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Corneal dystrophies & other
miscellaneous corneal
conditions
MBBS
KGMU
Common corneal disorders
• Keratitis/ corneal ulcer.
• Corneal trauma.
• Keratomalacia.
• Ectatic conditions.
• Corneal dystrophies.
• Corneal degenerations.
Differences between dystrophy &
degeneration
Corneal dystrophy
• Bilaterally symmetrical.
• Often hereditary.
• Limited to a particular corneal
layer.
• Non-inflammatory.
Corneal degeneration
• Non-hereditary.
• Usually unilateral sometimes
bilateral.
• Not strictly limited to a
particular corneal layer.
• Non inflammatory
Corneal dystrophies
Corneal Dystrophies
• Epithelial & sub-epithelial.
• Bowman’s membrane.
• Stromal.
• Endothelial.
Epithelial, sub-epith & Bowman’s corneal
dystrophies
• Epithelial & sub-epithelial – manifest in adults.
• Epithelial basement membrane dystrophy.
• Meesman dystrophy.
• Bowman’s layer dystrophies – manifest in childhood.
• Thiel Behnke corneal dystrophy.
• Reis-Bucklers corneal dystrophy.
Comparison between epithelial, sub-
epithelial, Bowman’s dystrophies
• Similarities:
• Symptoms:
• Asymptomatic / associated with recurrent corneal erosions.
• Foreign body sensation & watering.
• Treatment by PTK –photo-therapeutic keratectomy by EXCIMER
LASER.
• Difference:
Slit lamp examination shows patterns typical for each one.
Meesman’s dystrophy (intra-epithelial
microcystic appearance)
Stromal Dystrophies
•Granular form
•Lattice form
•Macular form Bilateral.
Manifest at puberty.
Diminution of vision is the presenting complaint.
Central cornea.
Granular stromal dystrophy
AD. Crumb-like accumulation of hyaline material
Lattice dystrophy
(AD. Criss-cross lines).
Macular Dystophy
AR Opacities dispersed throughout stroma.
Endothelial dystrophies
•Fuchs endothelial dystrophy – AD. Elderly.
•CHED – Congenital hereditary endothelial
dystrophy. AD/AR.
•PPMD –Posterior polymorphous dystrophy. AD.
Features common to all endothelial
dystrophies
• Limbus-to-limbus corneal clouding
• Bilateral.
• Endothelium is attenuated or even absent
• Oedematous cornea may be 2-3 times normal thickness.
• Generalised haze or diffuse ground glass appearance.
• Photophobia and lacrimation in late stages due to bullous
keratopathy.
Specular microscopy in endothelial dystrophy
Normal endothelim
Decreased cell count, pleomorphism,
polymegathism
Congenital hereditary endothelial dystrophy
(CHED)
• Autosomal dominant (later in infancy).
• Autosomal recessive
• Earlier presentation (at birth; nystagmus).
CHED
Posterior polymorphous dystrophy
• Autosomal dominant.
• Bilateral.
• 2nd or 3rd decade….rarely -in early infancy.
• Vesicle like lesions in non-banded part of Descemet’s membrane.
• Periph ant synechiae & raised IOP may be present.
Management of endothelial dystrophies
• Specular microscopy – for endothelial cell count.
• Pachymetry –corneal thickness.
Treatment required if symptomatic.
Symptomatic treatment:
• Hypertonic saline eye drops.
• Bandage contact lens.
Definitive treatment:
Endothelial keratoplasty (DSAEK).
Penetrating keratoplasty.
Corneal degenerations
Corneal degenerations
• Arcus senilis / juvenilis.
• Band shaped keratopathy.
• Terriens marginal degeneration.
• Salzmann nodular degeneration.
• Spheroidal degeneration.
Arcus senilis
Terrien marginal degeneration
• Bilateral.
• Progressive thinning of superior
peripheral cornea.
• No inflammation.
• Presents with myopia or
astigmatism.
Band shaped keratopathy
• Horizontal opacification in
palpebral aperture.
• Chronic uveitis, silicon oil.
• Blind shrunken eyes.
• Hyperparathyroidism,
sarcoidosis.
• Treatment – chelation with
EDTA.
• PTK ??
Ectatic conditions
Ectatic conditions
(non inflammatory)
• Keratoconus.
• Pellucid marginal degeneration.
• Keratoglobus.
Keratoconus
• Congenital weakess of corneal collagen.
• Conical shape of cornea because of central thinning and bulging
(Munson sign).
• Manifests after puberty.
• High myopia & astigmatism.
• Treatment options:
• Rigid contact lens.
• Corneal cross linking (C3R).
• Keratoplasty.
Keratoconus
Pellucid marginal degeneration
• Painless bilateral thinning of inferior peripheral cornea.
• Myopia & astigmatism.
• It is probably a variant of keratoconus.
Keratomalacia
Keratomalacia
• Bilateral.
• Rapidly increasing clouding of
cornea.
• No congestion.
• Melting of cornea.
• Night blindness +/-
• Other features of malnutrition /
diarrhoea.
• Timely injecs of Vit A & control of
malnutrition.
Corneal injuries
• Best possible repair also ends up
in subnormal visual gain.
• Timely keratoplasty is required in
visually significant opacity to
prevent amblyopia.
• Donor tissue selection should be
very carefully done - good
endothelial count.
Need of the hour
• Proper education of medical personnel, school teachers and health
workers regarding causes and prevention of childhood blindness.
• Training of medical personnel at primary and secondary health care
centres regarding early diagnosis of treatable conditions and suitable
management.
• To know ‘when to refer’ to higher centre.
• Over-the-counter sale of corticosteroid eye drops to be stopped.
Do your best always
Our students are the future of this beautiful institution text

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Corneal_dystrophies_&_misc.pptx

  • 1. Corneal dystrophies & other miscellaneous corneal conditions MBBS KGMU
  • 2. Common corneal disorders • Keratitis/ corneal ulcer. • Corneal trauma. • Keratomalacia. • Ectatic conditions. • Corneal dystrophies. • Corneal degenerations.
  • 3. Differences between dystrophy & degeneration Corneal dystrophy • Bilaterally symmetrical. • Often hereditary. • Limited to a particular corneal layer. • Non-inflammatory. Corneal degeneration • Non-hereditary. • Usually unilateral sometimes bilateral. • Not strictly limited to a particular corneal layer. • Non inflammatory
  • 5. Corneal Dystrophies • Epithelial & sub-epithelial. • Bowman’s membrane. • Stromal. • Endothelial.
  • 6. Epithelial, sub-epith & Bowman’s corneal dystrophies • Epithelial & sub-epithelial – manifest in adults. • Epithelial basement membrane dystrophy. • Meesman dystrophy. • Bowman’s layer dystrophies – manifest in childhood. • Thiel Behnke corneal dystrophy. • Reis-Bucklers corneal dystrophy.
  • 7. Comparison between epithelial, sub- epithelial, Bowman’s dystrophies • Similarities: • Symptoms: • Asymptomatic / associated with recurrent corneal erosions. • Foreign body sensation & watering. • Treatment by PTK –photo-therapeutic keratectomy by EXCIMER LASER. • Difference: Slit lamp examination shows patterns typical for each one.
  • 9. Stromal Dystrophies •Granular form •Lattice form •Macular form Bilateral. Manifest at puberty. Diminution of vision is the presenting complaint. Central cornea.
  • 10. Granular stromal dystrophy AD. Crumb-like accumulation of hyaline material
  • 12. Macular Dystophy AR Opacities dispersed throughout stroma.
  • 13. Endothelial dystrophies •Fuchs endothelial dystrophy – AD. Elderly. •CHED – Congenital hereditary endothelial dystrophy. AD/AR. •PPMD –Posterior polymorphous dystrophy. AD.
  • 14. Features common to all endothelial dystrophies • Limbus-to-limbus corneal clouding • Bilateral. • Endothelium is attenuated or even absent • Oedematous cornea may be 2-3 times normal thickness. • Generalised haze or diffuse ground glass appearance. • Photophobia and lacrimation in late stages due to bullous keratopathy.
  • 15. Specular microscopy in endothelial dystrophy Normal endothelim Decreased cell count, pleomorphism, polymegathism
  • 16. Congenital hereditary endothelial dystrophy (CHED) • Autosomal dominant (later in infancy). • Autosomal recessive • Earlier presentation (at birth; nystagmus).
  • 17. CHED
  • 18. Posterior polymorphous dystrophy • Autosomal dominant. • Bilateral. • 2nd or 3rd decade….rarely -in early infancy. • Vesicle like lesions in non-banded part of Descemet’s membrane. • Periph ant synechiae & raised IOP may be present.
  • 19. Management of endothelial dystrophies • Specular microscopy – for endothelial cell count. • Pachymetry –corneal thickness. Treatment required if symptomatic. Symptomatic treatment: • Hypertonic saline eye drops. • Bandage contact lens. Definitive treatment: Endothelial keratoplasty (DSAEK). Penetrating keratoplasty.
  • 21. Corneal degenerations • Arcus senilis / juvenilis. • Band shaped keratopathy. • Terriens marginal degeneration. • Salzmann nodular degeneration. • Spheroidal degeneration.
  • 23. Terrien marginal degeneration • Bilateral. • Progressive thinning of superior peripheral cornea. • No inflammation. • Presents with myopia or astigmatism.
  • 24. Band shaped keratopathy • Horizontal opacification in palpebral aperture. • Chronic uveitis, silicon oil. • Blind shrunken eyes. • Hyperparathyroidism, sarcoidosis. • Treatment – chelation with EDTA. • PTK ??
  • 26. Ectatic conditions (non inflammatory) • Keratoconus. • Pellucid marginal degeneration. • Keratoglobus.
  • 27. Keratoconus • Congenital weakess of corneal collagen. • Conical shape of cornea because of central thinning and bulging (Munson sign). • Manifests after puberty. • High myopia & astigmatism. • Treatment options: • Rigid contact lens. • Corneal cross linking (C3R). • Keratoplasty.
  • 29. Pellucid marginal degeneration • Painless bilateral thinning of inferior peripheral cornea. • Myopia & astigmatism. • It is probably a variant of keratoconus.
  • 31. Keratomalacia • Bilateral. • Rapidly increasing clouding of cornea. • No congestion. • Melting of cornea. • Night blindness +/- • Other features of malnutrition / diarrhoea. • Timely injecs of Vit A & control of malnutrition.
  • 32. Corneal injuries • Best possible repair also ends up in subnormal visual gain. • Timely keratoplasty is required in visually significant opacity to prevent amblyopia. • Donor tissue selection should be very carefully done - good endothelial count.
  • 33. Need of the hour • Proper education of medical personnel, school teachers and health workers regarding causes and prevention of childhood blindness. • Training of medical personnel at primary and secondary health care centres regarding early diagnosis of treatable conditions and suitable management. • To know ‘when to refer’ to higher centre. • Over-the-counter sale of corticosteroid eye drops to be stopped.
  • 34. Do your best always Our students are the future of this beautiful institution text