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Cornea.ppt
The document discusses the anatomy and clinical examination of the cornea. It contains the following key points: 1) The cornea has 5 layers - an epithelium, Bowman's membrane, a thick stromal layer, Descemet's membrane, and an endothelium. The stroma comprises 90% of the corneal thickness and contains collagen fibrils. 2) The cornea receives its nerve supply from the ophthalmic division of the trigeminal nerve via the nasociliary nerve. Clinical tests like the corneal reflex test examine the integrity of these nerve pathways. 3) Common corneal pathologies include infections like herpes simplex keratitis and acanthamoeba keratitis.
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Cornea.ppt
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- 2. Anatomy of theCornea
- 3. Anterior 1/6 ofouter coat Curved & Dom shaped Fibrous, Transparent & No BVs
- 4. • Measured bycorneal Caliber or Pentacam corneal topography • Important in Congenital Glaucoma
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- 6. Limbus ( What isThe LIMBUS ?)
- 8. 5 Layers ofthe Cornea a.Epithelium: b.Bowman’s membrane: c.Stroma: 90% of corneal thickness collagen fibrils that are parallel to each other d.Descemet’s membrane: e.Endothelium:
- 9. NERVE SUPPLY OFTHE CORNEA 5TH C.N OPHTH. division NASOCILIARY N 2 Long CILIARY N PAIN & COLD & SUPERFICIAL TOUCH
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- 11. Corneal senstion test =corneal reflex test = Blinking reflex • Aim • Technique • result
- 12. • Causes oflost corneal reflex • Receprors: Keratitis: HSV,HZV, Keratomalacia, Corneal scars High IOP Topical anaeathesia CL • Afferent: • Center : • Efferent: 5th n. lesion Occipital cortex lesion 7thh n. lesion (facial palsy) Corneal reflex
- 13. SUPPURATIVE SUPERFICIAL KERATITS (CORNEAL ULCERS) DEFINITION LocalizedNecrosis of Sup. Stroma with destruction of overlying Epith.
- 14. Symptoms Stitching Referred to theeye brow Because of: • corneal edema • accompanying iridocyclitis Lacrimation
- 15. MANAGEMENT OF CORNEALULCERS INVESTIGATIONS + TREATMENT A) Corneal Scrapping ( Culture & Sensitivity ) Gram Stain for Bacteria Geimsa Stain for Trachoma & Acanthamoeba Silver Stain for Fungi B) Local ttt (1) Atropine sulphate 1% (3) Bandage or Dark Glasses (4) Counter irritant (2) Dressings ( Antibiotic dps & oint ) C) Systemic ttt Antibiotics Analgesics Vitamins A & C
- 16. Acanthamoeba keratitis Aetiology Protozoa( Tap water and Swimming pools ) 70% of cases are C L wearers Clinical Picture Punctate or Dendritic K Partial or Complete ring of Infiltration
- 17. Dendritic Corneal Ulcer HerpesSimplex Virus ( Epitheliotropic ) 1ry infection in early childhood Dormant in 5th Ganglion Recurrence with body resistance
- 18. Herpes Zoster Ophthalmicus Varicella-Zoster(Neurotropic) Virus Old age - Immunity Clinical Picture : Lids : Dermatoblepharitis ( pain and rash ) Keratitis : ( Hutchinson’s rule ) Epithelial Keratitis ( Punctate or dendritic ) Interstitial Keratitis
- 19. Ulcer with Lagophthalmos Bell’s phenomena Symptoms as usual corneal ulcer ( of vision is not marked..why?) Signs Incomplete lid closure Ciliary injection & +ve flurorescein Ulcer in lower 1/3 with straight upper border Treatment Usual ttt Methyl cellulose drops 0.5% several times/day
- 23. Degenerative Conditions ARCUS SENELIS Bilateralperipheral Fatty degeneration Common in old age Symptoms non Signs Clear zone between the opacity and Limbus (Lucid interval of vogt) NB ARCUS JUVENILIS may occur in hyperlipidemia or juv. DM
- 24. • Sympyoms: Stitchingpain, lacrimation, photophobia, .. • Treatment: FB removal (Search for other FBs)
- 25. Definition Progressive conical distortionof the cornea with: • irregular astigmatism • axial stromal thinning • apical protrusion • increasing myopia.
- 26. KERATOPLASTY Aim: Replacingthe opaque part by a clear cadaveric cornea Types: - Lamellar ( Superficial ) - Deep ( Penetrating ) NB: Both of them may be partial or total Indications: - Optical a) Central corneal opacities b) Keratoconus - Therapeutic a) Resistant corneal ulcer b) Corneal fistula
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- 28. Examination of cornea reveals:15-$1 Million 14-$500,000 13-$250,000 12-$125,000 11-$64,000 10-$32,000 9-$16,000 8-$8,000 7-$4,000 6-$2,000 5-$1,000 4-$500 3-$300 2-$200 1-$100 B-Anterior staphyloma C-Arcus senilis D- Decematocele A-Nebula C-Arcus senilis
- 29. 15-$million 14-$500,000 13-$250,000 12-$125,000 11-$64,000 10-$32,000 9-$16,000 8-$8,000 7-$4,000 6-$2,000 5-$1,000 4-$500 3-$300 2-$200 1-$100 Examination of corneareveals: A-Nebula B-Leucoma C- Decematocele D- keratoconus B-Leucoma
- 30. Examination of corneareveals: A-Nebula B-Leucoma adherent C-Leucoma non-adherent D- Keratectasia 15-$million 14-$500,000 13-$250,000 12-$125,000 11-$64,000 10-$32,000 9-$16,000 8-$8,000 7-$4,000 6-$2,000 5-$1,000 4-$500 3-$300 2-$200 1-$100 A-Nebula
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