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Abnormalities of corneal

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