ophthalmology

1. BY
Mukhtar Jama ,MBBS, MD
Diseases of the Cornea

2. OUTER COAT.1
MIDDLE COAT.2
INNER COAT.3
Three Coats of Eye Ball

4. Tough Fibrous Coat
Post 5/6th of Globe
White & Opaque
Sclera
Radius---12mm
Outer Coat

5. Tough Fibrous Coat
Ant 1/6th of Globe
Transparent
Cornea
Outer Coat

6. Vertical-------10.6 mm
Horizontal---11.7 mm
Thickness
Central portion----0.52 mm
Peripheral portion----1 mm
Size of Cornea

7. Three Layers
Epithelium & its Basement. 1
(Stroma & its ant condensation ( Bowman Zone. 2
( Endothelium & its Basement (Descemet Membrane.3
Structure

9. FromAnteriorto Posterior
Epithelium. 1
Bowman Zone. 2
Stroma. 3
Descemet Membrane. 4
Endothelium. 5
Structure

10. Superficial
Punctate epithelial erosions.1
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

12. Superficial
Punctate epithelial keratitis.2
.It is the hallmark of viral infections
Swollen epithelial cells
Visible unstained
Stains with rose bengal
Signs of Corneal Disease

13. Superficial
Epithelial Oedema.3
Sign of
Endothelial decompensation
Severe acute elevation of IOP
Signs of Corneal Disease

15. Superficial
Filaments.4
Small coma shaped mucus strands lined with
.epithelium
One end attached with epithelium
Signs of Corneal Disease

16. Superficial
Pannus.5
Inflammatory or degenerative ingrowth of fibro
vascular tissue from limbus
Signs of Corneal Disease

18. Stromal Lesions
Infiltrates.1
Focal areas of active stromal inflammation
Edema. 2
Increased corneal thickness
Decreased transparency
Vascularization. 3
Signs of Corneal Disease

19. Lesions of Descemet Membrane
Breaks. 1
Corneal enlargement
Keratoconus
Birth trauma
(Folds (Striate Keratopathy. 2
Surgical trauma
Ocular hypotony
Stromal oedema
Signs of Corneal Disease

21. 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

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23. :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

24. INFECTIOUS Non INFECTIOUS
Pain No pain
Discharge No discharge
AC reaction: present A C reaction: absent
Central Peripheral
: ++++Trauma : -------Trauma

27. Infectious keratitis

28. ✓A corneal ulcer is anocular 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

29. Control of infection- 1
Control of inflammation- 2
–- 3
– lid
– bandage
- 4
Promotion of re-epithelialization
lubrication
closure
soft contact lens
Prevention of perforation
– tissue adhesive glue
– conjunctival flap
– systemic immunosuppressive agents
Corneal grafting
PRINCIPLES OF MANAGEMENT
OF CORNEAL DISEASE

30. Ocular surface disease: Trauma, post-herpetic
corneal disease, bullous keratopathy, corneal
.exposure, dry eye and diminished corneal sensation
Contact lens wear
MICROBIAL KERATITIS
(( Bac terial

31. Pathogens which can produce corneal infection in intact
.epithelium
Neisseria gonorrhoeae.1
Corynebacterium diphtheriae.2
Listeria.3
Haemophilus.4
MICROBIAL KERATITIS
(( Bac terial

32. Oval, yellow-white, densely opaque stromal
suppuration surrounded by relatively clear cornea
Staph. aureus and strep.
pneum oniae

33. Bacterial ulcer

34. History
Clinical examination (including staining and
(sensitivity
Hospitalization
Corneal scrapping
Treatment
MANAGEMENT

35. ✓Acute painful injected eye.
✓Profuse tearing and discharge.
✓Decrease visual acuity.
✓Large F.B
✓Stromal invasion with epithelial excavating
edge.
Differentiators

36. 1. Fluroquinolones
✓ Every 5 mins /hour
✓ Hour /24 hs
✓ 2 hour /24 hs
2. Fortified eye drops ulcer < 2 ws ,
improvement not obvious.
(N.B)Don’t miss resistant bacteria.
1. Steriods
Treatment

37. Wrong diagnosis
Wrong treatment
Drug toxicity
Poor response to
treat ment

38. –
Filamentous fungal keratitis
Aspergillus
- Fusarium
FUNGAL KERATITIS

39. Greyish-white ulcer with indistinct margins
Surrounded by feathery infilterates
Ring infilterate
Endothelial plaque
Hypopyon
History of vegetable matter
inj ury

40. ✓Dull grey infiltrate.
✓Satellite lesions.
✓Awareness of those ulcers resembling bacterial
keratitis
✓Awareness of those caused by yeast better
defined borders
✓Real flags
Differentiators

41. Fungal Keratitis

43. Usually develops in pre-existing corneal disease or
immunocompromised patient
Yellow-white ulcer
Dense suppuration
Candida keratitis

45. Suppurative bacterial keratitis
Herpetic stromal necrotic keratitis
D/D of fungal keratitis

46. Culture
Biopsy
Antifungal therapy – Initially broad-
spectrum econazole 1%topically – Then
depending upon sensitivity natamycin or
imidazole for 6 weeks
Systemic ketoconazole
Therapeutic penetrating keratoplasty
MANAGEMENT

47. Protozoan –active
((trophozoite) –dormant (cystic
Common in swimmers and CL wearers
ACANTHAMOEBA
KERA TITIS

48. Blurred vision and disproportionate pain
Patchy anterior stromal infilterates
(Perineural infilterates (radial keratoneuritis
Infilterates coalesce –ring abcess, ulceration
and hypopyon
White satellite lesions
CLINICAL FEATURES

49. Acanthamoeba Keratitis

50. ✓History:
Ulcer simulators resemble HS in shape but ??
Light sensitive ( Jacket- over- the head sign)
✓Treatment :
Differentiators

52. Corneal scrappings stained with calcoflour
white
Corneal biopsy
Treatment with chlorhexidine,
polyhexamethylenebiguanide drops,
.dipropamidine and propamidine
Therapeutic penetrating keratoplasty
MANAGEMENT

53. -
-
Primary ocular herpes:
Blepharoconjunctivitis
(Keatitis (punctate epithelial

54. Opaque cells arranged in a course punctate
or stellate pattern
Central desquamation leads to a linear
–Fluorescein
– Rose Bengal stain
–Diminished corneal
branching ulcer.
stain
sensitivity
Anterior stromal infilterates
Geographical or amoeboid ulcer
DENDRITIC ULCER

57. Herpes zoster keratitis
Healing corneal abrasion
Pseudodendrites due to soft contact lens
Acanthamoeba keratitis
Drug toxicity
Differential diagnosis

58. ✓Dentritic ulcer.
✓Loss of corneal sensation.
✓Photophobia.
Types of HSV keratitis:
✓Primary
✓Recurrent
✓Dentritic , Geographic , Metaherptica
✓Diabetic foot in the eye Neurotrophic
Differentiators

59. Antiviral therapy –
–
–
Acycloguanosine 3% ointment
Trifluorothymidine 1% drops
Adenine arabinoside 3% ointment, 0.1%
drops
Idoxuridine
Debridement (with sterile cotton-tipped bud
(2mm beyond the edge of ulcer
TREATMENT

60. Stromal necrotic keratitis
Disciform keratitis
OTHER ENTITIES

61. –
Predominantly affects children
Etiology
Tuberculosis – Delayed
hypersensitivity reaction to staphylococcal or other
bacterial antigen
PHLYCTENULOSIS

62. Photophobia, lacrimation and
.blepharospasm
PRESENTATION

63. Conjunctival: Pinkish-white nodule surrounded by
hyperaemia
Corneal: May resolve spontaneously or extend
radially to the cornea. May cause severe ulceration or
.perforation
SIGNS

65. Short course of topical steroids
Topical antibiotics
TREATMENT

66. (:keratoconjunctivitis sicca (KCS
Or
keratitis sicca: is a multifactorial disease of the tears and
the ocular surface disturbance with corneal
manifestations
:Causes
Dry eye- 1
Vitamin A deficiency- 2
Keratoconjunctivitis
Sic ca

68. 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
Lagophthalmos -1
Proptosis-2
Lid malposition- 3
Exposure Keratopathy

70. 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

72. Thank you