cornea

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cornea

• Medical student f.jahantigh

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• Clear tissue no vessel
• Horizontal diameter 11-12 mm vertical diameter
  10-11 mm
• Thickness 550 micron
• 43/25 diopter (58/60) refraction
• Glassiness of cornea armed structure of collagen
  no vessel less water consequence endothelium
  pomp

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Anatomy physiology

• 5 layer
• epithelium 50-60 µm thickness (10)
  region of cell stem cell in limbus
• Bowman Zone
• Stroma collagen water keratocyte
  /90 of thickness of cornea
• Descemet membrane
• Endothelium no mitosis dysfunction due
  to cornea edema
• supply o2 from vessel of limbus Aqueous humor
  and tear film provides nutrients glucose from
  aqueous humor
• Nerve Branches of the ophthalmic division of
  trigeminal nerve

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Corneal ulcer

• Infection viral bacterial fungal
  parasite
• Non infection

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Bacterial

• Risk factor
• lens
• Trauma
• Immune disorders of the eye
• Immunocompromised
• Misuse of eye s drop

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Clinical finding

• Pain . Redness . Photophobia . Decrease vision .
  Purulent secretion
• Tearing/ conjunctival congestion .local white
  infiltration in stroma . Reaction of anterior
  chamber and hypopyon
• Common organism
  non common
• S . Aureus
  Neisseria
• s. Epidermis
  Moraxella
• Strep. Pneumonia trauma
  mycobacterium
• Sodomonas aeruginosa lens
  nocardial
• Enterobacteria
  Corynebacterium

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Stroma infiltration
Keratitis with hypopyon
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• Lab test culture and smear from edge of ulcer
  lens solution and container of lens
• Treatment multi - D
• Fortified AB gr- and gram such as gentamicin
  cefazolin
• Monotherapy with fluoroquinolone( no for strep )
• When ulcer lt 3mm
• peripheral ulcer
• cornea is not very thin

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• Corticosteroid no in first infection phase but
  after infection control for reduce tissue damage
  
• Corneal transplant progressive infection
  desmatocel formation and corneal perforation
• Strep 24-48 h latency gray ulcer with defined
  border and clear around and hypopyon
• Sodomonas grey or yellow infilteration
  severe pain and hypopyon
• infiltration Bluish green because of pigment
  production

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Viral herpes simplex virus

• Type I II
• unilateral Blepharoconjunctivitis
  lymphadenopathy vesicles on skin and eyelid
  epithelial and stromal keratitis and uveitis
• difference between adenovirus and HSV
• HSV vesicle .ulcer on bulbar conjunctiva
  dendritic epithelial keratitis
• Adenovirus almost bilateral pseudomembranous due
  to adenovirus

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• DX CLINICAL
• TREATMENT self limited
• Oral and topical therapy for reduce symptoms and
  speed up recovery
• Recurrence not related to stress and mense
  systemic infection exposure with light ad lens
• Recurrence of hsv can involve each segment of the
  eye

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• Blepharoconjunctivits eyelid and conjunctiva
  self limited anti viral drug reduce period
• Epithelial keratitis foreign body sensation in
  eye .photosensitivity redness blurred vision
  reduce of corneal sense
• Treatment reduce period and HSV neuropathy BUT
  its not effected on recurrence and progress
  infection
• Trifluridine 1 Q3h 10-14 day or
• Acyclovir 3 toxicity is less and oral
• Acyclovir 2 gr daily 5 dose for 2-3 week
• Corticosteroid is not use in active phase if the
  patient use systemic cs for another reason he
  must use systemic anti viral drug

Ddx VSV EBV Adenovirus scare of epithelial
defect neurotrophic keratopathy after hsv.dm.
brain tumor (CPA) LENS topical drug
acanthamoeba keratitis metabolic dysfunction
.farbery disease and tyrosinemia .
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• Stromal keratitis most visual impairment .each
  attack increase chance of next attack
• type non necrosis ( interstitial discy )or
  necrosis
• Interstitial interstitial opacities focal or
  multi focal in stroma usually in absence
  epithelial ulcer recurrent episodes lead to
  appearance blood vessel in cornea
• Discy the initial inflammation of endothelium
  with stroma edema and epithelium for round or
  oval Iridiocyclitis can be relative with it
• Necrotic necroes and inflammation of cornea can
  be severe and progressive on this moment it dose
  not discernable with bacterial and fungal
• Treatment cs topical anti viral drug oral

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necrotic
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Iridiocyclitis granulomatous and non
granulomatous unilateral involve with increase
intraocular pressure

• Varicella zoster dermatom involve common
  T3-L3gtV1
• The most common ocular manifestation spotted
  epithelial keratitis and dendriticy epithelial
  keratitis
• Lose of corneal sense and chronic inflammation of
  stroma lead to appearance vessel in cornea and
  opacity nerve palsy (III)
• TREATMENT acyclovir 800 q5h 7-10 day
  (72h)antibiotic topical sach as chloramphenicol
  if immunocompromised acyclovir iv wet and warm
  comperes keratouveitis (topical steroid
  cycloplegic agent )pain( cs oral age gt60 40-50
  mg daily . Capsaicin . amitriptyline
  carbamazepine gabapentin
• Hospitalization bad condition diffuse disease
  immunosuppressive

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fungal

• Risk factor foreign bodyvegetable lens
  trauma long use steroid corneal surgery
  chronic keratitis (HSVVSV) warm and humid
  weather
• Inflammation lesser than bacterial usually white
  and grey infiltration irregular margins feathery
  multiple lesions and satellite lesion s
  epithelium maybe safe despite stroma
  infiltration large or deep infiltration make
  hypopyon or plaque
• candida keratitis manifested by white center and
  bulging
• DX coloring gr . Gimsa . KOH/culture / biopsy

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• Treatment natamycin 5 severe ketoconazole oral
• yeast amphotericin b topical and for
  severe fluconazole
• debridemant
• transplant

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Acanthamoeba keratitis

• Protozoan ( trophozoite and cyst) in water and
  soil
• Resistant to freezing dehumidify normal level
  of chlorine
• Severe pain photophobia
• Initial stage limited to epithelium and can be
  appearance with diffuse epitheliopathy or
  dendritic like
• Stromal infection in center and initial stage
  superficial non purulent infiltration ( white and
  gray) and radial peri neuritis
• Dx smear culture biopsy

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Radial peri neuritis ,
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• Treatment no lens /Neosporin drop
  /polyhexamethybiguanid 2/ brolene drop 1/ tab
  ketoconazole200 mg BID liver check/
• First q 0/5 h after 48 h reduce dose
• NASID and cycloplegic / debulking /steroid after
  infection phase

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Keratoconus
Down atopy marfan mvp congenital flappy
eyelid

• Non inflammatory and degenerative
• Genetic / environment
• Fragmentation of bowman layer/stroma getting thin
  /gap and plica in Descemet membrane
• Usually bilateral bat different damage
• process Reduce by age
• Manifestation 1. irregular red reflex early
  finding 2. monsoon mark 3. F 4.vogt striae
  5.focal rupture and spot like scar
• Acute hydrops self limited

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monson
Fleisher ring
Vogt striae
Rizzutti sign
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• Treatment lens/ cross linking / transplant
• For hydrops oint and drop hypertonic chloride -
  sodium for pain cycloplegic and inhibitor aqueous
  humor

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Corneal dystrophy

• Epithelial
• Map Dot fingerprint s cogan
• Due to recurrence scratch of
• Cornea .
• Reis buckler dystrophy

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corneal Stroma dystrophy
Lattice multiple line
Macular opacity up to limbus stroma between is
turbid
Opacity Stroma between is clear
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Descemet and endothelial dystrophy

• Congenital hereditary endothelial dystrophy
  common in Iran
• Thickening of Stroma
• Grand glass

• Fuchs endothelial dystrophy
• Thickening of cornea stroma edema plica in
  Descemet membrane . guttata

• Posterior polymorphous

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Corneal degeneration
inflammationbilateral and progressive but slowly
2th 3th cause congenital

idiopathic
Arcus senilis white ring in old age Clear area
between limbus and that It s not related to blood
cholesterol
terrien peripheral of cornea is be thin almost
in superior sediment fat in progressive edge
Rapture sever astigmatism
Salzmann nodule white and bulge nodule after
keratitis chronic blepharitis (trachoma)
Band keratopathy Calcification of superficial
layer Chronic inflammation hypercalcemia
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End

• Thank you for attention