Transparencies Corneal oedema Drying of cornea Depositions on cornea Inflammation of cornea Corneal degenerations Dystrophies of cornea Vascularisation of cornea Corneal opacities Corneal Diseases Keratitis
Corneal ulceration Corneal Scarring
Corneal Opacification Corneal opacity Slight opacification allowing the details of iris to be seen thr. Opacity is called nebula/ nebular c.o. More dense thr. Which iris & puppilary margin are visible. (no details) called macula / macular c.o. If very dense, white & totally opaque obscuring the view of iris & pupil is called leucoma /leucomatous c.o. Corneal opacity Old central leucoma – sometimes show horizontal pigmented line i.e. b/o deposition of iron from precorneal tear film. Adherant leucoma Corneoiridic scar If ectatic ant. Staphyloma Vn. Corneal oedema Hydration of cornea becomes above 78% central thickness increases & transperency Reduces. Causes –raised i.o.p.
endothelial damage- b/o surgery,
Secondary inflammation like uveitis, dystrophies epithelial damage- mechanical injury, Chemical injury ,radiational injury Corneal oedema Can affect entire cornea. Epithelium- steamy appearance. Stroma- haziness thr.out cornea. If persists for long period epithelium tends to be raised into large vesicle or bullae i.e. vesicular or bullous keratopathy intense pain & ocular irritation. S.K.- delicate grey lines. Corneal diseases Filamentary keratopathy- formation of epithelial threads /corneal filaments. Keratic precipitates- deposition of leucocytes & other cells on back the of Cornea. Hypopyon- polymorphonuclear leucocytes which accumulates in angle of a.c. Examination of cornea External exam.-Torch, Slit-lamp Surface irregularities- Placidos disc Curvature-keratometry, corneal topography Thickness-optical pachymeter, ultrasonic pachymeter, slit scanning topography. Endothelium- with slit lamp, cell counting with microscope. Source of infection
1. Exogenous infection- conjunctival sac
2. Endogenous infection- immunological in
Nature.
3. Contiguous spread from ocular tissue-
anatomical continuation. Corneal Diseases Keratitis- corneal inflammation . Non-Ulcerative keratitis 1.Superficial keratitis- inflammation involving epithelium & bowm. Memb. S.P.K.-If only occuring in discrete patches. 2.Deep keratitis- further categorised as stromal or interstitial keratitis or endothelitis Keratitis Keratitis Etiological classification 1. Infective keratitis 2. Allergic keratitis 3. Trophic keratitis 4. Keratitis associated with diseases of skin & mucous memb. 5. Keratitis associated with systemic collagen vascular disorder. 6. Traumatic keratitis 7. Idiopathic keratitis Corneal ulcer
A loss or discontinuation of epithelium with
inflammation in surrounding cornea is called corneal ulcer. infective or sterile
A corneal scar is final outcome of any
Inflammation. Topographical / morphological classification 1.Ulcerative keratitis (corneal ulcer)- Depending upon location Depending upon purulence Depending upon hypopyon Depending upon depth of ulcer & perforation Depending upon slough formation 2.Non-Ulcerative keratitis Etiology of corneal ulcer 1.Corneal epithelial damage- Corneal abrasion, Epithelial drying- xerosis, exp. keratitis Necrosis of epithelium-keratomalacia Desquamation of epithelial cell- c. oedema Epithelial damage due to trophic changes 2. Source of infection- 3. Causative organisms- Corneal ulcer Corneal ulcer Pathology of localised corneal ulcer Four stages- 1.Stage of progressive infiltration.
2. Stage of active ulceration.
3. Stage of regression.
4. Stage of cicatrization. Symptoms of corneal ulcer
1. Pain
2. Watering – reflex blepharospam
3. Photophobia –stimulation of nerve endings
4. Blurred vision
5. Redness of eyes Signs of corneal ulcer Lids are swollen Marked blepharospasm Conjunctivociliary congestion with chemosis Keratouveitis Hypopyon Ulcer stained by fluroscein Corneal ulcer Complications of corneal ulcer 1. Toxic iridocyclitis 2. Secondary glaucoma 3. Descemetocele 4. Perforation of corneal ulcer- prolapse of iris ant. Capsular cataract corneal fistula purulent uveitis Subluxation / ant. Dislocation of lens intraocular hemorrhage 5. Corneal scarring / opacity Management of corneal ulcer 1.Clinical evaluation- History kaking,
General physical examination,
Ocular examination- With diffuse light,
Regurgitation test Slit lampBimicroscopic exam.-. fluorescein dye test - 2. Laboratory investigations- routine & microbiological 3. Treatment Treatment of uncomplicated corneal ulcer 1.Specific t/t- Topical antibiotic Systemic antibiotic 2. Non specific t/t- Cycloplegic drugs Systemic analgesic anti-inflammatory Vitamins 3. Physical & general measures – Hot fomentation Dark goggles Nutritious diet & rest Treatment of Non-healing corneal ulcer 1. Removal of any cause- Local cause Systemic cause 2. Mechanical debridement of ulcer 3. Cauterisation of ulcer 4. Bandage / soft contact lens 5. Peritomy Treatment of impending perforation 1. No strain 2. Pressure bandage 3. Lowering of i.o.p. 4. Tissue adhesive glue 5. Conjunctival flap 6. Bandage soft contact lens 7. Penetrating therapeutic keratoplasty EXAMINE CAREFULLY
