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Cornea class 5
Cornea class 5
Cornea class 5
Cornea class 5
Cornea class 5
Cornea class 5
Cornea class 5
Cornea class 5
Cornea class 5
Cornea class 5
Cornea class 5
Cornea class 5
Cornea class 5
Cornea class 5
Cornea class 5
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Cornea class 5

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  1. CORNEA
  2. PERIPHERAL CORNEAL INFLAMMATION 1. Marginal keratitis 2. Rosacea keratitis 3. Phlyctenulosis
  3. Marginal keratitis Subepithelial infiltrate separated by clear zone Sup & Inf Limbus Circumferential spread Bridging vascularization followed by resolution <ul><li>Hypersensitivity reaction to Staph. exotoxins </li></ul><ul><li>Associated with Staph. blepharitis </li></ul><ul><li>Unilateral, transient but recurrent </li></ul>Progression Treatment - short course of topical steroids
  4. Rosacea keratitis <ul><li>Chronic progressive idiopathic condition </li></ul><ul><li>Facial skin </li></ul><ul><li>Ocular </li></ul><ul><li>involvement in 10% </li></ul>
  5. Rosacea keratitis Peripheral inferior vascularization Subepithelial infiltration Thinning and perforation if severe Progression Treatment - topical steroids and systemic tetracycline or doxycyline
  6. Phlyctenular Keratoconjunctivitis <ul><li>Non specific delayed hypersensitivity reaction to bacterial antigens </li></ul><ul><li>Common in childhood </li></ul>
  7. Phlyctenulosis <ul><li>Small pinkish-white nodule </li></ul><ul><li>near limbus </li></ul><ul><li>Usually transient and resolves </li></ul><ul><li>spontaneously </li></ul><ul><li>Starts astride limbus </li></ul><ul><li>Resolves spontaneously or extends onto cornea </li></ul>Conjunctival phlycten Treatment - topical steroids, cycloplegics Corneal phlycten
  8. Keratitis associated with Systemic collagen vascular disorders <ul><li>Rheumatoid arthritis </li></ul><ul><li>Systematic vasculitidis </li></ul><ul><li>– wegeners granulomatosis </li></ul><ul><li>- polyartertitis nodosa </li></ul>
  9. Rheumatoid arthritis <ul><li>Sclerosing keratitis </li></ul><ul><li>Peripheral corneal thinning </li></ul><ul><li>Acute stromal keratitis </li></ul><ul><li>Treatment </li></ul><ul><li>- topical : steroids </li></ul><ul><li>: cyclosporine </li></ul><ul><li>- systemic: cytotoxic </li></ul><ul><li>-keratoplasty </li></ul>
  10. Mooren’s ulcer <ul><li>Serpiginous ulcer/ rodent ulcer </li></ul><ul><li>Rare, sup ulcer of degenerative type </li></ul><ul><li>Elderly </li></ul><ul><li>Starts at corneal margin spreads over the whole of tissue. </li></ul><ul><li>Epithelial erosion autoimmune lysis due to release of collagenolytic enzymes </li></ul>
  11. Clinical features <ul><li>¼ of the cases bilateral </li></ul><ul><li>Cause –unknown </li></ul><ul><li>Severe persistent pain and lacrimation </li></ul><ul><li>Starts as grey infiltrates- ulcerates </li></ul><ul><li>Ulcer undermines the epithelium and sup lamellae at the advancing edge forming a whitish overhanging edge </li></ul><ul><li>The ulcer base – vascularized </li></ul><ul><li>Rarely perforates </li></ul>
  12. Mooren’s ulcer <ul><li>Progresses with intermission- nebula over the whole cornea </li></ul><ul><li>Vision is markedly affected </li></ul>
  13. Treatment <ul><li>Difficult – coz of ischemic aetiology </li></ul><ul><li>Excision of 4-7 mm of adjacent conj strip </li></ul><ul><li>Thus eliminating the conj sources of collagenase and proteoglycanase </li></ul><ul><li>Topical antibiotics and steroids ? Effective </li></ul><ul><li>Perforation- cyanoacrylate glue and contact lens </li></ul><ul><li>Lamellar keratoplasty+IV methotrexate therapy </li></ul>
  14. Keratomalacia <ul><li>Vitamin A def </li></ul><ul><li>Bilateral </li></ul><ul><li>Children are Extremely ill and die </li></ul>
  15. <ul><li>Night blindness-older children </li></ul><ul><li>Conj- dry and xerosis- bitots spots </li></ul><ul><li>Cornea dull and insensitive </li></ul><ul><li>Yellow infiltrates- > necrosis+melting in few hours </li></ul><ul><li>Absence of inflammatory reaction </li></ul><ul><li>Apathetic state- inability to close the eye lids->exposure keratitis </li></ul><ul><li>Treatment- Vit A supplementation </li></ul>

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