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