Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
How To Examine A Corneal
Pathology
Dr. Pooja Bandivadekar
Senior Resident
Dr. R. P. Center for Ophthalmic Sciences
AIIMS
Examination Of Corneal Pathology-
Overview
Evaluation Of Visual Potential And Prognostication
Laboratory Investigations An...
Examination Of Corneal Pathology-
Clinical History
• Age of onset
• Mode of onset
• Unilateral or bilateral
• History of t...
Examination Of Corneal Pathology-
Clinical Assessment
• Assessment of vision,
Refraction
• Systemic Evaluation
• Torch Lig...
Examination of Corneal Pathology-
Clinical Assessment
Cornea And
Adnexal
Examination
Evaluation Of
The Lid
Slit lamp
Biomi...
Corneal Pathology- Adnexal
Evaluation
Corneal Pathology-
Slit lamp Examination
Direct
Illumination
Diffuse
Illumination
Focal
Illumination
Indirect
Illumination...
Slit Lamp Examination-
Diffuse Illumination
Slit Lamp Examination-
Diffuse Illumination
Slit Lamp Examination-
Focal Illumination
Slit Lamp Examination-
Retro Illumination
Slit Lamp Evaluation-
Sclerotic Scatter
• Corneal
opacities
• Interstitial
deposits
• Perforating scars
Slit Lamp Examination-
Specular Reflection
• Morphology of
endothelial cells
• Guttae and
excrescences
• Assessment for
co...
Slit Lamp Examination-
Fluorescein staining
Examination of Corneal Pathology-
Documentation Of Corneal Opacity
Examination of Corneal Pathology-
Documentation Of An Ulcer
Examination of Corneal Pathology-
Documentation of Decompensation
Examination of Corneal Pathology-
Tear Film Evaluation
Tear Film
Function Test
TBUT
Schirmer’s test
Tear Meniscus
Height
T...
Tear Film Evalaution-
Schirmer’s Test
• Tear production –
Aqueous component
• Basal Schirmer Test
• Schirmer I - < 15 mm
•...
Tear Film Evalaution-
Tear Film Breakup Time
Tear Film Stability
Tear Film Evaluation-
Tear Meniscus Height
• Pathological
<0.3 mm height
• Aqueous deficiency
• Poor lid to globe
appositi...
Esthesiometry
Examination Of Corneal Pathology
Assessment Of Intraocular Pressure
• Irregular mires on
applanation tonometry
• Effect of...
Examination Of Corneal Pathology
Assessment Of Fundus
• Optic nerve status-
Pupillary reactions,
Consensual reactions
• Ul...
Examination of Corneal Pathology-
Laboratory Investigations
Keratometry
Pachymetry
Impression Cytology
Corneal Scraping
Laboratory Investigations-
Keratometry
• Assessment of
astigmatism
• Planning of surgery-
– DSAEK v/s PKP
– Triple procedu...
Laboratory Investigations-
Pachymetry
• Methods
– Ultrasonic
– ASOCT based
– Scheimflug and scanning
slit
– UBM
• Indicati...
Laboratory Investigations-
Impression Cytology
• Non-invasive
• Indications
– Limbal stem cell
deficiency and dry eye -
ce...
Laboratory Investigations-
Corneal Scraping
Corneal Scraping
Smear
Gram’s stain
10% KOH
mount
Culture
Bacterial
Fungal
Oth...
Examination of Corneal Pathology
Advanced Diagnostic Techniques
Advanced
Diagnostic
Techniques
Corneal
Topography
Confocal...
Advanced Diagnostic Techniques
Videokeratography
• Placido disc based
• Surface topography of
entire cornea
• Indications
...
Advanced Diagnostic Techniques
Slit Scanning Imaging
• Combined with placido
disc imaging
• Elevation based
topography
• I...
Advanced Diagnostic Techniques
Scheimflug Imaging
• Elevation based
• Pachymetric values
• Good repeatability
• Indication...
Advanced Diagnostic Techniques -
ASOCT
Indications
• Monitoring of corneal ulcers
• Lasik flaps
• Pannus morphology
• Plan...
Advanced Diagnostic Techniques
Ultrasonic Biomicroscopy
• Indications
• Keratoplasty work-up-
• Limbal mass
– Dermoids
– O...
Advanced Diagnostic Techniques
Specular Count
• Indications
– Fuch’s endothelial dystrophy
– Posterior polymorphous
dystro...
Examination of Corneal Pathology
What Next?
Diagnosis
Prognosis
Management
Examination Of Corneal Pathology
Visual Potential Assessment
• Macular function tests
• Laser Interferometry
• Potential A...
Summary
• Accurate elicitation of history is important
• Detailed slit lamp examination is
necessary
• Fluorescein stainin...
How to examine a corneal pathology-basics
Upcoming SlideShare
Loading in …5
×

How to examine a corneal pathology-basics

4,918 views

Published on

cornea examination, eye pictures, slit lamp, ophthalmic, eye, kerato,

Published in: Health & Medicine
  • Be the first to comment

How to examine a corneal pathology-basics

  1. 1. How To Examine A Corneal Pathology Dr. Pooja Bandivadekar Senior Resident Dr. R. P. Center for Ophthalmic Sciences AIIMS
  2. 2. Examination Of Corneal Pathology- Overview Evaluation Of Visual Potential And Prognostication Laboratory Investigations And Corneal Imaging Bedside Tests Clinical Evaluation Of Cornea And External Eye Clinical History
  3. 3. Examination Of Corneal Pathology- Clinical History • Age of onset • Mode of onset • Unilateral or bilateral • History of trauma or chemical injury • Previous ocular surgery • Use of medications
  4. 4. Examination Of Corneal Pathology- Clinical Assessment • Assessment of vision, Refraction • Systemic Evaluation • Torch Light Examination – Ocular Movements – Fixation – Deviations
  5. 5. Examination of Corneal Pathology- Clinical Assessment Cornea And Adnexal Examination Evaluation Of The Lid Slit lamp Biomicroscopy Tear Film Evaluation
  6. 6. Corneal Pathology- Adnexal Evaluation
  7. 7. Corneal Pathology- Slit lamp Examination Direct Illumination Diffuse Illumination Focal Illumination Indirect Illumination Sclerotic scatter Retro illumination Specular Reflection
  8. 8. Slit Lamp Examination- Diffuse Illumination
  9. 9. Slit Lamp Examination- Diffuse Illumination
  10. 10. Slit Lamp Examination- Focal Illumination
  11. 11. Slit Lamp Examination- Retro Illumination
  12. 12. Slit Lamp Evaluation- Sclerotic Scatter • Corneal opacities • Interstitial deposits • Perforating scars
  13. 13. Slit Lamp Examination- Specular Reflection • Morphology of endothelial cells • Guttae and excrescences • Assessment for corneal decompensation
  14. 14. Slit Lamp Examination- Fluorescein staining
  15. 15. Examination of Corneal Pathology- Documentation Of Corneal Opacity
  16. 16. Examination of Corneal Pathology- Documentation Of An Ulcer
  17. 17. Examination of Corneal Pathology- Documentation of Decompensation
  18. 18. Examination of Corneal Pathology- Tear Film Evaluation Tear Film Function Test TBUT Schirmer’s test Tear Meniscus Height Tear Clearance rate Tear Osmolarity And Composition
  19. 19. Tear Film Evalaution- Schirmer’s Test • Tear production – Aqueous component • Basal Schirmer Test • Schirmer I - < 15 mm • Schirmer II- < 10 mm • < 5 mm -
  20. 20. Tear Film Evalaution- Tear Film Breakup Time Tear Film Stability
  21. 21. Tear Film Evaluation- Tear Meniscus Height • Pathological <0.3 mm height • Aqueous deficiency • Poor lid to globe apposition • Raised if naso- lacrimal obstruction
  22. 22. Esthesiometry
  23. 23. Examination Of Corneal Pathology Assessment Of Intraocular Pressure • Irregular mires on applanation tonometry • Effect of – Scarring – Edema – High astigmatism • Tonopen
  24. 24. Examination Of Corneal Pathology Assessment Of Fundus • Optic nerve status- Pupillary reactions, Consensual reactions • Ultrasound examination- – Endophthalmitis – Retinal Detachment – Optic nerve head cupping
  25. 25. Examination of Corneal Pathology- Laboratory Investigations Keratometry Pachymetry Impression Cytology Corneal Scraping
  26. 26. Laboratory Investigations- Keratometry • Assessment of astigmatism • Planning of surgery- – DSAEK v/s PKP – Triple procedures • Contact lens trials for visual rehabilitation
  27. 27. Laboratory Investigations- Pachymetry • Methods – Ultrasonic – ASOCT based – Scheimflug and scanning slit – UBM • Indications – Corneal opacities – Keratoconus and ectatic disorders – Ocular surface disorders-
  28. 28. Laboratory Investigations- Impression Cytology • Non-invasive • Indications – Limbal stem cell deficiency and dry eye - cell morphology and goblet cells – Diagnosis and monitoring ocular surface neoplasia- metaplasia
  29. 29. Laboratory Investigations- Corneal Scraping Corneal Scraping Smear Gram’s stain 10% KOH mount Culture Bacterial Fungal Others PCR Viral Acanthamoeba
  30. 30. Examination of Corneal Pathology Advanced Diagnostic Techniques Advanced Diagnostic Techniques Corneal Topography Confocal Scan Specular Count ASOCT UBM
  31. 31. Advanced Diagnostic Techniques Videokeratography • Placido disc based • Surface topography of entire cornea • Indications – Corneal astigmatism – Selective suture removal in keratoplasty – Contact lens rehabilitation of patients with corneal scars
  32. 32. Advanced Diagnostic Techniques Slit Scanning Imaging • Combined with placido disc imaging • Elevation based topography • Indications – Corneal ectatic disorders- keratoconus, PMD – Post- LASIK ectasia – Progression analysis
  33. 33. Advanced Diagnostic Techniques Scheimflug Imaging • Elevation based • Pachymetric values • Good repeatability • Indications – Corneal ectatic disorders- keratoconus, PMD – Post- LASIK ectasia – Progression analysis
  34. 34. Advanced Diagnostic Techniques - ASOCT Indications • Monitoring of corneal ulcers • Lasik flaps • Pannus morphology • Planning and management of lamellar keratoplasties • Descemet membrane detachment
  35. 35. Advanced Diagnostic Techniques Ultrasonic Biomicroscopy • Indications • Keratoplasty work-up- • Limbal mass – Dermoids – OSSN • Ocular surface diseases- – Evaluation – Planning of surgery
  36. 36. Advanced Diagnostic Techniques Specular Count • Indications – Fuch’s endothelial dystrophy – Posterior polymorphous dystrophy – Follow-up of keratoplasty – Eyes with glaucoma, uveitis, pseudo-exfoliation • Assessment of contralateral eye important
  37. 37. Examination of Corneal Pathology What Next? Diagnosis Prognosis Management
  38. 38. Examination Of Corneal Pathology Visual Potential Assessment • Macular function tests • Laser Interferometry • Potential Acuity Meter • Visually evoked potentials
  39. 39. Summary • Accurate elicitation of history is important • Detailed slit lamp examination is necessary • Fluorescein staining in all the cases • Thorough assessment of corneal sensations • Tailored laboratory and imaging techniques

×