cornea anatomy and all diseases

2. DISEASES OF CORNEA
Dr. Abdul Basir safi
Lecturer of Nangrahar Medical
faculty
head of eye department
E-mail: basirsafi123@yahoo.com

3. • Epithelium
• Bowman’s membrane
• Stroma
• Descemet’s membrane
• Endothelium
ANATOMY OF CORNEA

4. • Refraction total eye is 60D but cornea
is43- 45D.
• protection
NERVE SUPPLY OF CORNEA
• Ophthalmic Division Of Trigeminal Nerve
CORNEA IS TRANSPARENT STRUCTURE
• Regular arrangement of lamellae
• Avascular structure
• Dehydration
Function of the cornea

5. • Nutrition of cornea
• Peri limbal Blood Vessels
• Aqueous Humour
• Oxygen
Defence of Ocular Surface
Normal Defence mechanisms:
1. Eyelids
2. Tear film proteins, lysozyme,
betalysin and lactoferrin.
3. Corneal epithelium
4. Normal ocular flora

6. 1. Inflammation ( keratitis)
2. Degeneration
3. Ectasies
4. Congenital anomalies.
Diseases of cornea

7. KERATITIS
1. BACTERIAL KERATITIS
2. FUNGAL KERATITIS
3. VIRAL KERATITIS
4. MECHANICAL
Stage corneal ulcer
1. Progression
2. Regression
3. Healing
Source of infection
1. Exogenes
2. Endogens
3. Ocular

8. Progression
corneal ulcer
Regression
Healing
corneal scar

9. penetrate intact corneal epithelium.
1. N Gonorrhea
2. Diphtheria
3. Homophiles Aygeptius
4. Listeria
Organism intact
epithelium

10. 1. Corneal anesthesia Use of topical
anesthetic solution.
2. Local immune suppression as due
to topical corticosteroids.
3. Previous viral infection.
4. Trichiasis
5. Entropion
6. Eye lid positional
abnormality
7. Dacryo cystitis
Predisposing factors
ocular

11. 1. Malnutrition
2. Diabetes
3. Collagen vascular diseases
4. Chronic alcoholism
5. Aids
Predisposing factors
systemic

12. 1. Dimness of vision
2. Watering (lacrimation)
3. photophobia
4. blepharospasm
5. Pain and foreign body sensation
6. Discharge (Macu purulent /
purulent)
7. discompartible
Symptoms of Corneal
Ulcer

13. 1. Visual acuity may be affected
2. Edema of lid
3. Blepharospasm
4. Ciliary and conjunctival
congestion
5. Hazyness and hypopyon.
Signs

15. 1. Iritis
2. Secondary intraocular
hypertension
3. Descematocele or keratocele
4. Corneal opacities
• Nebula
• Macula
• Leucoma
5. keratectasia
Complication of corneal
ulcer

16. 6. Synechia
7. Corneal fistula
8. Cataract
9. Staphyloma
10. Lens subluxation
11. Intra ocular hemorrhage
12. Dislocation of lens
13. Panophthalmitis
14. Endophthalmitis
Complication of corneal ulcer
Staphyloma

17. Synechia

18. LOCAL TREATMENT
• Control of infection with
appropriate antibiotic
a. based on clinical judgment
b. based on finding of smear
examination
c. based on culture and
sensitivity report
Treatment of uncomplicated
corneal ulcer

19. 1. Control of infection (Antibiotic
drops)
2. Rest of eye (Atropine)
3. Cleanliness (cauterisition)
4. Application of hot fomentation
5. Protection of eye (black glass)
6. Support of nutrition
Treatment of uncomplicated
corneal ulcer

20. 1. Systemic Antibiotics
2. Analgesic anti-inflammatory
3. Supportive treatment
4. Acetazolamide
Systemic Treatment

21. Local factors
trichiasis
exposure keratitis
chronic dacryocystitis
General factors
• Diabetes's millets
• Vitamin A deficiency
• Malnutrition
• AIDS
Non healing corneal
ulcer

23. • Definition =due to ulcer:
hypopyon + iridocyclitis
• Etiology
• 80% fungal infection pneumococc
and pseudomonas
• 20% other organism
Hypopyon corneal
ulcer

24. Clinical pictures
• Clinical picture is depends on two
factors.
• Virulence of organism
• Resistance of host
• Hypopyon in AC ( pass in AC)
• Iritis
• Synechia
• Miosis
• Secondary glaucoma
• Salagish pupil reflex

25. Complication
1. Perforation
2. Secondary glaucoma
3. Endophthalmitis
4. Panophthalmitis
Treatment
1.Control of infection
2.Clean of ulcer
3.Hot fomentation
4.Rest (Atropine)
5.Protection
6.Electrolysis for trachiasis

27. • Rare type of hypopyon
• corneal ulcer
• It is common in rural
agriculture area
• Aspergillus
• Candidiasis
Fungal corneal ulcer
Mycotic ulcer
(keratomycosis)
Fungal corneal ulcer

28. • Injury by vegetative material
• Injury by animal tail
• Long use of Antibiotic and
steroids
• secondary fungal ulcer
• Dry eye
• Herpes simplex keratitis
• Bullous keratopathy
Predisposing factors

29. Sings and symptoms
• Is sever than B ulcer.
• Massive hypopyon is present
• Irregular ulcer margin
• Dirty feature of ulcer
• Corneal abscess
treatment
• scraping and debridement of
ulcer
• Atropine
• Anti fungal drugs
• Keratoplasty

30. Viral keratitis

31. Introduction
• Viruses that cause corneal
disease are
• Herpes simplex ( HSV)
• Varicella zoster ( VZV)
• Adenovirus
• Epstein Barr virus ( EBV)
• Cytomegalovirus (CMV) can
also cause keratitis and is
more commonly associated
with AIDS

32. Herpes simples keratitis
• DNA viruses
• There are two types of HSV
• HSV-1 is more commonly
associated with labial and
ocular infection.
• HSV-2 is associated with genital
infection.
• Type one trigeminal ganglion
• Type two spinal ganglion

33. Dendratic keratitis

35. Treatment
1. Specific treatment
2. Non specific treatment
• Acyclovir
• Triflurothymidine drop
• Adenine arabinoside

36. Varicella zoster viral

37. Herpes zoster Keratitis
Varicella keratitis (VZV)
• Occurs in two forms:
• Primary ( varicella)
• Recurrent ( herpes zoster)
• Mechanism of damage
• Cellular infiltration
• Ischemic vasculitis
• Inflammatory granulomatous
reaction

38. Predisposing factors
• Old age
• Diabetes
• Alcoholic person
• Cancer
• AIDS

39. Complication
1. Iridocyclitis
2. Paralysis of 3th, 4th, 6th and 7th
3. Optic neuritis
Treatment
• Oral acyclovir
• Local acyclovir
• Steroid
• Analgesic
• Antibiotic
• Cycloplegic

41. Degeneration of cornea
1. Arcus senilis
2. Band shape keratopathy
Degeneration of cornea
Arcus senilis
• Arcus may be associated with familial.
• Bilateral
• Unilateral arcus is rare it may with
carotid diseases and ocular hypotony
• Over the age of 80years.

43. BAND KERATOPATHY
Band keratopathy is common disorder
Deposition of Ca salt in BM, stroma and Epi
Cause
• Ch-iridocyclitis in children
• Phthisis bulbi
• Chronic keratitis
• Chronic Glaucoma
• Rheumatoid arthritis
• Hyperparathyroidism
• High level of Calcium and phosphorus
• Ch.Renal failure
• Familial

44. ECTATIC CONDITION OF
CORNEA
1.Keratoconus (conical
cornea)
2.keratoglobus
keratoconus

46. Keratoconous
• It’s bilateral non inflammatory
condition 85%.
• Family history is not positive.
• Unilateral is rare and from
unknown causes
• Keratoconus is with Down’s
syndrome, atopic dermatitis,
Retinitis pigmentosia, aniridia,
VKC and Morffan syndrome,
osteogenesis, mitral valve
prolapse.

47. Munson’s sign

48. Keratoconous
Classification
1. Mild<48D
2. moderate (48-54D)
3. Sever >54D
PATHOLOGY
• Thinning of central cornea
• Rupture of Decement Membrane
Clinical picture
• Blurred vision
• Cone shape of cornea
• Placida's disk
• Munson’s sign
• Ophthalmoscopic sign

49. Placido’s disc examination
Normal
abnormal
Placido’s disc

51. Photophthalmia is
keratocounjunctivitis
Type of photophthalmia
1. Industrial photophthalmia
2. Snow photophthalmia
Clinical picture
Treatment
• Cold compress
• Eye pad
Photophthalmia

52. Keratoplasty or corneal
transplantation
1. Penetrating keratoplasty
2. Lamellar keratoplasty
CORNEAL PRESERVATION
• Short term storage 48hr
• Intermediate storage 2weeks
• Long term storage 35 days

55. keratomlacia
Corneal ulcer due to vit-A
deficiency
• The cornea become soft and
necrotic known as keratomlacia
• Bil cornea damage from center
• Bitot spot
• Less then 50– 70 IU
• Night blindness or nyctalopia

56. keratomlacia
Corneal ulcer due to vit-A
deficiency
Function of vit A
• Vision
• Mucus cell - keratin producing cell
• Anti infective vitamin
• Daily need of vitamin A in children is
1500—5000iu
• Daily need of vitamin A in adult is
3000—5000iu
Treatment
• In mild cases 30000iu per day for 1 week
• In sever cases 20000 iu / kg daily.

57. Treatment
Keep cornea well cover by
eye lid and bandage.
•Artificial tears and
ointment.
•Tarsorrhaphy
−Total tarsorrhaphy
−Lateral tarsorrhaphy
•Treatment of underling
causes.

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