CORNEA

INTERSTITIAL KERATITISDef –Inflammation of the corneal stroma without primary involvement of the epithelium or endothelium

Causes

Syphilis Tuberculosis Cogan's syndrome

SYPHILITIC INTERSTITIAL KERATITIS

Bilateral Manifests between 5-15 years of age Manifestation of local antigen antibody

reaction

SYPHILITIC IKClinical featuresHutchisons triad IK Hutchisons teeth Vestibular deafness.

SYPHILITIC IK3 stagesInitial progressive stage -2 weeks Corneal Edema: periphery – center Anterior uveitis

Pain , lacrimation, photophobia, circumcorneal congestion

Ground glass appearance

INTERSTITIAL KERATITIS

SYPHILITIC IKFlorid stage- 2 months Eye is acutely inflamed Deep vascularization covered by hazy

cornea appear dull reddish pink- salmon patch appearance

Epaulette- superficial vessels and conjunctiva heap at the limbus

INTERSTITIAL KERATITIS

SYPHILITIC IK

SYPHILITIC IKStage of regression -1-2 years

Acute inflammation resolves Clearing of cornea from periphery to center Resolution with some opacities and ghost

vessels- non perfused vessels

INTERSTITIAL KERATITIS

Non-perfused "ghost" vessels.

SYPHILITIC IKDiagnosis- positive VDRLTreatmentLocal Topical steroids Atropine Keratoplasty if dense opacities

Systemic – high dose of penicillin

INTERSTITIAL KERATITISEnd stage- scarring

TUBERCULOUS IK Features similar to syphilitic IK

Unilateral

Sectoral- lower sector

Treatment- systemic antitubercular drugs, topical steroids and cycloplegics

INTERSTITIAL KERATITISCogan’s syndrome

Interstitial keratitis – idiopathic Tinnitus Vertigo Deafness

Exposure keratitis Improper wetting of the ocular surface by the

tear film due to inability to close the eyes on blinking despite normal tear production

Causes Lagophthalmos Proptosis Orbital tumor Facial nerve paralysis

Exposure keratitisSigns

Inferior punctate epithelial erosion Secondary infectionSevere ulceration

Exposure keratitis

Exposure keratitis

Exposure keratitisTreatment Lubricant eye drops Taping of lids Antibiotics Tarsorraphy

Treat the cause

Neurotrophic Keratitis

Occurs in anesthetic cornea

Paralysis of sensory nerve supply of the cornea Trigeminal nerve

Altered metabolic activity of epithelium in the absence of sensation

Neurotrophic KeratitisCauses Congenital- Riley-Day syndrome Acquired

Trigeminal nerve dysfunction- infection, destruction, surgery, injury to gasserian ganglion

Leprosy

Neurotrophic Keratitis Clinical features –

No pain , no lacrimation Complete loss of corneal

sensations Ciliary congestion Punctate epithelial erosion

to severe ulceration Treatment

As an ulcer Tarsorrhaphy

Tarsorrhaphy

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Keratitis associated with diseases of skin and mucous membraneRosacea keratitis Chronic progressive

idiopathic condition Facial skin and eyes Irritation, burning , tearing,

redness Inferior PEE, marginal

keratitis, peripheral neovascularisation

Treatment

Keratitis associated with diseases of skin and mucous membraneRosacea keratitis Chronic progressive idiopathic condition Facial skin and eyes

Keratitis associated with Systemic collagen vascular disorders

Rheumatoid arthritis

Systematic vasculitidis

– wegeners granulomatosis

- polyartertitis nodosa

Rheumatoid arthritis Scelrosing keratitis Peripheral corneal thinning Acute stromal keratitis Treatment

- topical : steroids

: cyclosporine

- systemic: cytotoxic

-keratoplasty