This document discusses various corneal diseases including herpes zoster ophthalmicus, syphilitic interstitial keratitis, acanthamoeba keratitis, onchocerciasis, and xerophthalmia. It describes the mechanisms, risk factors, signs, symptoms, investigations, and treatments for each condition. Key points include that herpes zoster ophthalmicus can cause acute or chronic eye involvement including epithelial keratitis, conjunctivitis, and neurotrophic keratitis. Syphilitic interstitial keratitis presents with limbitis, salmon patch vessels, and scarring. Acanthamoeba keratitis causes pseudodendrites, stromal infiltration,

1. OPTOM FASLU MUHAMMED
CORNEA

2. HERPES ZOSTER OPTHALMICUS
 Varicella zoster virus causes chicken pox(varicella )
&shingles (herpes zoster )
 HZO discribes shingles involving the dermatome
supplied by the opthalmic division of the 5 th cranial
nerve
 Mechanism of involvement :
1. Direct invasion : causing conjuctivits& keratitis
2. Secondry inflammation : Scleritis , uveitis
3. Reeactivation : causes necrosis & inflammof the
sensory ganglia leading to cornal anasthesia &
neurotropic ulcers

3. RISK OF OCULAR INVOLVEMENT
1. Hutchinson sign : invovlment of the skin suppliued
by external nasal nerve , a branch of nasocillary
nerve, supply the lip and side & root of the nose –
strong corelation with ocular involvemnt
2. Age : 6 -7 th decade
3. AIDS :
if affected in children r/o immunocomp/malignancy

4.  ACUTE SHINGLES
Skin lesions in the dermatomes , varies accrding to
age of the lesions –vesicles-> crusting-> scar
 Eye disease
1)Acute 2)Chronic
1)Acute :
a)Acute epithelial keratitis :
In 50% of cases within 2 days of onset of rashes
Resolve sponatneously
Characterised by dendritic lesions
Rx: Topical antiviral

5. b) Conjuctivitis
Follicular /pappilary
On Rx
c)Episcleritis :
Reslove spontaneously
Mild NSAIDS
d) Scleritis :
e)Nummular keratitis :
10 days after onset of rash
Characterised by fine grandular sub epithelial
depositis surrounded by halo of stromal haze

6. f) Disciform keratitis
g)Anterior uveitis
h)Monitor IOP
i)Neurological complications
CN palsies 3 ,4 6
Encephalitis

7.  CHRONIC EYE DISEASES
1) Neurotropic keratitis
2) Scleritis -scleral atrophy
3) Mucous plaque keratitis : sudden appearance
4) Lipid degenration
5) Lipid granulomata
6) Eyelid scarring-entropion /extropion

8. INTERSTICIAL KERATITIS
 Inflammtion of the corneawithout primary
involvement of the epithelim or endothelium
 Immune mediated process
 Etiology : syphillis / herpetic keartitis , cogans
syndrome
SYPHYLLITIC IK
 CONGENITAL / AQUIRED
CONGENITAL :
 Transplacentally
 Causes anterioir uveitis , IK, dislocation of the lens ,
optic atropy, retinopathy

9. AQUIRED
uveitis , IK, optic neuritis , madarosis
SYPHILITIC IK
1)Presentation:
 If congenital : 5 – 25 yrs
Anterior uveitis , b/l
 If aquired : unilateral
2)Signs :
 limbitis , deep stromal vascularization – salmon patch
apperence
 Granulaomamtous anterior uveitis
 After months the vessels become non –perfused : Ghost
vessals
 If the cornea later becomes inflammed , vessels are refilled
and bleeds
 Scarring

10.  Rx: systemic antibiotics (pencillin)
 Steroids and clyclopegics

11. PROTOZOAN KERATITIS
ACANTHAMOEBA
 Commonly found in URT
 Cystic form –highly resilent & infective in
favourable environmental condition , also produce
enzymes for tissue penetration
 Symptoms :
 Blurred vision & Severe pain out proportion to the
lesions

12.  SIGNS :
 Early : irregular epithelial surface
 Epithelial psuedodentrites
 Limbitis with stromal infiltration
 Gradual enlargement of infitrate and coalescence
to form a ring abscess
 Scleritis
 Stromal opacification and vascul
 Corneal melting

13.  INVESTIGATIONS :
1. Staining of the corneal scraping (PAS / calcofluor
white )
Gram and Gimesa
2. Cultures :
3. Others :
RX:
 Suspected if the patient do not respond well with
antibiotics
1. Debridment :
2. Topical Amoebicides : polyhexamethylene biguanide
0.02%
And/ chlorhexidien digluconate 0.02%
3. Pain control

14.  ONCHOCERCIASIS
 River blindness
1. Caused by oncecerca volvulus
2. Second most common infectious cause of
blindness
3. Sign:
 L ive microfilariae can be seen in the cornea
/aqeous /vitreous in 50 %
 Anterior Uveitis
 Punctate keratitis and sclerosing keratitis initally in
3 and 9 o clock postion , later on extending on to
the whole cornea and scarring
1. Rx: systemic Ivermectin and steroids ( for acute
inflammation )

15. XEROPHTHALMIA
 Defficency of vit . A
 Vit . A: Functions
1. Epithelial surfaces
2. Immune function
3. Retinal photorecetops
CAUSES :
1. MAL ABSR/ NUTRI
2. ALCOHOL
3. SELECTIVE DIET

16. DIAGNOSIS
 SYMPTOMS:
1. Night blindness/ nyctalopia
2. Loss of vision
CONJUCTIVA
1. XEROSIS:
Dryness in interpalpbral zone
Loss of globlet cells
Squamous metaplasia, keratinization

17. 2.BITOTS SPOTS :
Keratinised epithelium in the interp…---
cornybacterium xerosis
CORNEA
1. Lusterless- due to second xerosis
2. B/L punctate epithelial erosions epitheliad
defects
3. Keratinization
4. Corneal melting (liqufactive necrosis) –perforation

18. RETINA
Retinopathy –yellowish peripheral dots
Rx:
Kearatolamalacia –indicated severe vitm defficency –
medical emergency – risk of death
SYSYTEMIC
ORAL: 2 lkh IU
IM : 1 lakh IU
Dietary supplements

19.  Local
Lubricants
Retinoic acid – promote Healing
Corneal perforation – Sx

20. WHO Grading of Xeropthalmia
XN- Night blindness
X1-conjuctival xerosis (X1A), Bitots Spots ( X1B)
X2- corneal xerosis
X3 – corneal ulceration
X3A< 1/3 rd
X3 B > 1/3 rd
XS corneal ulcer
XF-xeropthlamic fundus