CORNEA

CORNEAInfection and inflammation subdivision)1Anatomy and PhysiologyAnt part of the eye

Avascular

Transparant

Refracting and Protective window of Route light rays (MEDIA REFRACTA)

2Fig .Anatomy

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4Fig. Histology

5TransparancyUniform StructureAvascularDeturgescence thourgh Na K pump in endothelial cells 6NutritionPerilimbal capillariesAir + tear filmAqueous humorInnervation : N V17Desease of the corneaExtremely seriousPermanent visual impairmentBlindnessPrompt diagnosis and prompt treatment 8PathologyCongenitalInflamation : KeratitisTumorTraumaDegeneration9Corneal opacityDystrophyInfiltrate : inflammation infectionScar : nebula macula leucoma leucoma adheren staphyloma corneaEdemaDegeneration

Corneal dystrophydisturbance during development phace

Granular, macular, lattice, gelatinousKeratitisKeratitis : - Superficial - Profunda (interstitial) - Non ulceration - Cornea Ulcer

Superficial : epithel and superficial stroma

Cornea ulcer: defect / discontinuity12

Superficial KeratitisFig histologyEthiology : - Infective - Degenerative - Allergic - Toxic

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15Classification Cornea UlcerBacterialViralFungalHypersensitivity reactionNeurothropicExposureIdiopathic16Clinical PresentationPainPhotophobiaLacrimationBlepharo spasmeBlurred visionPericorneal / ciliary injectionInfiltrate, edem, defect cornea17

18Bacterial Corneal UlcerSight threateningProgressive stromal in flurocenProgresive tissue destructionCornea perforationInfection to adjacent tissue19Risk FactorsContact lens wearTrauma Contaminated ocular medicationImpaired defense mechanismAltered structure of corneal surface20Clinical PersentationPain, photophobia, blepharospasme lacrimation, decreased visionPericorneal injection red eyeSharply demarcated epithelial defect Stromal edema Suppurative Stromal inflamationAnt chamber reaction : KP. Hypopyon

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22Viral Corneal ulcerClinical presentationHSK (Herpes Simpleks Keratitis)Foreignbody sensation, photophobia Lacrimation, blurred visionPericornea injection / ciliary flushRose bangal, fluoroscein Staining (+)Reduced corneal sensation23

24Keratitis herpes simpleks

25HZ0 (Herpes Zooster Ophtalmic)Zoster dermatitis affected N V1Punctate or dendritic epithelial keratitis50% decreared corneal sensationIntestitial keratitis and anterior uveitis > HSK (Herpes Simpleks Keratitis)26

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Fungal Corneal ulcerRish Factor :Gardener : preplant or vegetableContact lens wearCorticosteroid treatment topical / systemic

32Clinical PresentationResemble with batecterial ulcerGray-white infiltrate, irreguler and filament marginsSatelite infiltrateAnterior chamber reaction, hypopion33

34Hypersensitivity reactionAtopic keratoconjunctivitisSteven Johnson syndromeOcular cicatrical PemphigoidMooren Ulcer

123435Treatment cornea ulcerEtiology / causePredisposing factorsPotentially sight threateming

36Local - cycloplegic : atropin 0.5% - Specific : antibiotic, anti viral, anti fungal, anti inflamation / immunosuppresive eye drop / ointment

Systemic : oral : IV Subconjunctiva, subtenon- Surgical ( complication )37ComplicationsCorneal scar : nebula, macula, leucomaIridocyclitis : Synechia, complited cataract, secondary glaucomaPerforationEndofthalmitisPanophthalmitisAtrophia bulbi

Visual impairment visual loss38

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40Perforasi kornea

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42Corneal scar

nebulaMacula

Corneal scar, leucoma adheren,staphyloma cornea

reconstruction

Corneal degenerationBand keratopathy arcus senile

THANK YOU FOR ATTENTION48The Red EyeSubconjungtival hemorrhagieConjungtivitis : Acute ChronicEpiscleritisScleritisAcute keratitisIritisIridocyclitisAcute congestive glaucomaNeovascular glaucoma