keratoconus / keratoglobus/ lenticonus etc detail ……...

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