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Abnormalities of cornealTransparencies

Corneal oedemaDrying of cornea

Depositions on corneaInflammation of corneaCorneal degenerations

Dystrophies of corneaVascularisation of corneaCorneal opacities

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Corneal DiseasesKeratitisCorneal ulceration

Corneal ScarringCorneal Opacification

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Corneal opacity

Slight opacification allowing the details of iristo be seen thr. Opacity is called nebula/nebular c.o.More dense thr. Which iris & puppilary marginare visible. (no details) called macula /macular c.o.

If very dense, white & totally opaqueobscuring the view of iris & pupil is calledleucoma /leucomatous c.o.

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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, dystrophiesepithelial damage- mechanical injury,

Chemical injury ,radiational injury

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Corneal oedema

Can affect entire cornea.Epithelium- steamy appearance.

Stroma- haziness thr.out cornea.If persists for long period epithelium tends tobe raised into large vesicle or bullae i.e.

vesicular or bullous keratopathy intensepain & ocular irritation.S.K.- delicate grey lines.

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Examination of cornea

External exam .-Torch, Slit-lampSurface irregularities- Placidos disc

Curvature- keratometry, corneal topographyThickness- optical pachymeter, ultrasonicpachymeter, slit scanning topography.

Endothelium - with slit lamp, cell countingwith microscope.

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Source of infection

1. Exogenous infection- conjunctival sac

2. Endogenous infection- immunological in

Nature.

3. Contiguous spread from ocular tissue-

anatomical continuation.

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Keratitis

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Keratitis

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Topographical / morphologicalclassification

1.Ulcerative keratitis (corneal ulcer)-Depending upon location

Depending upon purulenceDepending upon hypopyonDepending upon depth of ulcer & perforation

Depending upon slough formation2.Non-Ulcerative keratitis

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Etiology of corneal ulcer

1.Corneal epithelial damage-Corneal abrasion,

Epithelial drying- xerosis, exp. keratitis Necrosis of epithelium- keratomalaciaDesquamation of epithelial cell- c. oedema

Epithelial damage due to trophic changes2. Source of infection-3. Causative organisms-

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Corneal ulcer

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Corneal ulcer

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Pathology of localisedcorneal ulcer

Four stages-

1.Stage of progressive infiltration.

2. Stage of active ulceration.

3. Stage of regression.

4. Stage of cicatrization.

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Symptoms of corneal ulcer

1. Pain

2. Watering

reflex blepharospam

3. Photophobia stimulation of nerve endings

4. Blurred vision

5. Redness of eyes

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Signs of corneal ulcer

Lids are swollenMarked blepharospasm

Conjunctivociliary congestion with chemosisKeratouveitisHypopyon

Ulcer stained by fluroscein

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Corneal ulcer

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Complications of corneal ulcer

1. Toxic iridocyclitis2. Secondary glaucoma3. Descemetocele

4. Perforation of corneal ulcer-prolapse of irisant. Capsular cataractcorneal fistula

purulent uveitisSubluxation / ant. Dislocation of lensintraocular hemorrhage

5. Corneal scarring / opacity

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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

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Treatment of uncomplicatedcorneal ulcer

1.Specific t/t- Topical antibioticSystemic antibiotic

2. Non specific t/t-Cycloplegic drugsSystemic analgesic anti-inflammatoryVitamins

3. Physical & general measures Hot fomentationDark gogglesNutritious diet & rest

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Treatment of Non-healingcorneal ulcer

1. Removal of any cause-Local cause

Systemic cause2. Mechanical debridement of ulcer 3. Cauterisation of ulcer

4. Bandage / soft contact lens5. Peritomy

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