Keratoconus is a non-inflammatory bilateral ectatic condition of the cornea that causes progressive thinning and conical protrusion. It typically starts during puberty and progresses slowly. Symptoms include irregular astigmatism and myopia. Signs include Fleischer's ring, Munson's sign, and irregular astigmatism on retinoscopy. Treatment options include glasses, rigid gas permeable contact lenses, INTACS, collagen cross-linking, and keratoplasty for later stages. Keratoglobus is a rare noninflammatory diffuse corneal ectasia present from birth. Lenticonus is a rare congenital anomaly of the crystalline lens characterized by a conical protrusion on the lens capsule.

1. Keratoconus, Lenticonus, Lentiglobus ,
Microspherophakia & Lens Coloboma
Dr. Sharad
SCEH, Lahan,
O.A 2nd year student class

2. keratoconus

3. • Keratoconus (conical cornea) is a non-inflammatory bilateral (85%) ectatic
condition of cornea in its axial part. It usually starts at puberty and progresses
slowly .

4. Etiopathogenesis.
• developmental condition & degenerative condition
• hereditary dystrophy and endocrine anomaly.
• Essential pathological changes are progressive thinning and ectasia which occur
as a result of defective synthesis of mucopolysaccharide and collagen tissue .

5. Clinical features & Symptoms.
• Patient presents with a defective vision due to progressive myopia and
irregular astigmatism .
• Sign : 1. Window reflex is distorted.
• 2. Placidodisc examination shows irregularity of the circles .
• 3. Slit-lamp examination may show thinning and ectasia of central cornea
• 4. Fleischer’s ring at the base of cone, folds in Descemet’s and Bowman’s
membranes .

6. Signs of Keratoconus :
• 5. On retinoscopy a yawning reflex (scissor reflex ) & irregular astigmatism .
• 6. Ondistant direct ophthalmoscopy : oil droplet reflex
• 7. Munson’s sign, i.e., localised bulging of lower lid when patient looks down is
positive .
• 8. Keratometry. Normal average keratometric values are 45 D. In keratoconus
keratometric values are increased. keratoconus is graded as: mild (< 48 D), moderate
(48–54 D), and severe (>54 D).

7. morphological classification
• Nipple cone has a small size (<5 mm) and steep curvature.
• • Oval cone is larger (5–6 mm) and ellipsoid in shape.
• • Globuscone is very large (>6 mm) and globe like

11. Complications
• Keratoconus may be complicated by development of acute hydrops
due to rupture of Descemet’s membrane .
• Lacrimation
• Photophobia
• Blepharospasm

13. Association Ocular conditions like
• Ectopia lentis, congenital cataract, aniridia
• Retinitis pigmentosa & vernal keratoconjunctivitis (VKC)
• Marfan’s syndrome
• Down’s syndrome
• Ehlers-Danlos syndrome,

14. Treatment :
• 1. Spectacle correction may improve vision in early cases.
• 2. Contact lenses (rigid gas permeable /RGP lens ) usually improve the
vision in early cases. Scleral contact lens (Rose-K) may be useful.
• 3. INTACS the intracorneal ring segments, are reported to be useful .
• 4. Corneal collagen cross linking with riboflavin (CXL or C3R) and UV-A rays
may slow the progression .
• 5. . Keratoplasty may be required in later stages. Deep anterior lamellar
keratoplasty (DALK) or penetrating keratoplasty (PK )

15. Keratoconus :

18. KERATOGLOBUS : Keratoglobus is a rare, noninflammatory corneal
ectasia characterized by diffuse protrusion and thinning of the cornea.

20. • It is nonprogressive and inherited as an autosomal recessive trait.
• It must be differentiated from congenital buphthalmos, where increased corneal
size is associated with raised intraocular pressure, angle anomaly and/or cupping
of optic disc.

21. How keratoconus is differentiated from keratoglobus
• Keratometry readings can reach 50-60 D. Fleischer rings, Vogt striae, and anterior
stromal scarring are not typical, but Descemet membrane thickening and folds
are common.

22. Management of keratoglobus
• No medical therapy has been discovered to treat the underlying pathology.
Instead, attention is focused on complications such as acute hydrops.
• Hypertonic saline, cycloplegia, and bandage soft contact lenses are the
mainstay of treatment.
• Aqueous suppressants have also been proposed to decrease stromal uptake of
fluid .
• SURGERY : penetrating keratoplasty (PK) was one of the first surgical procedures
attempted . A second surgical option involves the use of DSAEK donor tissue to
patch the host endothelium.

23. Lenticonus :
• It is a rare congenital anomaly of the eye characterized by a conical protrusion on
the crystalline lens capsule and the underlying cortex.
• It can reach a diameter of 2 to 7 mm.
• The conus may occur anteriorly or posteriorly.

24. anterior & posterior lenticonus

26. Association