This presentation describes the background of the cornea and the corneal diseases in general, also it describes in detailed manner how to manage the corneal ulcer with its different causes
8.
Three Layers
1.Epithelium & its Basement
2.Stroma & its ant condensation ( Bowman Zone(
3.Endothelium & its Basement (Descemet Membrane(
Structure
10.
From Anterior to Posterior
1.Epithelium
2.Bowman Zone
3.Stroma
4.Descemet Membrane
5.Endothelium
Structure
11.
50-60µm thick
Covers the stroma anteriorly
Continuous with epithelium of conjunctiva
Life of epithelial cells is 7 days
Prevent aqueous solutions to penetrate
Epithelium
15.
Central cornea is avascular
Corneoscleral limbus is generously supplied by
anterior conjunctival branches of the anterior ciliary
arteries
Aqueous humor and tear film provides nutrients
Blood supply
16.
Branches of the ophthalmic division of
trigeminal nerve and are solely sensory
Most are concentrated in the anterior stroma
beneath the Bowman zone and send branches
forward into epithelium
Descemet membrane and endothelium are not
innervated
Nerve Supply
17.
The microvilli of the anterior surface of the
squamous cell layer are wet by the mucin of tear film
These cells are joined by tight junctions that exclude
water soluble substances
Cornea
18.
Tight junctions of the epithelial cells
Endothelial pump mechanism
Absence of blood vessels
Absence of pigments
Scarcity of cell nuclei in stroma
Regular structure of stroma
Transparency
19.
Superficial
1.Punctate epithelial erosions
Tiny ,slightly depressed, epithelial defects
which stain with flourescein but not with
rose Bengal
PEE are non specific and may develop in a
wide variety of keratopathies
Signs of Corneal Disease
30.
Def: Corneal ulcers are defect in the corneal epithelium
with or without stromal infiltration.
Types:
A) Infectious ulcerative keratitis
B) Non infectious ulcerative keratitis
Corneal ulcers
31.
Bacteria and
Fungi
Bacteria and
Fungi VirusesViruses AcanthamoebaAcanthamoeba
Systemic
Autoimmune/
Inflammatory
Systemic
Autoimmune/
Inflammatory
Local ToxicLocal Toxic
InfectiousInfectiousNon infectiousNon infectious
EtiologyEtiology
32.
Causes:
Local causes:
Punctate marginal keratitis: Staphylococci, Streptococci, hypersensitivity to
medications
Peripheral keratitis associated with blepharitis:
Systemic causes:
Generally manifestation of systemic, immune-mediated disease
Most common: Rheumatoid arthritis, Wegener’s granulomatosis and
polyarteritis nodosa
Non Infectious Ulcerative Keratitis
33.
INFECTIOUSINFECTIOUS Non INFECTIOUSNon INFECTIOUS
Pain No pain
Discharge No discharge
AC reaction: present AC reaction: absent
Central Peripheral
Trauma: ++++ Trauma: -------
37. A corneal ulcer is an ocular emergency that
raises high stakes of questions about
diagnosis and management.
When a large corneal ulcer is staring you in
the face time isn't in your side.
Despite varying etiologies and presentations,
as well as different treatment approaches ,
corneal ulcers have one thing in common : the
potential to cause devastating loss of vision.
Important Facts
38.
1-Control of infection
2-Control of inflammation
3-Promotion of re-epithelialization –
lubrication – lid
closure – bandage
soft contact lens
4-Prevention of perforation
– tissue adhesive glue
– conjunctival flap
– systemic immunosuppressive agents
Corneal grafting
PRINCIPLES OF MANAGEMENT
OF CORNEAL DISEASE
48.
Greyish-white ulcer with indistinct margins
Surrounded by feathery infilterates
Ring infilterate
Endothelial plaque
Hypopyon
History of vegetable matter
injury
49. Dull grey infiltrate.
Satellite lesions.
Awareness of those ulcers resembling bacterial
keratitis
Awareness of those caused by yeast better
defined borders
Real flags
Differentiators
63.
Opaque cells arranged in a course punctate
or stellate pattern
Central desquamation leads to a linear
branching ulcer. –Fluorescein
stain – Rose Bengal stain
–Diminished corneal
sensitivity
Anterior stromal infilterates
Geographical or amoeboid ulcer
DENDRITIC ULCER
72.
Conjunctival: Pinkish-white nodule surrounded by
hyperaemia
Corneal: May resolve spontaneously or extend
radially to the cornea. May cause severe ulceration or
perforation.
SIGNS
75.
keratoconjunctivitis sicca (KCS(:
Or
keratitis sicca: is a multifactorial disease of the tears and
the ocular surface disturbance with corneal
manifestations
Causes:
1-Dry eye
2-Vitamin A deficiency
Keratoconjunctivitis
Sicca
77.
Exposure keratopathy (EK) is the cornea damage that
occurs from prolonged exposure of the ocular surface to
the outside environment.
EK can lead to ulceration, microbial keratitis, and
permanent vision loss from scarring
Causes:
1-Lagophthalmos
2-Proptosis
3-Lid malposition
Exposure Keratopathy
79.
is a degenerative disease of the cornea caused by
damage of the trigeminal nerve which results in
impairment of corneal sensitivity, spontaneous corneal
epithelium breakdown, poor corneal healing and
development of corneal ulceration, melting and
perforation
Diagnosis:
by placing a cotton wad or cotton thread in contact with
the corneal surfaceCorneal sensitivity test:
Neurotrophic keratitis