Disorders of cornea. Diseases of Uveal tractus

1. THEMETHEME:: Disorders of corneaDisorders of cornea..
Diseases of uveal tractusDiseases of uveal tractus..

2. Anatomy of corneaAnatomy of cornea
1. Epithelium
- multilayer, nonkeratinized;
- protective function.
2. Bowman’s layer (membrane)
- randomly dispersed collagen fibrils,
- homogenous.
- poorly elastic,
- well resistant to trauma,
- permeable to infectious agents,
- does not regenerate,
- replaced by scar tissue,
- tightly connected with stroma, is in fact a
condensation of its superficial layer.

3. Anatomy of corneaAnatomy of cornea
3. Stroma
- constitutes 90% of total corneal thickness,
- composed of parallel oriented keratocytes
and collagen lamellae.
4. Descemet’s membrane
- homogenous,
- transparent,
- very elastic,
- is a condensation of endothelial cells,
- loosely connected with stroma, may
detach,
- regenerates,
- resistant to infectious agents,
- not resistant to damage.
5. Endothelium
- regenerates,
- loss of more than 40% leads to corneal

4. Properties of cornea and methods of
examination
1.Spherical (size10 х 11 mm, curv.rad. = 7,8 mm)
• keratoscopy
2. Smooth
• 1% fluorescein solution stains superficial defects;
3. Wet, shiny
• corneal xerosis (Vit.A deficiency)
• Sjogren’s syndrome
4. Transparent
• focal, bifocal examination
• biomicroscopy
5. Very sensitive
•Freu’s hair
•algesimetry
5-dot
5-dot 13-dot

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6. SOURCES OF CORNEAL NUTRITIONSOURCES OF CORNEAL NUTRITION
 -- tear liquidtear liquid
 -- anterior chamber humouranterior chamber humour
 -- diffusion from perilimbal vesselsdiffusion from perilimbal vessels
 InnervationInnervation ––n. ophthalmicus,n. ophthalmicus,
sympathetic nervessympathetic nerves

7. Pathology of corneal sizePathology of corneal size:: microcorneamicrocornea,,
megalocorneamegalocornea
Pathology of corneal shapePathology of corneal shape:: keratoconuskeratoconus,,
keratoglobuskeratoglobus,, keratotoruskeratotorus

8. Corneal topographic map atCorneal topographic map at
keratoconuskeratoconus

9. Corneal dystrophy (Lattice lines)Corneal dystrophy (Lattice lines)

10. Macular dystrophyMacular dystrophy

11. Arcus senilis (corneal arc)Arcus senilis (corneal arc)

12. Classification of keratitis’Classification of keratitis’
І. Exogenous
1. Post-traumatic:
• mechanical,
• physical,
• chemical agents.
2. Infectious, bacteria's:
• coccal flora,
• diphtheria ulcer.
3. Viral:
• trachoma’s ulcer,
• varicella ulcer,
• epidemic keratoconjunctivitis.
4. Fungal.
5. Due to infections of conjunctiva, eyelids, meibomian
glands.

13. Classification of keratitis’Classification of keratitis’
II. Endogenous.
1. Infectious:
• syphilitic,
• tuberculous:
- tuberculous hematogenous,
- allergic tuberculous (phlyctenulosis),
• malarial, brucellosis, laeprae.
2. Neurogenous:
• neuroparalytic
• herpetic:
- Herpes Simplex (punctate subepithelial,
dendritic, stromal disciformic)
- Herpes Zoster
3. Caused by vitamin deficiency.
4. Unknown etiology.

14. Corneal syndromeCorneal syndrome
Subjective symptoms:
•Foreign body sensation
•Photophobia
•Blepharospasm
•Tearing
•visual impairment
Objective symptoms:
•Corneal infiltrate
•Loss of transparency
•Perilimbal injection
•Vascularization
•Loss of spherisity
•Tissue defect

15. Corneal infiltrationCorneal infiltration

16. Superficial vascularization (grow ofSuperficial vascularization (grow of
vessels)vessels)

17. Differential diagnosticsDifferential diagnostics
Infiltrate Old opacification
Perilimbal injection + -
Signs of eye irritation + -
(tearing, blepharospasm,
photophobia)
Corneal surface not shiny, smooth
rough
Color grey, yellow white-grey
Limits indistinct distinct

18. Corneal “creeping” ulcerCorneal “creeping” ulcer
-- Characterized by progressive andCharacterized by progressive and
regressive edgesregressive edges,, that spread alongthat spread along
the surface and deep into stromathe surface and deep into stroma
- Complicated by iridocyclitisComplicated by iridocyclitis ––
inflammation of vascular layerinflammation of vascular layer
- HypopionHypopion –– pus in the anterior chamberpus in the anterior chamber

19. Descemetocele (stretching ofDescemetocele (stretching of
Descemet’s membrane)Descemet’s membrane),,
corneal perforationcorneal perforation
Treatment of bacterial corneal ulcerTreatment of bacterial corneal ulcer
1)1) Before descemetoceleBefore descemetocele
- Lacrimal sac irrigationLacrimal sac irrigation
- Treatment of ulcer ground withTreatment of ulcer ground with
antiseptic solutionsantiseptic solutions
- Eyedrops of wide-spectrum antibioticsEyedrops of wide-spectrum antibiotics
every 1-2 hours (fluoroquinolons,every 1-2 hours (fluoroquinolons,
cephalosporins, macrolids)cephalosporins, macrolids)
- Epithelizing agentsEpithelizing agents
- MidriaticsMidriatics
22)) After descemetoceleAfter descemetocele
- Supine positionSupine position
- MioticsMiotics
- AntibioticsAntibiotics
- Medications for the reduce ofMedications for the reduce of
intraocular pressureintraocular pressure
- KeratoplastyKeratoplasty –– fibrin films,fibrin films,
conjunctival sealing, cornealconjunctival sealing, corneal
transplantationtransplantation

20. Amoebic keratitisAmoebic keratitis

21. Herpes-simplex dendriformic superficialHerpes-simplex dendriformic superficial
keratitiskeratitis

22. Herpetic disciformic deep keratitisHerpetic disciformic deep keratitis

23. Herpes zoster keratitisHerpes zoster keratitis

24. Tuberculosis keratitisTuberculosis keratitis
 1)1) tuberculosis-allergictuberculosis-allergic
superficial keratitissuperficial keratitis
((flyctenuloticflyctenulotic))
 2)2) Tubercuclosis-Tubercuclosis-
hematogenous deephematogenous deep
keratitiskeratitis
- Deep diffuseDeep diffuse
- sclerotizingsclerotizing
- keratoiridocyclitiskeratoiridocyclitis

25. Outcomes of keratitisOutcomes of keratitis’’
 nubeculanubecula ((cloudinesscloudiness))
 maculamacula ((spotspot))
 leucomaleucoma
-- simplesimple
- adherent- adherent

26. KeratoplastyKeratoplasty
 Lamellar and full-Lamellar and full-
thicknessthickness
 By purposeBy purpose::
--opticaloptical
--tectonictectonic
--cosmeticcosmetic
--refractiverefractive

27. Disorders of the uveal tractusDisorders of the uveal tractus
1.1. Congenital anomaliesCongenital anomalies::
- aniridiaaniridia
- heterochromiaheterochromia
- iris colobomairis coloboma
- corectopiacorectopia
- policoriapolicoria
- albinismalbinism
- remaining pupillary membraneremaining pupillary membrane
2.2. UveopathiesUveopathies
3.3. InflammationInflammation–– uveitisuveitis
Anterior uveitisAnterior uveitis –– iritisiritis,,
iridocyclitisiridocyclitis
Posterior uveitisPosterior uveitis –– choroiditischoroiditis
PanuveitisPanuveitis
4.4. TumorsTumors
Classification of uveitis’Classification of uveitis’::
 1.1. ExogenousExogenous ((penetratingpenetrating
injuriesinjuries,, corneal ulcercorneal ulcer))
 2.2. EndogenousEndogenous:: infectionalinfectional
((metastaticmetastatic)),, toxic, allergictoxic, allergic,,
metabolicmetabolic ((goutgout,, diabetesdiabetes
mellitusmellitus))..
By clinical courseBy clinical course:: acuteacute,, chronicchronic
((non-granulematousnon-granulematous,,
granulematuosgranulematuos).).
By extensionBy extension:: focal, multifocalfocal, multifocal..
By the type of exudateBy the type of exudate:: serousserous,,
fibrinousfibrinous,, purulentpurulent,, hemorrhagichemorrhagic..

29. Iris colobomaIris coloboma

30. Heterochromia externaHeterochromia externa

31. AniridiaAniridia

32. Heterochromia internaHeterochromia interna

33. Symptoms of anterior uveitisSymptoms of anterior uveitis
Subjective symptoms:
•Severe pain in the eye,
increases at night
•Photophobia
•Blepharospasm
•Tearing
•Decrease of vision
Objective symptoms:
•Perilimbal injection of sclera
•Iris color change
•Pupil constriction
•Precipitates
•Exudate in the anterior
chamber– hypopion, hyphema
•Anterior chamber flare (Tindal’s
symptom)
•Posterior synechia
•Intraocular pressure fluctuation
•Exudate in the vitreous body

34. Perilimbal injectionPerilimbal injection,, precipitatesprecipitates,,
exudate in the anterior chamberexudate in the anterior chamber

35. Hypopion

36. Posterior synechia, iris bombePosterior synechia, iris bombe

37. Secclusio pupillaeSecclusio pupillae

38. Occlusio pupillae

39. Symptoms of posterior uveitisSymptoms of posterior uveitis
Subjective
symptoms:
•Central localization–
decrease of vision,
photopsia,
metamorphopsia, central
scotomas
•Peripheral localization–
visual field depression,
hemeralopia
(multifocal), peripheral
scotomas, photopsia
Objective symptoms:
•Infiltrate, localizing in choroid and
retina (corioretinal lesion) – white
or gray color, indistinct measures,
edema and prominent into vitreous
body
•Retinal vessels’ hemorrhages
•Exudate into vitreous body
(vitreitis)
•Signs of optical nerve involvement
(optical neuritis)

40. Recent chorioretinal lesionRecent chorioretinal lesion

41. Old multifocal chorioretinal lesionsOld multifocal chorioretinal lesions

42. CMV - chorioretinitisCMV - chorioretinitis

43. Toxoplasmosis chorioretinitisToxoplasmosis chorioretinitis

45. Thank youThank you
for yourfor your
attention!attention!