cornea ppt
TRANSCRIPT
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CLINICAL SpottersCLINICAL SpottersOF CORNEAOF CORNEA
JIJI K TJIJI K T
FELLOW OPTOMFELLOW OPTOM
THE EYE FOUNDATIONTHE EYE FOUNDATION
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CORNEACORNEA
Cornea is a transparent , avascular , watchCornea is a transparent , avascular , watch
glass like structure . It forms anterior oneglass like structure . It forms anterior onesixth of outer fibrous coat of the e eballsixth of outer fibrous coat of the e eballan! it is the most sensitive an! !elicatean! it is the most sensitive an! !elicate
structure of the e e.structure of the e e.
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"imensions"imensionsDiameter Diameter
Anterior #$$ mm %&' Anterior #$$ mm %&' # $( mm %)'# $( mm %)' *osterior + $$. mm*osterior + $$. mm
Radius of curvatureRadius of curvature Anterior + -. mm Anterior + -. mm *osterior + /. mm*osterior + /. mm
ThicknessThickness centre + 0. ( mmcentre + 0. ( mm
peripher + $.0 mmperipher + $.0 mmRefractive indexRefractive index + $.11 + $.11
Refractive power Refractive power + 22 " + 22 "
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3a ers of cornea3a ers of cornea
1.1.EpitheliumEpithelium
2.2. Bowman’s membraneBowman’s membrane
.. !troma!troma
".". Duan’s la#er Duan’s la#er $.$. Descemet’s membraneDescemet’s membrane%.%. EndotheliumEndothelium
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&a#ers of cornea&a#ers of cornea
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Evaluation of corneal diseasesEvaluation of corneal diseases
!#mptoms!#mptoms painpain
!ecrease! visual acuit!ecrease! visual acuit haloshalos
photophobiaphotophobia lacrimationlacrimation
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4igns4igns
EpitheliumEpithelium 55 erosions, oe!ema, filaments, spkserosions, oe!ema, filaments, spks!troma!troma 55
infiltrates, oe!ema, vascularisation,infiltrates, oe!ema, vascularisation,!eposits 6 scarring !eposits 6 scarring
Descemet’s membraneDescemet’s membrane 55
breaks, fol!s, localise! thickeningbreaks, fol!s, localise! thickening
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Cont7.Cont7.
Deposition of pi'mentsDeposition of pi'ments 55it is associate! with a varietit is associate! with a variet
of !isor!ersof !isor!ers(orneal sensation(orneal sensation 55 loss of corneal sensation inloss of corneal sensation in
viral keratitis 6neuroparal ticviral keratitis 6neuroparal tickeratitiskeratitis
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Diseases of corneaDiseases of cornea
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Congenital anomaliesCongenital anomalies
8icro cornea8icro cornea
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8icro cornea8icro cornea
9his is a rare unilateral or bilateral con!ition9his is a rare unilateral or bilateral con!ition
4igns4igns Corneal !iameter is $0mm or lessCorneal !iameter is $0mm or less
Ac shallow Ac shallow
Other !imensions are normal.Other !imensions are normal.
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8egalocornea8egalocornea
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8egalocornea8egalocornea
Rare bilateral, non progressive, enlargementRare bilateral, non progressive, enlargementof cornea.of cornea.
4igns4igns : Corneal !iameter $1mm or moreCorneal !iameter $1mm or more: "eep Ac"eep Ac: )igh m opia 6 astigmatism)igh m opia 6 astigmatism: Normal visual acuitNormal visual acuit
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Cornea planaCornea plana
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Cornea planaCornea plana
!i'ns!i'ns: 4evere !ecrease of corneal4evere !ecrease of corneal
curvature %; 5 (0#10"'curvature %; 5 (0#10"': ) permetropia) permetropia: 4hallow AC an!4hallow AC an!
: *re!isposition to angle closure*re!isposition to angle closureglaucomaglaucoma
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4clerocornea4clerocornea
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4clerocornea4clerocornea
: <suall bilateral con!ition<suall bilateral con!ition
: Opacification 6vasculari=ation ofOpacification 6vasculari=ation of
peripheral or entire cornea.peripheral or entire cornea.
: Restricte! to peripheral cornea #Restricte! to peripheral cornea #
sclerali=ation # cornea appear smaller.sclerali=ation # cornea appear smaller.
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Corneal oe!emaCorneal oe!ema
!i'ns!i'ns
It associate! with increase! cornealIt associate! with increase! cornealthicknessthickness
A variable !ecrease in corneal A variable !ecrease in corneal
transparenctransparenc
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Corneal oe!emaCorneal oe!ema
!#mptoms!#mptoms
Coloure! halosColoure! halos"ecrease! visual"ecrease! visualacuitacuit
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>ullous keratopath>ullous keratopath
: In corneal oe!ema,In corneal oe!ema,epithelium raise!epithelium raise!into large vesiclesinto large vesiclesor bullaeor bullae
: 3ea!ing to bullous3ea!ing to bullouskeratopathkeratopath
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Inflammations of the corneaInflammations of the cornea
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>acterial keratitis>acterial keratitis
Commonest causative organismsCommonest causative organisms
:*neumococus*neumococus
: 4taph lococus4taph lococus: *seu!omonas*seu!omonas
: ?onococcus.?onococcus.
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>acterial keratitis>acterial keratitis
4@8*9O844@8*9O84 Acute pain Acute pain
Re!nessRe!ness3acrimation3acrimation*hotophobia*hotophobia
"ecrease! &A"ecrease! &Ahite spot on the corneahite spot on the cornea
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>acterial keratitis>acterial keratitis
4I?N44I?N4
8arke! blepharospasm8arke! blepharospasm3i! oe!ema3i! oe!emaCiliar congestion of theCiliar congestion of theconBunctivaconBunctiva) pop on ma be) pop on ma bepresentpresent
: Iop ma be increase!Iop ma be increase!:
gre ish white ,gre ish white ,circumscribe! infiltrationcircumscribe! infiltration
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)ealing of corneal ulcer )ealing of corneal ulcer
ormation of fibrous tissueormation of fibrous tissueNot arrange! regularlNot arrange! regularl
9he refract the light irregularl9he refract the light irregularl9herefore the scar is more or less9herefore the scar is more or less9he scar is thin + opacit is slight +Nebula9he scar is thin + opacit is slight +Nebula
If rather more !ense + 8aculaIf rather more !ense + 8aculaIf still more !ense 6 white #3eucomaIf still more !ense 6 white #3eucoma
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Opacities of corneaOpacities of cornea
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"escemetocele"escemetocele
: Complication ofComplication ofbacterial keratitisbacterial keratitis
: "ue to the effect of"ue to the effect ofintra ocularintra ocularpressurepressure
: Associate! with Associate! withsever painsever pain
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8anagement8anagement
9opical fortifie! !rops9opical fortifie! !rops Atropine sulphate Atropine sulphate
)ot fermentation)ot fermentation Analgesics with antaci!s Analgesics with antaci!sOrall aceta=olami!eOrall aceta=olami!e
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ungal corneal ulcer ungal corneal ulcer
Infective mo!e # InBur with vegetativeInfective mo!e # InBur with vegetativematerial % thorn, branch of tree'material % thorn, branch of tree'
Common causative fungi are aspergillus,Common causative fungi are aspergillus,Can!i!a an! fusarium.Can!i!a an! fusarium.
4 mptoms same as for the bacterial ulcer 4 mptoms same as for the bacterial ulcer
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ungal corneal ulcer ungal corneal ulcer
!)*+!!)*+!"r looking"r looking@ellowish +white lesion with in!istinct@ellowish +white lesion with in!istinctmarginmargin"elicate, feather ,fingerlike proBections into"elicate, feather ,fingerlike proBections intothe a!Bacent stromathe a!Bacent stroma
?re ish halos 6 multiple satellite lesion?re ish halos 6 multiple satellite lesion4ome !egree of iri!oc clitis 6 h pop on4ome !egree of iri!oc clitis 6 h pop onare common.are common.
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ungal corneal ulcer ungal corneal ulcer
!iagram!iagram TreatmentTreatment 4crapping 64crapping 6!ebri!ment of the!ebri!ment of theulcer ulcer
Antifungal !rugs Antifungal !rugs%natam cin,nicon=ol%natam cin,nicon=ol
e 'e ' Atropine sulphates Atropine sulphates
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Acanthamoeba keratitis Acanthamoeba keratitis
Acanthamoeba is a free living Acanthamoeba is a free living
proto=oa, it is foun! in stagnant water , C3proto=oa, it is foun! in stagnant water , C3solution an! C3 cases.solution an! C3 cases.
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Acanthamoeba keratitis Acanthamoeba keratitis
!#mptoms!#mptoms>lurre! vn>lurre! vn4evere pain4evere pain
!i'ns!i'ns 3imbitis3imbitisChronic 4tromalChronic 4tromalkeratitis +break!ownkeratitis +break!ownof corneal epitheliumof corneal epitheliumCorneal abscessCorneal abscess
which ma perforatewhich ma perforateNo!ular scleritis is aNo!ular scleritis is afreDuent fin!ingsfreDuent fin!ings
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Acanthamoeba keratitis Acanthamoeba keratitis
"iagram"iagram TreatmentTreatment >rolene !rops>rolene !rops6ointments6ointmentsNeom cin !ropsNeom cin !rops6ointment6ointment
In resistant cases,In resistant cases,a therapeutic *;a therapeutic *;ma be reDuire!ma be reDuire!
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&iral keratitis&iral keratitis
Common viral infections inclu!eCommon viral infections inclu!e)erpes simplex keratitis)erpes simplex keratitis
)erpes =oster ophthalmicus)erpes =oster ophthalmicus A!enovirus keratitis A!enovirus keratitis
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)erpes simplex keratitis)erpes simplex keratitis
Ocular involvement b )4& occurs in twoOcular involvement b )4& occurs in twoforms , primar 6 recurrent with followingforms , primar 6 recurrent with followinglesionslesions
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)erpes simplex keratitis)erpes simplex keratitis
,rimar# herpes,rimar # herpesinfectioninfection
: 4kin lesions4kin lesions
: Acute follicular Acute follicularconBunctivitisconBunctivitis
: ine epithelialine epithelialpunctuate keratitispunctuate keratitis
: Coarse epithelialCoarse epithelialpunctuate keratitispunctuate keratitis
: "en!ritic ulcer "en!ritic ulcer
Recurrent herpesRecurrent herpesinfectioninfection
: Active epithelial Active epithelial
keratitis # !en!ritic 6keratitis # !en!ritic 6geographical ulcersgeographical ulcers
: 4tromal keratitis +4tromal keratitis +!isciform keratitis.!isciform keratitis.
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"en!ritic keratitis"en!ritic keratitis
!#mptoms!#mptoms : Acute pain Acute pain:
Re!nessRe!ness: 3acrimation3acrimation: *hotophobia*hotophobia
: >lurring of vn>lurring of vn
!i'ns!i'ns : Circum CiliarCircum Ciliar
congestioncongestion
: Initiall spks an! theInitiall spks an! theto form erosionsto form erosions
: 9he erosions coalesce9he erosions coalesceto form !en!riticto form !en!ritic
: Corneal sensation isCorneal sensation is!iminishe! or absent!iminishe! or absent
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"en!ritic keratitis"en!ritic keratitis
TreatmentTreatment : "ebri!ment of"ebri!ment of
the ulcer the ulcer : Anti viral agents Anti viral agents: Atropine or Atropine or
homatropinehomatropine
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?eographical keratitis?eographical keratitis
"iagram"iagram 3arger epithelial3arger epitheliallesionlesion
9 pical geographical9 pical geographicalconfigurationconfiguration
Enlargement ofEnlargement of!en!ritic ulcer.!en!ritic ulcer.
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"isciform keratitis"isciform keratitis
It is a !eep keratitis with !isc like oe!ema mainlIt is a !eep keratitis with !isc like oe!ema mainlcause! b herpes viruscause! b herpes virus
(linical features(linical features
: ocal !isc shape!ocal !isc shape!: 4tromal oe!ema4tromal oe!ema: "escemet s fol!s"escemet s fol!s:
"eep vascularisation"eep vascularisation
: >ullous keratopath>ullous keratopath: absent or !iminishe! corneal sensationabsent or !iminishe! corneal sensation
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"isciform keratitis"isciform keratitis
TreatmentTreatment : )eal an)eal an
associate!associate!epithelial lesionepithelial lesion
: 9opical9opicalcorticosteroi!scorticosteroi!s
un!er antiviralun!er antiviralcovercover: C cloplegicsC cloplegics
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)erpes =oster ophthlmicus)erpes =oster ophthlmicus
It is a common infection cause! b theIt is a common infection cause! b thevaricella + =oster virus. 9he infectionvaricella + =oster virus. 9he infectionmainl effects the el!erl pts.mainl effects the el!erl pts.
!#mptoms!#mptoms 55&esicular eruptions aroun! the e e ,&esicular eruptions aroun! the e e ,forehea! an! scalpforehea! an! scalp4ever pain4ever pain*hotophobia 6 lacrimation*hotophobia 6 lacrimation
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4igns4igns
4tage I4tage I: *unctate epithelial keratitis*unctate epithelial keratitis: 8icro !en!rites8icro !en!rites
: Nummular keratitisNummular keratitis: "isciform keratitis"isciform keratitis: 4ensation is !iminishe! or absent4ensation is !iminishe! or absent4tage II4tage II: Nummular 6 "isciform keratitisNummular 6 "isciform keratitis4tage III4tage III: Nummular keratitisNummular keratitis
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)erpes =oster ophthalmicus)erpes =oster ophthalmicus
Numular !iagramNumular !iagram TreatmentTreatment: Oral ac clovir Oral ac clovir : 4trong analgesics4trong analgesics: Antibiotic Antibiotic
corticosteroi!scorticosteroi!s: 9opical steroi!s9opical steroi!s: 9opical antibiotics9opical antibiotics: c cloplegicsc cloplegics
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"ifferentiating features bFw"ifferentiating features bFw).simplex 6 ).Goster keratitis).simplex 6 ).Goster keratitis
-.!implex-.!im plex: "en!ritic ulcer + thin,"en!ritic ulcer + thin,
branching, withbranching, with
terminal bulbsterminal bulbs: Corneal sensationCorneal sensation!ecrease!!ecrease!
: 8il! iritis8il! iritis
-. oster -. oster : "en!ritic ulcer +"en!ritic ulcer +
coarse , noncoarse , non
branching, nobranching, noterminal bulbs, stainterminal bulbs, stainpoorl withpoorl withfluoresceinfluorescein
:Corneal sensationCorneal sensationmarke!l !ecrease!marke!l !ecrease!
: iritisiritis
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Exposure keratitisExposure keratitis
(linical features(linical features: Epithelial erosionsEpithelial erosions
to sever ulcerationto sever ulceration: 4econ!ar4econ!ar
infection 6 eveninfection 6 evenperforationperforation
: 9he lower thir! of9he lower thir! ofthe cornea isthe cornea iscommonl affecte!commonl affecte!..
"iagram"iagram
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*eripheral keratitis*eripheral keratitis
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8arginal keratitis8arginal keratitis
!#mptoms!#mptoms: 8il! ocular irritation8il! ocular irritation: 3acrimation3acrimation: *hotophobia*hotophobia
!i'ns!i'ns
: 4ub#epithelial infiltrates at4ub#epithelial infiltrates atthe peripherthe peripher
: 4eparate! from the4eparate! from the
limbuslimbus: 3esion sprea!3esion sprea!circumferentiallcircumferentiall
: orm a fluoresceinorm a fluoresceinstaining ulcer staining ulcer
: Corneal sensation isCorneal sensation isunaffecte!unaffecte!
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8arginal keratitis8arginal keratitis
9reatment9reatment: 9opical corticosteroi!s9opical corticosteroi!s: 8il! c cloplegics8il! c cloplegics: Rx of blepharitis toRx of blepharitis to
prevent recurrenceprevent recurrence
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8ooren s ulcer 8ooren s ulcer
4I?N44I?N4: 4tarts at the palpebral area ,patches of4tarts at the palpebral area ,patches of
gre infiltrates at the margingre infiltrates at the margin: 4lowl un!ermining the epithelium 64lowl un!ermining the epithelium 6
superficial stromasuperficial stroma: It involves the entire circumference of theIt involves the entire circumference of the
corneacornea: )ealing + peripher + heale! area)ealing + peripher + heale! area
vascularise! ,thinne! 6 opaDuevascularise! ,thinne! 6 opaDue
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8ooren s ulcer 8ooren s ulcer
4 mptoms4 mptoms: 4ever pain4ever pain: *hotophobia*hotophobia: 3acrimation3acrimation: "ecrease! the vn +"ecrease! the vn +
irregular astigmatism.irregular astigmatism.
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8ooren s ulcer 8ooren s ulcer
9reatment9reatment: 9opical corticosteroi!9opical corticosteroi!:
C cloplegicsC cloplegics: ConBunctival excisionConBunctival excision: >C3>C3
: 4 stemic corticosteroi!s4 stemic corticosteroi!s
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Corneal "egeneration 6Corneal "egeneration 6" strophies" strophies
"egenerations"egenerations: <suall unilateral 6<suall unilateral 6
as mmetricalas mmetrical: 3ocate! peripher3ocate! peripher: accompanie! baccompanie! b
vascularisationvascularisation: No inheritance patternNo inheritance pattern: Onset + mi!!le life orOnset + mi!!le life or
laterlater: 4econ!ar to4econ!ar to
compromising factorscompromising factors
" strophies" strophies: >ilateral 6 s mmetrical>ilateral 6 s mmetrical: 3ocate! centrall3ocate! centrall: No vascularisationNo vascularisation: )ere!itar)ere!itar: Earl in onsetEarl in onset: <nrelate! to an s stemic<nrelate! to an s stemic
or local !isease oror local !isease orcon!itioncon!ition
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Arcus senilis Arcus senilis
it is bilateral lipi! !egeneration of peripheralit is bilateral lipi! !egeneration of peripheralcornea, affecting the most el!erl persons.cornea, affecting the most el!erl persons.
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>an! keratopath>an! keratopath
It is !eposition of calcium salts in the subIt is !eposition of calcium salts in the subepithelial la er of the cornea ,6 isepithelial la er of the cornea ,6 ischaracterise! b a hori=ontal ban!characterise! b a hori=ontal ban!shape! opacit .shape! opacit .
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Anterior ! stroph Anterior ! stroph
: 8ost of pts8ost of ptsas mptomaticas mptomatic
: >ut the others +>ut the others +
recurrent cornealrecurrent cornealerosionserosions
: *hotophobia 6*hotophobia 6lacrimationlacrimation
: &isual loss&isual loss
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4tromal ! strophies4tromal ! strophies
?ranular ! strophies?ranular ! strophies: 4tarts + pubert ,4tarts + pubert ,
progresses ver slowlprogresses ver slowl: "iscrete, crumb like white"iscrete, crumb like white
granule + ant. 4troma ofgranule + ant. 4troma ofthe central corneathe central cornea: As mptomatic As mptomatic: ew pts complain of lightew pts complain of light
scatteringscattering
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4tromal ! strophies4tromal ! strophies
8acular ! strophies8acular ! strophies: 4tarts + earl life with4tarts + earl life with
significant impairment ofsignificant impairment ofvnvn
: 3esions are focal ,gre +3esions are focal ,gre +white ,poorl !efine!white ,poorl !efine!opacit in clou! stromaopacit in clou! stroma
: 3esions sprea! to the3esions sprea! to theentire corneal stromaentire corneal stromainclu!ing the peripheralinclu!ing the peripheralcornea.cornea.
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4tromal ! strophies4tromal ! strophies
3attice ! stroph3attice ! stroph: *resents in earl life*resents in earl life
with recurrentwith recurrent
erosionserosions
: 3esions are branching3esions are branchingspi!er like !eposits inspi!er like !eposits inthe stromathe stroma
: "iffuse corneal ha=e"iffuse corneal ha=e: Corneal sensationCorneal sensation
!iminishe!!iminishe!
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*osterior ! strophies*osterior ! strophies
Corneal guttataCorneal guttata: Common agingCommon aging
processprocess
: ExcrescencesExcrescencesforme! b a stresse!forme! b a stresse!en!otheliumen!othelium
: "isrupt the normal"isrupt the normalen!othelial mosaic 6en!othelial mosaic 6appears a !ark spot.appears a !ark spot.
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*osterior ! strophies*osterior ! strophies
uchs en!othelialuchs en!othelial! stroph! stroph
: Affect in el!erl Affect in el!erl
peoples + femalespeoples + females: Corneal guttataCorneal guttata: En!othelialEn!othelial
!ecompensation!ecompensation: Epithelial oe!ema 6Epithelial oe!ema 6
bullous keratopath .bullous keratopath .
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Ectatic con!ition of corneaEctatic con!ition of cornea
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keratoconuskeratoconus
It is a bilateral conical protrusion of theIt is a bilateral conical protrusion of thecentral part of the cornea with thinning ofcentral part of the cornea with thinning ofits central an! inferior paracentral areas.its central an! inferior paracentral areas.
4@8*9O844@8*9O84: Impaire! vn + irregular m opicImpaire! vn + irregular m opic
astigmatismastigmatism
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4igns4igns
Irregular retinoscopic reflexIrregular retinoscopic reflex"istortion of mires of keratometer "istortion of mires of keratometer
&ogt s straie&ogt s straie*rominent corneal nerves*rominent corneal nerves9hinning of the cornea with protrusion9hinning of the cornea with protrusion
8oonson s sign8oonson s signleischer s ringleischer s ring
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;eratoconus;eratoconus
&ogt s straie&ogt s straie 8oonson s sign8oonson s sign
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;eratoconus;eratoconus
leischer s ringleischer s ring
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keratoconuskeratoconus
ComplicationComplication
: Acute h !rops Acute h !rops: Intolerance to C3Intolerance to C3
Acute h !rops Acute h !rops
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9reatment9reatment
Rigi! C3Rigi! C3*igg + back C3*igg + back C3C1RC1RCH3CH3IN9AC4IN9AC4
*;*;"A3;"A3;
*E33 CI" 8AR?INA3*E33 CI" 8AR?INA3
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*E33<CI" 8AR?INA3*E33<CI" 8AR?INA3"E?ENERA9ION"E?ENERA9ION
: Rare ,bilateral , marginal !egeneration.Rare ,bilateral , marginal !egeneration.: 9hinning involves in the inferior cornea.9hinning involves in the inferior cornea.: Ectasia above thinne! areaEctasia above thinne! area: Acute h !rops is complication Acute h !rops is complication
: No vascularisationNo vascularisation
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*elluci! marginal !egeneration*elluci! marginal !egeneration
"iagram"iagram 9reatment9reatment: <suall not reDuire!<suall not reDuire!: Correction ofCorrection of
astigmatism b R?*astigmatism b R?*C3C3
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Other corneal !isor!ersOther corneal !isor!ers
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4uperficial *unctate keratitis4uperficial *unctate keratitis
It is scattere! all over the cornea, usuallIt is scattere! all over the cornea, usuall!ue to viral infection.!ue to viral infection.
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4*;s4*;s
4 mptoms4 mptoms: IrritationIrritation: 3acrimation3acrimation: *hotophobia*hotophobia
4igns4igns: Epithelial opacities +Epithelial opacities +
scattere! all over thescattere! all over the
corneacornea: *oorl stain with*oorl stain with
fluoresceinfluorescein: 4ensation ma be4ensation ma be
!iminishe!!iminishe!: Ciliar congestionCiliar congestion
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4uperior limbic keratoconBunctivitis4uperior limbic keratoconBunctivitis
9his is a bilateral chronic inflammation of the9his is a bilateral chronic inflammation of thesuperior tarsal an! bulbar conBunctiva withsuperior tarsal an! bulbar conBunctiva withoe!ema of the superior limbal conBunctiva.oe!ema of the superior limbal conBunctiva.
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4uperior limbic keratoconBunctivitis4uperior limbic keratoconBunctivitis
4 mptoms4 mptoms: > sensation> sensation: *hotophobia*hotophobia: *ain*ain: 8ucoi! !ischarge8ucoi! !ischarge
4igns4igns: *apillar h pertroph*apillar h pertroph
of the superior tarsusof the superior tarsus
: ) peraemia 6) peraemia 6keratinisation of thekeratinisation of thesuperior bulbarsuperior bulbarconBunctiva.conBunctiva.
: *unctate epithelium 6*unctate epithelium 6filaments.filaments.
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;eratomalacia;eratomalacia
9his is characteri=e! b a !esiccation an!9his is characteri=e! b a !esiccation an!subseDuent necrosis of the cornea !ue tosubseDuent necrosis of the cornea !ue tolack of &it . Alack of &it . A
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