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THEME: Disorders of cornea.

Diseases of uveal tractus .

Lecturer Nykoluk AngelaMykolaivna

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Anatomy of cornea

1. Epithelium

- multilayer, nonkeratinized;- protective function.

2. Bowmans layer (membrane)

- randomly dispersed collagen fibrils,- homogenous.- poorly elastic,- well resistant to trauma,

- permeable to infectious agents,- does not regenerate,- replaced by scar tissue,- tightly connected with stroma, is in fact acondensation of its superficial layer.

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Anatomy of cornea

3. Stroma- constitutes 90% of total corneal thickness,- composed of parallel oriented keratocytesand collagen lamellae.

4. Descemets membrane

- homogenous,- transparent,- very elastic,- is a condensation of endothelial cells,- loosely connected with stroma, may detach,- regenerates,- resistant to infectious agents,- not resistant to damage.

5. Endothelium- regenerates,

- loss of more than 40% leads to cornealdystrophy.

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Properties of cornea and methods ofexamination

1. Spherical (size 10 11 mm, curv.rad. = 7,8mm)

keratoscopy2. Smooth 1% fluorescein solution stains superficial defects;

3. Wet, shiny corneal xerosis (Vit.A deficiency) Sjogrens syndrome4. Transparent focal, bifocal examination biomicroscopy5. Very sensitive Freus hair algesimetry

5-dot

5-dot 13-dot

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SOURCES OF CORNEAL NUTRITION

- tear liquid- anterior chamber humour

- diffusion from perilimbal vessels

Innervation n. ophthalmicus,

sympathetic nerves

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Pathology of corneal size: microcornea,megalocorneaPathology of corneal shape: keratoconus,keratoglobus, keratotorus

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Corneal topographic map atkeratoconus

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Corneal dystrophy (Lattice lines)

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Macular dystrophy

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Arcus senilis (corneal arc)

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Classification of keratitis . Exogenous

1. Post-traumatic: mechanical, physical, chemical agents.

2. Infectious, bacteria's: coccal flora, diphtheria ulcer.

3. Viral: trachomas ulcer , varicella ulcer, epidemic keratoconjunctivitis.

4. Fungal.

5. Due to infections of conjunctiva, eyelids, meibomian

glands.

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Classification of keratitis II. Endogenous.

1. Infectious: syphilitic, tuberculous:

- tuberculous hematogenous,- allergic tuberculous (phlyctenulosis),

malarial, brucellosis, laeprae.

2. Neurogenous: neuroparalytic herpetic:

- Herpes Simplex (punctate subepithelial,dendritic, stromal disciformic)- Herpes Zoster

3. Caused by vitamin deficiency.

4. Unknown etiology.

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Corneal syndrome

Subjective symptoms:

Foreign body sensation

Photophobia

Blepharospasm

Tearing

visual impairment

Objective symptoms:

Corneal infiltrate

Loss of transparency

Perilimbal injection

Vascularization

Loss of spherisity

Tissue defect

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Corneal infiltration

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Superficial vascularization (grow ofvessels)

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Differential diagnostics

Infiltrate Old opacification

Perilimbal injection + -

Signs of eye irritation + -(tearing, blepharospasm,photophobia)

Corneal surface not shiny, smoothrough

Color grey, yellow white-grey

Limits indistinct distinct

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Corneal creeping ulcer

- Characterized by progressive and

regressive edges, that spread alongthe surface and deep into stroma- Complicated by iridocyclitis inflammation of vascular layer-

Hypopion

pus in the anterior chamber

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Descemetocele (stretching ofDescemets membrane),

corneal perforation

Treatment of bacterial corneal ulcer1) Before descemetocele- Lacrimal sac irrigation- Treatment of ulcer ground with

antiseptic solutions- Eyedrops of wide-spectrum

antibiotics every 1-2 hours(fluoroquinolons, cephalosporins,macrolids)

- Epithelizing agents- Midriatics2 ) After descemetocele- Supine position- Miotics

- Antibiotics- Medications for the reduce of

intraocular pressure- Keratoplasty fibrin films,

conjunctival sealing, cornealtransplantation

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Amoebic keratitis

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Herpes-simplex dendriformic superficialkeratitis

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Herpetic disciformic deep keratitis

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Herpes zoster keratitis

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Tuberculosis keratitis1) tuberculosis-allergicsuperficial keratitis(flyctenulotic)2) Tubercuclosis-

hematogenous deepkeratitis

- Deep diffuse- sclerotizing- keratoiridocyclitis

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Outcomes of keratitis

nubecula (cloudiness)

macula (spot)

leucoma- simple- adherent

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Keratoplasty

Lamellar and full-thicknessBy purpose:

-optical-tectonic-cosmetic-refractive

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Disorders of the uveal tractus1. Congenital anomalies:- aniridia- heterochromia- iris coloboma- corectopia- policoria- albinism- remaining pupillary membrane

2. Uveopathies3. Inflammation uveitisAnterior uveitis iritis,

iridocyclitisPosterior uveitis choroiditisPanuveitis

4. Tumors

Classification of uveitis :1. Exogenous (penetrating

injuries, corneal ulcer)2. Endogenous: infectional(metastatic), toxic, allergic,metabolic (gout, diabetesmellitus).

By clinical course: acute, chronic(non-granulematous,granulematuos).

By extension: focal, multifocal.By the type of exudate: serous,

fibrinous, purulent, hemorrhagic.

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Iris coloboma

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Heterochromia externa

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Aniridia

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Heterochromia interna

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Symptoms of anterior uveitis

Subjective symptoms:

Severe pain in the eye,increases at night

Photophobia

Blepharospasm

Tearing

Decrease of vision

Objective symptoms:Perilimbal injection of scleraIris color changePupil constriction

PrecipitatesExudate in the anteriorchamber hypopion, hyphemaAnterior chamber flare ( Tindalssymptom)Posterior synechiaIntraocular pressure fluctuationExudate in the vitreous body

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Perilimbal injection, precipitates,exudate in the anterior chamber

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Hypopion

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Posterior synechia, iris bombe

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Secclusio pupillae

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Occlusio pupillae

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Symptoms of posterior uveitis

Subjectivesymptoms:

Central localization decrease of vision,

photopsia,metamorphopsia, centralscotomasPeripheral localization visual field depression,

hemeralopia(multifocal), peripheralscotomas, photopsia

Objective symptoms:Infiltrate, localizing in choroid andretina (corioretinal lesion) whiteor gray color, indistinct measures,

edema and prominent into vitreousbody

Retinal vessels hemorrhages

Exudate into vitreous body(vitreitis)

Signs of optical nerve involvement(optical neuritis)

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Recent chorioretinal lesion

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Old multifocal chorioretinal lesions

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CMV - chorioretinitis

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Toxoplasmosis chorioretinitis

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Thank you

for your

attention!