Cornea undergraduates' revision,Ahmed Osama Hashem MD ,Ophthalmology

Cornea slides revisionAhmed Osama Hashem

PhD, MSc Ain Shams University

FRCS

Lecturer Ophthalmology Kafrelsheikh university.

Test of corneal sensation lt eye

(corneal abscess) with hypopyon

(corneal abscess) with hypopyon (Fungal)

(corneal abscess) with hypopyon (Fungal) hypopyon,Feathery edges,,

Acanthamoeba Ring ulcer

Herpetic blepharitis lt lower eyelid (vesicles)

Dendretic ulcer Rose Bengal stain..

Dendretic ulcer, FL stain

Dendretic ulcer Rose Bengal stain..

Herpes Zoster ophthalmicus,, Lt eye(ophthalmic of the trigeminal n.)

Lt eye Inferior Temporal limbal Foreign body

Post Trachomatous calcification ,,lower lid entropion trichiasis

Penetrating keratoplasty interrupted sutures

Protruding loose stitch of PKP

Chemical injury , cornea vascularized and opacified

Keratomalacia ,,anterior staphyloma vitamin A deficiency,,,

Keratomalacia

Keratomalacia

Keratomalacia (Blind painful eye )

+ Bitot spot,,,

Xerosis,, vitamin A deficiency

Neurotrophic ulcer

Medial Tarsorrhaphy

lagophthalmos• Definition: inability to close the palpebral fissure

• Lagophthalmos lead to exposure keratopathy,

Bell’s phenomenon…,, the upper 2/3 covered by upper lid while the ulcer affect the lower third,,,,

Bell’s phenomenon

Peripheral ulcerative keratitis,, Mooren’s ulcer (Ischemia from peripheral vasculitis)

Marginal Keratitis

Marginal ulcer coalesce to form Ring ulcer

2ry corneal ulcer

Trachomatous ulcer

Gonococcal conjunctivitis

Diphtheritic conjunctivitis

Phlyctenular ulcer

Phlycten

Hypersensitivity reaction

PHLYCTENULOSIS

• Predominantly affects children

• Etiology – Tuberculosis – Delayed hypersensitivity reaction to staphylococcal or other bacterial antigen

phlycten

• A phlyctenule (also called phlycten) is a characteristic nodular affection occurring as an allergic response of the conjunctival and corneal epithelium to some endogenous allergens to which they have become sensitized.

PRESENTATION

• Photophobia, lacrimation and blepharospasm.

SIGNS

• Conjunctival: Pinkish-white nodule surrounded by hyperaemia

• Corneal: May resolve spontaneously or extend radially to the cornea. May cause severe ulceration or perforation.

phlycten

phlycten

phlycten

Causes:

• Tuberculous protein

• Staphylococcus protein-most common

• Others- Moraxella axenfeld bacillus and certain parasites

• Predisposing factors:

• Age—3-15 yrs

• Under nourished

• Living conditions- over crowded and unhygienic conditions

• Season- more in spring and summer

Fascicular ulcer

• Treatment:

• local-

• -topical steroid-dexamethasone or betamethasone

• -antibiotic drops and ointment

• -atropine 1% eye ointment once daily if cornea is involved

• specific:

Tuberculosis should be excluded by Chest x-ray, mantoux test, ESR and if necessary full dose ATT should be given.

• -Septic focus in the form of tonsillitis, adenoiditis, teeth caries should be treated by antibiotics and necessary surgical interventions.

• -parasitic infestation should be ruled out and treated if necessary.

• General:

high protein diet and Vit. A, C, and D supplementation.

DD Pinguecula

DD,, Pterygium

Degenerative corneal conditions

• Arcus Senilis

Photophthalmia

KERATOCONUS

• Onset at puberty

• Central or paracentral stromal thinning

• Apical protrusion

• Irregular astigmatism

• Autosomal dominant transmission with incomplete penetrance proposed

CLASSIFICATION

• By keratometry: - Mild (< 48 D), - moderate (48-54 D) - severe (> 54 D)

• By morphology: - Nipple cones – Oval cones – Globus cones

Early signs

• Ophthalmoscopy: Oil droplet reflex

• Retinoscopy: Irregular scissor reflex

• Keratometry: Irregular astigmatism (principal meridians no longer 90 degree apart and mires cannot be superimposed)

• Placido disc: Irregular reflected ring

• Slit-lamp: Very fine deep stromal striae (Vogt lines).

LATE SIGNS

• Decreased visual acuity

• Munson sign

• Fleischer ring

• Corneal scarring

• Acute hydrops

Manson’s sign

Iron deposition around base of the cone in keratoconus,Fleischer ring

Rigid contact lens…

Rigid contact lens

Streak ,,retinoscopy

Acute hydrops in keratoconus

Oil droplet,,cone side view,,Manson sign in keratoconus,,,