This document summarizes several corneal disorders: - Corneal abrasion is a scrape or scratch of the corneal epithelium, most commonly caused by objects hitting the eye. Symptoms include eye pain and blurred vision. Treatment involves removing any foreign objects and using analgesics and antibiotics. - Corneal dystrophies are inherited disorders that affect the cornea's layers and transparency. Symptoms may include visual impairment and corneal erosion. Treatment addresses erosion and sometimes requires keratoplasty. - Band keratopathy is a type of corneal degeneration causing a white, band-shaped calcification. It is often caused by hypercalcemia or eye inflammation. Treatment focuses on the underlying cause along with superficial debridement.

1. Corneal disorders -2-:
Corneal Abrasion
By Leena Rasmi

2. Corneal Abrasion
• Definition: scrape or scratch injury on the corneal epithelium
• Epidemiology: most common eye injury
• Etiology:
• Injury from an object (e.g., tree branch, fingernail, ball, mascara
brushes) hitting, flying into, or poking the eye
• Foreign matter stuck under the eyelid
• Entropion
• Prolonged contact lens wear or improperly fitted lenses
• UV light (i.e., UV keratitis)
• Thermal burns (e.g., cigarettes)
• Dry eyes (e.g., Sjogren syndrome)

3. Clinical findings
• Foreign body sensation in the eye
• Eye pain
• Epiphora
• Blurred vision
• Photophobia
• Conjunctival injection

4. • Diagnostics: examination of the eye using fluorescein staining
• Treatment
• Removal of any retained foreign object
• Analgesia: oral NSAIDs, topical NSAIDs (e.g., diclofenac, ketorolac), or
narcotics, depending on pain severity
• Infection prophylaxis
• In the general population: antibiotic eye drops or ointment
(e.g., erythromycin)
• In contact lens wearers: antibiotic eye drops or ointment with
antipseudomonal activity (e.g., ciprofloxacin)
• Consider eye patching

5. Corneal
dystrophies

6. Corneal dystrophy
• These are rare inherited disorders. They affect different layers of
the cornea and often affect corneal transparency
• They may be divided into:
• Anterior dystrophies involving the epithelium. These may present
with recur-rent corneal erosion.
• Stromal dystrophies presenting with visual loss. If very anterior
they may cause corneal erosion and pain.
• Posterior dystrophies which affect the endothelium and cause
gradual loss of vision due to corneal oedema. They may also cause
pain due to epithelial erosion.
Symptoms may include:​
•Progressive visual impairment​
•Corneal erosion​
•Treatment
•Treat corneal erosion, as in above.​
•Keratoplasty in severe cases or
when other treatment modalities
have not been successful​

7. Corneal Degeneration
•Definition: changes of
the cornea that cause corneal
deterioration and, potentially,
dysfunction
•Etiology
•Normal aging
•Secondary to various pathological
processes (e.g., calcium salt
deposits in band
keratopathy associated
with hypercalcemia in the setting
of sarcoidosis)

8. Band keratopathy
• Definition: a type of corneal degeneration that involves the
appearance of a band-shaped area of calcification across the
central cornea
• Etiology
• Idiopathic
• Risk factors
• Hypercalcemia (e.g., hyperparathyroidism, sarcoidosis), hy
perphosphatemia (e.g., chronic renal failure)
• Chronic, inflammatory eye disease (e.g., uveitis, keratitis)
• Exposure to harmful chemicals (e.g., mercury vapors)
• Family history of band keratopathy
• Pathophysiology:
increased serum calcium, serum phosphate, and/or corneal surface
pH (caused by chronically inflamed eyes) → change in solubility of
calcium and phosphate → calcium phosphate precipitation out of
tears, aqueous humor, and corneal tissue
→ calcium phosphate deposition as salts in the Bowman layer
and superficial stroma of the cornea

9. • clinical findings
• Decreased visual acuity
• Foreign body sensation
• Photophobia
• Diagnostics
• Slit lamp examination showing band-like, horizontal, opaque white
areas on the cornea
• Followup includes investigation of underlying causes and may include:
• Serum calcium and phosphate measurement
• Parathyroid hormone level measurement
• Renal function tests
• Sarcoidosis workup (e.g., serum ACE, chest x-ray)
•Treatment:
•Treatment of the underlying cause (e.g., uveitis, hypercalcemia)​
•Superficial debridement and lamellar keratectomy
•Prognosis: Visual deficits caused by band keratopathy can typically be
treated successfully but will recur if the underlying condition is not
addressed.​

10. Curvature
anomalies of
the Cornea

11. Keratoconus
• Definition: a noninflammatory corneal condition in which
the cornea becomes thinner than normal and develops a conic shape,
bulging outward at the center
• Etiology: unknown; frequently associated with other conditions
• Neurodermatitis
• Allergic asthma
• Marfan syndrome
• Ehlers-Danlos syndrome
• Down syndrome
• A positive family history of keratoconus has been found in a
minority of cases (10%)
• Clinical findings: symptoms are often initially unilateral; however,
they always become bilateral in the further course of disease
• Progressive decrease in visual acuity
• Myopia
• Astigmatism
• Photophobia

12. • Diagnosis
• Slit lamp examination showing protrusion and thinning
of the cornea
• Ultrasound pachymetry (measurement of corneal
thickness via ultrasound)
• Computerized corneal topography
• Treatment
• Correcting astigmatism and myopia: glasses or rigid
gas permeable contact lenses
• In progressive keratoconus: crosslinking with UV-A light
(corneal crosslinking)
• If conservative treatment options fail: keratoplasty

13. Corneal Graft

14. Keratoplasty (corneal transplantation)
Indications
•Significant visual impairment as a result of pathological changes
in the cornea, e.g., opacification, irregular curvature
•Keratitis that cannot be controlled by conservative treatment
•Procedure: replacement of diseased cornea with cornea harvested from
a recently deceased donor
•Perforating keratoplasty (replacement of the complete cornea):
indicated when both anterior and posterior corneal layers are
damaged
•Lamellar keratoplasty (replacement of only
the anterior or posterior corneal layers): indicated when
only anterior or posterior corneal layers are damaged
•Follow-up care
•Graft rejection prevention: corticosteroid eye drops
•Monitoring and treatment for graft rejection

15. Corneal deposits

16. Arcus senilis (corneal arcus)
• Definition: A yellow or gray discoloration of the corneal margin
caused by deposits of fat and cholesterol , a condition associated
with normal aging, in which annular deposits of lipids appear
around the corneal margin
• Epidemiology: Incidence increases with age.
• 60% in those 50–60 years
• Almost 100% in those > 80 years
• Clinical findings: asymptomatic
• Diagnostics: slit lamp examination
• Treatment
• In older patients: no treatment necessary
• Occurrence before 50 years of age: rule out lipid disorders

17. Kayser-Fleischer rings
• Copper accumulation in Descemet
membrane of the cornea that results in 1–2
mm wide, green-brown rings in the periphery
of the iris
• Diagnostic sign of Wilson disease

18. Sclera

20. Scleritis vs Episcleritis

21. phenylephrine eye drops
test
Scleritis complications
Scleromalacia ( thinning of the sclera )​ , Keratitis​ , Uveitis ​ , Cataract , Glaucoma

22. Blue sclera
• Blue discoloration is caused by thinning or transparency of scleral
collagen with visualization of the underlying uvea
• Important causes include the following:
• Osteogenesis imperfecta.
• Ehlers–Danlos syndrome type VI
• Marshall–Smith syndrome , Russell–Silver syndrome , Hallermann–
Streiff–François syndrome.

23. Osteogenesis Imperfecta
It is an inherited disease of connective tissue, usually caused by defects in the
synthesis and structure of Type 1 collagen. There are multiple types, at least
two of which have ocular features.

24. Thank You