization at base

Perforation rare

Sclera uninvolved

NO CLEAR ZONE b/w ulcer & limbus

DIAGNOSIS OF EXCLUSION





TREATMENT OF MOOREN'S ULCER

n Topical antibiotics for infiltration

n Frequent topical steroids

n Systemic steroids/Cyclosporin

n Conjunctival peritectomy

n Bandage contact lens

n Lamellar corneal grafts
CORNEAL ECTASIAS

n Secondary to inflammations
anterior staphyloma

? Non inflammatory
keratoconus
keratoglobus
pellucid marginal degeneration

KERATOCONUS

n Non inflammatory, self limiting, ectasia of central

cornea

n Cornea becomes conical

n Congenital weakness of the cornea

n Manifest after puberty


? Central/paracentral stromal thinning

? Apical protrusion

? Irregular astigmatism

Keratoconus

n
n Bilateral in 90% cases, onset asymmetrical

n Etiology
Destruction of stromal tissue by collagenaze
? Heredity

? Asso. with atopic diseases

? Hormonal influences

? Systemic ds i.e Marfans, Downs, Ehlers Danlos

syndrome

KERATOCONUS

SEVERITY MORPHOLOGY

n Mild K reading

n Nipple cones

< 48D

<5mm

? Moderate

? Oval cones

K reading

5-6mm

48-54 D

? Severe

? Globus cones

K reading

>6mm

>54 D


SYMPTOMS

n Frequent change of glasses

n Decreased tolerance to CL wear

n Monocular diplopia

n Distortion for distant and near objects

SIGNS

n Streak retinoscopy

n Slit lamp examination

scisssoring reflex

corneal thinning

stress lines of vogt

? DDO

Fleischers ring

oil droplet reflex

corneal scarring

hydrops

? Keratometry

Munsons sign

malalignment of mires

Rizzuti's sign



? Placido disc

unevenly placed circles

? Corneal topography




MUNSONS SIGN


FLEISCHER'S RING

VOGT'S STRIAE


HYDROPS

TOPOGRAPHY

n
TREATMENT OF

KERATOCONUS

n Spectacles early cases

n Contact lenses

n Epikeratoplasty

n Penetrating keratoplasty

n U V cross linking

DEGENERATIONS

AND

DESTROPHY
Degenerations

Dystrophies

1.Unilateral and asymmetric

1.Bilateral and symmetric

2.Not inherited

2.Inherited (AD)

3.Located eccentrical y

3.Central y located

4.Usual y accompanied by

4.Avascular

vascularization
5.Middle life or later

5.Early onset

6.Progressive lesions

6.Slower in progression

7.ass. With systemic conditions

7.Not related to any systemic or

Ageing, infl amation or trauma

local conditions

CORNEAL DEGENERATIONS

n Age related Arcus senilis

n Pathological Band shaped keratopathy

Climatic droplet keratopathy

Salzmann's nodular degeneration

Terrien marginal degeneration


Arcus senilis

n M/c peripheral corneal opacity

n Lipoid infiltration of corner seen in elderly

n Present almost universally in people above 60 yrs

of age

n It is a yellowish white deposit that occurs first in

the inferior then in the superior aspect finally

joining to form an arc

n Lucid interval of Vogt is characteristic, being

sharply defined on the periphery, fading in the

center

?U/L arcus-associated with carotid ds or ocular

hypotony

Histology ?lipid first deposited in the

ant.1/2of descemet's membrane and then in

ant. stroma


ARCUS SENILIS

Band keratopathy

n Hyaline infiltration of superficial parts of cornea

followed by deposition of calcium salts in the ant

part of Bowmans menbrane

n Causes

- ocular ? Chr. Ant. Uveitis

- Pth. Bulbi

- Silicone oil in AC

- Chr. keratitis
- Age related

- Metabolic ? increase ca, CRF

- Hereditary
n

Peripheral inter-palpeberal calcification with

clear cornea separating sharp peripheral margins

of the band from the limbus

n

Spread centrally to form band like chalky

plaque

n

Advance lesion ? nodular & elevated with

discomfort d/t epi. breakdown



Treated by chelation- mild cases
n Sodium EDTA ? applied with cotton bud

n Exc. Laser keratectomy


BAND SHAPED KERATOPATHY

Salzmann nod. degn

n Bluish white avasc. nodule- Sup. Layer of stroma

& Bowmann memb.

n Seen with previous corneal Ds

n Slow progression

n Treat- lam. KP


SALZMANN'S NODULAR

DEGENERATION

Spheroidal degn( climatic droplet KP)

n Common in people exposed to hot & dry weather

n Exposed inter- palp. cornea sparing the limbus

n Sign- small amber colored granules in sup.

Stroma,

n Treat- lamellar KP, PRK


Terrien marginal degeneration

n Usually bilateral

n Slow progressive thinning of peripheral cornea

sparing the limbus

n More frequently seen in males

n Eye is quite with no inflammation

n Vascularised pannus is seen with yellow deposit

of lipid

n May cause myopic or irregular astigmatism

n Perforation can occur with mild trauma
CORNEAL DYSTROPHIES

n Anterior Cogans microcystic dystrophy

Reis ? Buckler


? Stromal Granular

Macular

Lattice

? Endothelial Fuchs endothelial dystrophy



Posterior polymorphous

dystrophy



Epi. BM dys

n Also k/a - Map dot fingerprint dys.

n m/c dys.

n Onset - 2nd decade

n Recurrent corneal erosions ? 10%

n Signs- dot like opacity , epi. microcysts, sub-epi map

like pattern

n Treat- same as rec. corneal erosions( saline , bandage

48hrs, ointment)


Reis ? Buckler dys

n AD

n Onset- early childhood

n Arise in region of bow. Memb

n Recurrent erosions

n Cornea- irregular dense grey sub-epi. Opacity

arranged in fish net pattern

n Treat- PRK, lam KP

n HIGH RECURRENCE AFTER CORNEAL

TRANSPALANT


REIS-BUCKLER

DYSTROPHY

Hereditary stromal corneal dys

n Bilateral

n Around puberty

n Central area of cornea, chr. By discrete areas of

opacity in sup. Areas of stroma

n Hyaline deposits b/w the cornel lamellae

n Symptom less without inflammation

n Progress slowly until visual impairment

n Treat- KP




GRANULAR CORNEAL

DYSTROPHY

MACULAR CORNEAL

DYSTROPHY




GRANULAR MACULAR

LATTICE CORNEAL DYSTROPHY


ENDOTHELIAL CORNEAL DYS

n M/C Fuch's dys-


n AD, seen in elderly

n m/c in females

n d/t changes in endothelium with formation of

hyaline excrescences on DM ( corn. Guttata)

n TREAT- Nacl 5% drop or ointment,

bandage contact lens.

-Pen KP

FUCH'S ENDOTHELIAL

DYSTROPHY

n Stage of cornea guttata

n Stage of endothelial

decompensation

n Stage of bullous

keratopathy

n Stage of scarring

This post was last modified on 07 April 2022