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

DISEASES OF THE CORNEA

Department of Ophthalmology

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IMMUNE MEDIATED KERATITIS

n Phlyctenular keratitis

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n Marginal ulcer( catarrhal ulcer)

n Asso. with acne rosacea

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n Asso with systemic collagen vascular disease

n Chronic serpiginous(Mooren) ulcer

n Interstitial keratitis

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n Disciform keratitis
INTERSTITIAL KERATITIS

n Non ulcerative deep stromal keratitis

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n Infective or allergic in origin

n Causes: Syphilis congenital 90%,

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acquired 10%

Tuberculosis

Cogan's syndrome

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Leprosy

Sarcoidosis

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? Local Ag ?Ab reaction



n Progressive stage

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n Florid stage

n Stage of regression

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Bilateral
Keratitis is secondary to uveitis
Treatmemt

n Systemic : penicillin

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n Local: lubricants
steroids
cycloplegics

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MARGINAL(CATARRHAL) ULCER

n Form of peripheral ulcerative keratitis

n Immune response to staphylococcal toxins,

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Moraxella, Haemophilus

n Old age

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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

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n Clear zone b/w lesion & limbus

n Vascularization + in recurrent cases

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n Treatment Antibiotic+ steroids


ROSACEA KERATITIS

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n Ds. of sebaceous glands of

skin

n Women > men

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n Facial eruptions in butterfly

configuration

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n Keratits in 5-10% cases

ROSACEA KERATITIS

n Infiltrates + small corneal ulcers near limbus

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n Prominent vascularization

n Blepharoconjunctivitis

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n Frequent recurrences

n Local treatment - low dose steroids

n Systemic therapy- Tetracycline 3-6 months

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Doxycycline


KERATITIS IN RHEUMATOID

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ARTHRITIS

n Sclerosing keratitis

n Perpheral corneal thinning( contact lens

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cornea)

n Acute stromal keratitis

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n Acute corneal melting

SHIELD ULCER IN VKC

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MOOREN'S ULCER

n Form of inflammatory peripheral ulcerative

keratitis

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n Two forms Limited form/ Benign

Progressive/Virulent

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? Etiology Autoimmune

Ischaemic necrosis

Enzymes produced by conj.

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Degenerative

MOOREN'S ULCER
n Severe pain

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n Signs Superficial infiltration

Shallow ulceration

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Overhanging edge

Vascularization at base

Perforation rare

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Sclera uninvolved

NO CLEAR ZONE b/w ulcer & limbus

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DIAGNOSIS OF EXCLUSION

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TREATMENT OF MOOREN'S ULCER

n Topical antibiotics for infiltration

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n Frequent topical steroids

n Systemic steroids/Cyclosporin

n Conjunctival peritectomy

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n Bandage contact lens

n Lamellar corneal grafts
CORNEAL ECTASIAS

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n Secondary to inflammations
anterior staphyloma

? Non inflammatory

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keratoconus
keratoglobus
pellucid marginal degeneration

KERATOCONUS

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n Non inflammatory, self limiting, ectasia of central

cornea

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n Cornea becomes conical

n Congenital weakness of the cornea

n Manifest after puberty

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? Central/paracentral stromal thinning

? Apical protrusion

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? Irregular astigmatism

Keratoconus

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n
n Bilateral in 90% cases, onset asymmetrical

n Etiology
Destruction of stromal tissue by collagenaze

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? Heredity

? Asso. with atopic diseases

? Hormonal influences

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

syndrome

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KERATOCONUS

SEVERITY MORPHOLOGY

n Mild K reading

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n Nipple cones

< 48D

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<5mm

? Moderate

? Oval cones

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K reading

5-6mm

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48-54 D

? Severe

? Globus cones

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K reading

>6mm

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>54 D


SYMPTOMS

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n Frequent change of glasses

n Decreased tolerance to CL wear

n Monocular diplopia

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n Distortion for distant and near objects

SIGNS

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n Streak retinoscopy

n Slit lamp examination

scisssoring reflex

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corneal thinning

stress lines of vogt

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? DDO

Fleischers ring

oil droplet reflex

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corneal scarring

hydrops

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? Keratometry

Munsons sign

malalignment of mires

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Rizzuti's sign

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? Placido disc

unevenly placed circles

? Corneal topography

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MUNSONS SIGN

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FLEISCHER'S RING

VOGT'S STRIAE

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HYDROPS

TOPOGRAPHY

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n
TREATMENT OF

KERATOCONUS

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n Spectacles early cases

n Contact lenses

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n Epikeratoplasty

n Penetrating keratoplasty

n U V cross linking

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DEGENERATIONS

AND

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DESTROPHY
Degenerations

Dystrophies

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1.Unilateral and asymmetric

1.Bilateral and symmetric

2.Not inherited

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2.Inherited (AD)

3.Located eccentrical y

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3.Central y located

4.Usual y accompanied by

4.Avascular

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vascularization
5.Middle life or later

5.Early onset

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6.Progressive lesions

6.Slower in progression

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7.ass. With systemic conditions

7.Not related to any systemic or

Ageing, infl amation or trauma

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local conditions

CORNEAL DEGENERATIONS

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n Age related Arcus senilis

n Pathological Band shaped keratopathy

Climatic droplet keratopathy

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Salzmann's nodular degeneration

Terrien marginal degeneration

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Arcus senilis

n M/c peripheral corneal opacity

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n Lipoid infiltration of corner seen in elderly

n Present almost universally in people above 60 yrs

of age

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n It is a yellowish white deposit that occurs first in

the inferior then in the superior aspect finally

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joining to form an arc

n Lucid interval of Vogt is characteristic, being

sharply defined on the periphery, fading in the

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center

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

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hypotony

Histology ?lipid first deposited in the

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

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ant. stroma


ARCUS SENILIS

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Band keratopathy

n Hyaline infiltration of superficial parts of cornea

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followed by deposition of calcium salts in the ant

part of Bowmans menbrane

n Causes

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- ocular ? Chr. Ant. Uveitis

- Pth. Bulbi

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- Silicone oil in AC

- Chr. keratitis
- Age related

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- Metabolic ? increase ca, CRF

- Hereditary
n

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Peripheral inter-palpeberal calcification with

clear cornea separating sharp peripheral margins

of the band from the limbus

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n

Spread centrally to form band like chalky

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plaque

n

Advance lesion ? nodular & elevated with

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discomfort d/t epi. breakdown

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

n Exc. Laser keratectomy

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BAND SHAPED KERATOPATHY

Salzmann nod. degn

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

& Bowmann memb.

n Seen with previous corneal Ds

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n Slow progression

n Treat- lam. KP

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SALZMANN'S NODULAR

DEGENERATION

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Spheroidal degn( climatic droplet KP)

n Common in people exposed to hot & dry weather

n Exposed inter- palp. cornea sparing the limbus

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n Sign- small amber colored granules in sup.

Stroma,

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n Treat- lamellar KP, PRK


Terrien marginal degeneration

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n Usually bilateral

n Slow progressive thinning of peripheral cornea

sparing the limbus

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n More frequently seen in males

n Eye is quite with no inflammation

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n Vascularised pannus is seen with yellow deposit

of lipid

n May cause myopic or irregular astigmatism

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n Perforation can occur with mild trauma
CORNEAL DYSTROPHIES

n Anterior Cogans microcystic dystrophy

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Reis ? Buckler


? Stromal Granular

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Macular

Lattice

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? Endothelial Fuchs endothelial dystrophy



Posterior polymorphous

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dystrophy

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Epi. BM dys

n Also k/a - Map dot fingerprint dys.

n m/c dys.

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n Onset - 2nd decade

n Recurrent corneal erosions ? 10%

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

like pattern

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

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48hrs, ointment)


Reis ? Buckler dys

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n AD

n Onset- early childhood

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n Arise in region of bow. Memb

n Recurrent erosions

n Cornea- irregular dense grey sub-epi. Opacity

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arranged in fish net pattern

n Treat- PRK, lam KP

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n HIGH RECURRENCE AFTER CORNEAL

TRANSPALANT

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REIS-BUCKLER

DYSTROPHY

Hereditary stromal corneal dys

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n Bilateral

n Around puberty

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

opacity in sup. Areas of stroma

n Hyaline deposits b/w the cornel lamellae

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n Symptom less without inflammation

n Progress slowly until visual impairment

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n Treat- KP

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GRANULAR CORNEAL

DYSTROPHY

MACULAR CORNEAL

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DYSTROPHY

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GRANULAR MACULAR

LATTICE CORNEAL DYSTROPHY

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ENDOTHELIAL CORNEAL DYS

n M/C Fuch's dys-

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n AD, seen in elderly

n m/c in females

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n d/t changes in endothelium with formation of

hyaline excrescences on DM ( corn. Guttata)

n TREAT- Nacl 5% drop or ointment,

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bandage contact lens.

-Pen KP

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FUCH'S ENDOTHELIAL

DYSTROPHY

n Stage of cornea guttata

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n Stage of endothelial

decompensation

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n Stage of bullous

keratopathy

n Stage of scarring

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