Corneal Disease

Dr Senata Tinaiseru
Advanced Eye and Ear Care
Congenital abnormalities of
cornea
1. Microcornea:
• a congenital condition
• the corneal diameter is <10 mm (or <9 mm in newborns).
• Unilateral or bilateral
• It is believed to arise due to arrest of growth of the cornea in
the 5th gestational month.
• Hypermetropic
2.Megalocornea:
• Large corneal diameter > 13mm
• Bilateral
• Usually X-linked
• 90% of the affected individuals are Males
• High Myopia and Astigmatism
• Megalocornea
3. Cornea Plana: Severe decrease in corneal curvature resulting in
reduced refractive power of the cornea ( 20D – 30D)
• Rare
• Bilateral
• Hypermetropia
• Clinical photographs of a 49-year-
old man with recessive
autosomal cornea plana.
• (A) A widened limbal zone and a
marked arcus senilis are clinical
signs typical of cornea plana.
Unfortunately the central corneal
opacity is not very well
reproduced in the photograph.
• (B) A side view of the same
cornea. A greatly reduced corneal
curvature and a shallow anterior
chamber are shown here
Corneal ectasias:
Ectasia:
• an enlargement, dilation, or ballooning effect
Corneal ectasia?
• are a group of uncommon, noninflammatory, eye disorders
characterised by
• bilateral thinning of the central, paracentral,or
peripheral cornea
• Most common
1. Keratoconus
2. Keratoglobus
3. Pellucid marginal degeneration
1.Keratoconus:
• a progressive, non- inflammatory,
• bilateral, asymmetric disease
• characterized by paraxial stromal thinning and weakening that
leads to corneal surface distortion.
• Onset = around puberty, slow progression thereafter until the
3rd & 4th decades of life
• Role of heredity?
• Most pts. do not have positive family Hx.
• Presentation:
1. Reduce visual Acuity
2. Frequent changes in spectacle prescription
3. Glare
4. Ghost images
5. Monocular Diplopia
Signs:
1. Progressive myopia and irregular astigmatism
2. Rizzuti sign -------> conical reflection on the nasal cornea when a
penlight is shone from the temporal side
3. Munson sign --------> bulging of Lower Eyelid in Down Gaze
4. Oil droplet reflex -------> by Direct Ophthalmoscopy
5. Scissor Reflex --------> Retinoscopy
6. Bowmans scarring ------- > due to previous hydrops
7. Stromal vertical, fine lines (Vogt Straie) --------> Slit Lamp
8. Epithelial Iron deposits ( Fleischer Ring) ----> S/L cobalt blue filter
9. Apical Scarring ------> at the apex of the cone
10. Acute hydrops ----> rapture in Descmet’s membrane
11. Prominent corneal Nerve
Munson sign & Rizzuti Sign:
Fleischer ring & Vogt Straie:
Hydrops & Corneal Nerves
• AS-OCT showing large,
cystic intrastromal
accumulation of fluid in a
patient with keratoconus
and acute corneal hydrops.
• Detection of Keratoconus:
1.Retinoscopy
2. Slit lamp
3. Keratometer
4. Corneal Topography
The receiver operating characteristic (ROC)
curves of the optical coherence tomography
pachymetric keratoconus screening method (“1
abnormal” criterion) and the topographic
keratometry, inferior-superior, astigmatism, and
skew percentage (KISA%) method.
CLASSIFICATION OF KERATOCONUS
Classification based on shape of Cone:
• Nipple Shape: small diameter ( 5mm) round shape Easiest to fit
with CL
• Oval Cones: Large dia ( > 5mm) Often displaced inferiorly . More
difficult to fit wit Cl
• Globus Cones: Largest Dia ( >6mm) 75% of the total cornea is
affected ,Most difficult to fit with lenses
ON THE BASIS OF Keratometer
Reading:
Grades of Keratoconus:

• Mild K ( < 48 D)
• Moderate K ( 48D – 54D)
• Severe K ( > 54D )
Associations:
Systemic:
• Downs Syndrome
• Marfan’s Syndrome
• Turner syndrome
• Ehlers- Danlos Syndrom etc
Ocular :
• Persistent Eye rubbing
• Aniridia
• Retinitis pigmentosa
Treatment:
• Spectacles:
• RGP ( Rigid Gas Permeable Contact Lenses)
• Keratoplasty
2. Keratoglobus:
• “the condition in which the entire cornea is
abnormally thin”
Or
• Generalized thinning of cornea
Onset: at birth
Signs: ectasia is Generalized
• acute hydrops occur less commonly
• Cornea is more prone to rupture on trauma
Management:
• CL ------ scleral CL
• Surgery ------poor results
3.Pellucid marginal degeneration:
• Inferior corneal thinning ( sometimes superior cornea too)
• Bilateral
• Onset: 20 years to 40 years
• Cresent shape band of inferior cornea extending from 4 – 8
o’clock
• Intact epithelium
• No fleischer rings, no Vogt straie
• High Astigmatism ( against the rule)
Treatment:
• Spectacles: not usefull
• CL: RGP CL
• Surgery: keratoplasty
THANK YOU