Corneal abnormalities and ulcers can be congenital, dystrophic, or degenerative in nature. Congenital anomalies include microcornea, megalocornea, and nanophthalmos. Corneal dystrophies affect the epithelium, Bowman's layer, stroma, or endothelium. Epithelial dystrophy causes thickened grey epithelium and recurrent erosions. Degeneration such as arcus senilis appears as a grey-white ring around the cornea in older individuals. Corneal ulcers present as a discontinuity in the epithelial surface and can be infectious, caused by bacteria, fungi, or viruses, or non-infectious. Treatment depends on the underlying cause and may involve antibiotics

1. CORNEAL
ABNORMALITIES
& CORNEAL
ULCER
By: Qurat-ul-ain
Ophthalmic Medical
Technologist/ MBA Health &
Hospital management

2. CONGENITAL
ANOMALIES OF
CORNEA
• Microcornea
• Megalocornea
• Microphthalmos
• Nanophthalmos
• Sclerocornea
• Cornea plana
• Keratectasia

3. 1. Micro-cornea
Corneal diameter <10mm.
It can be unilateral or
bilateral.
Eye may be normal in size or
smaller
Hypermetropia is present.
2. Megalo-cornea
Corneal diameter is >13mm.
Eyeball is normal otherwise.
3. Micro-
ophthalmos
The entire eye is small with
axial length at least 2
standard deviations below
the mean for age.
Features of dysgenesis:
Coloboma, Orbital cyst
Having CNS abnormalities.

4. 4. Nanophthalmo
s
Eye is structurally normal
apart from small axial length
of <20mm.
Ocular associations
include:
• Glaucoma (esp. angle
closure)
• Hypermetropia
• Ametropia
• Amblyopia
5. Sclero-cornea
Peripheral corneal
opacification
No visible demarcation
between cornea and sclera.
Appearance of reduced
corneal diameter.
In few cases, entire cornea
get opacified.
6. Cornea Plana
The cornea is flatter than
normal.
Hypermetropia

5. CORNEAL
DYSTROPHIES
• Epithelial dystrophies
• Bowman’s layer/ anterior stromal
dystrophies
• Stromal dystrophies
• Endothelial dystrophies

6. 1. Epithelial
Dystrophy
Affects the anterior cornea
Thickened grey epithelium
Irregular or comma shaped putty grey
patches
Fine refractile parallel curvilinear lines
Results in decreased vision/ recurrent
corneal erosions.
Risk factors: family history, trauma,
LASIK or intraocular surgery.
2. Ant. Stromal
Autosomal dominant pattern.
Onset is usually during
childhood
Deposits increases in density
with age.
Presence of grey white fine,
round, sub-epithelial opacities,
most dense centrally.

7. 3. Stromal
Dystrophy
Hereditary
Affecting central part of
cornea
Can be granular, macular or
lattice like in appearance.
Treatment of choice is
keratoplasty.
4. Endothelial
Dystrophy
Cortical guttata (beaten
metal appearance)
Stromal oedema.
Present with blur vision
worse in the mornings.
Micro-cysts and bullae
Can be associated with open
angle glaucoma.

8. DEGENERATION OF
CORNEA
• Central degeneration
• Peripheral degeneration
Arcus senilis
Arcus juveniles
Band-shaped degeneration

9. Arcus Senilis
Bilateral annual lipoid
infiltration of cornea in aged
persons.
Usually occurs above 40
years of age.
Greyish white circular line
concentric with limbus.
Does not affect vision and
does not require treatment.
Arcus Juveniles
Usually occurs below 40
years of age.
It does not affect vision.
Band-shaped
Common in old, blind and
shrunken eyes.
Associated with hypothyroidism,
vitamin D deficiency and
sarcoidosis.
Due to the age related deposition
of calcium-salts in epithelial
basement membrane, Bowman’s
membrane & anterior stroma.
Opacity in inter-palpebral fissure
extending across the cornea.
It is removed by chelation.

10. CORNEAL ULCERS
Dis-continuation in normal epithelial surface of cornea associated with
necrosis of the surrounding corneal tissue.

11. Corneal Ulcers
Non-Infectious
Inflammatory Local toxic
Infectious
Bacteria &
Fungi
Viruses Acanthamoeba

12. COMPARISON OF INF & NON-
INFECTIOUS CORNEAL ULCERS
Infectious
• Pain
• Discharge
• AC reaction: present
• Central
• Trauma ++++
Non-infectious
• No pain
• No discharge
• AC reaction: absent
• Peripheral
• Trauma -------

13. DIFFERENTIAL DIAGNOSIS
Symptoms Bacterial Viral Fungal
Discharge Mucopurulent ++ Watery May be present
Pain Severe Moderate Mild
Systemic (fever,
headache)
+ ++ -
Recurrence - ++ -
History of trauma Penetrating injury H/o cough and flu Vegetative trauma

14. SIGNS OF CORNEAL DISEASE
Superficial
Punctate epithelial
erosion
Punctate epithelial
keratitis
Epithelial oedema
Filaments
Pannus
Stromal lesions
Infiltrates
Focal areas of active
stromal inflammation
edema
Increased corneal
thickness
Decreased transparency
vascularization
Descemet
membrane lesions
Breaks
Corneal enlargement
Keratoconus
Birth trauma
Folds (striate
keratopathy)
Surgical trauma
Ocular hypotony
Stromal oedema

15. Signs Bacterial Viral Fungal
Injection Marked moderate Marked
Follicles - + -
Ulcer Ulcer with well-defined
margins, little or no
stromal haze with
smaller stromal infiltrate
Dendritic and
geographic pattern
Smaller epithelial defect,
ulcer will ill defined
margins, greater stromal
haze with larger stromal
infiltrate, satellite
Hypopyon mobile - Dense, immobile
Depth May be deep Superficial Deep
Corneal sensation present Reduced/absent Present
Pre-auricular
lymphadenopathy
+ + -

16. TREATMENT

17. Bacterial Fungal Viral Protozal
Topical antibiotics:
Ciprofloxacin
Vancomycin
Ofloxacin
Moxifloxacin
Removal of epithelium Antiviral agent:
Acyclovir e/d (3%)
Gancyclovir e/d (0.15%)
Trifluorothymidine e/d
(1%)
Antiamoebic agent:
Propanidine isethionate (0-1%)
Polyhexamethyelene biguanide
(0.02%)
Ciprofloxacin Clotrimazole
Miconazole
Oral antibiotics:
T. Ciprofloxacin
Topical-filamentous:
Natamycin (5%)
Econazole (1%)
Amphotericin B (0.15%)
Miconazole (1%)
Debridement:
For dendritic ulcers
Mydriatics:
Atropine (1%)
Cyclopentolate
(1%)
Candida:
Econazole (1%)
Natamycin (5%)
Fluconazole (2%)
Clotrimazole (1%)
Oral ketoconazole (200mg)
Topical steroids: Sub-conjunctival fluconazole
Systemic anti-fungals:
Itraconazole (100mg)
Voriconazole (100mg)
Excisional penetrating
keratoplasty

18. RESOURCES:
• https://www.eyenews.uk.com/education/trainees/post/corneal-dystrophies-
simplified
• https://eyewiki.aao.org/Epithelial_Basement_Membrane_Dystrophy#:~:text=Epithelia
l
• Comprehensive ophthalmology by Nasir Chaudhry

19. THANK YOU!