Prof, DR, dr Rukiah Sawal SpM (K)

Anatomy and PhysiologyAnt part of the eye

• Avascular

• Transparant

• Refracting and Protective “ window” of

Route light rays

(MEDIA REFRACTA)

Fig .Anatomy

Fig. Histology

TransparancyUniform Structure• Avascular

• Deturgescence

NutritionPerilimbal capillaries• Air + tear film

• Aqueous humor

Innervation : N V1

Desease of the corneaExtremely serious

Permanent visual impairment

Blindness

Prompt diagnosis and prompt treatment

PathologyCongenital

Inflamation : Keratitis

Tumor

Trauma

Degeneration

KeratitisKeratitis : - Superficial - Profunda (interstitial) - Non ulceration - Cornea Ulcer

Superficial : epithel and superficial stroma

Cornea ulcer: defect / discontinuity

Superficial KeratitisFig histology

Ethiology :

- Infective

- Degenerative

- Allergic

- Toxic

Classification Cornea Ulcer1. Bacterial2. Viral3. Fungal4. Hypersensitivity reaction5. Neurothropic6. Exposure7. Idiopathic

Clinical PresentationPainPhotophobiaLacrimationBlepharo spasmeBlurred visionPericorneal / ciliary injectionInfiltrate, edem, defect cornea

Bacterial Corneal UlcerSight – threatening- Progressive stromal in flurocen- Progresive tissue destruction- Cornea perforation- Infection to adjacent tissue

Risk FactorsContact lens wearTrauma Contaminated ocular medicationImpaired defense mechanismAltered structure of corneal surface

Clinical PersentationPain, photophobia, blepharospasme lacrimation, decreased visionPericorneal injection – red eyeSharply demarcated epithelial defect Stromal edema Suppurative Stromal inflamationAnt chamber reaction : KP. Hypopyon

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

Keratitis herpes simpleks

HZ0Zoster dermatitis affected N V1Punctate or dendritic epithelial keratitis50% decreared corneal sensationIntestitial keratitis and anterior uveitis >

HSK

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

Clinical PresentationResemble with batecterial ulcerGray-white infiltrate, irreguler and filament

marginsSatelite infiltrateAnterior chamber reaction, hypopion

Hypersensitivity reaction1. Atopic keratoconjunctivitis2. Steven Johnson syndrome3. Ocular cicatrical Pemphigoid4. Mooren Ulcer

1

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Treatment cornea ulcerEtiology / causePredisposing factorsPotentially sight threateming

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

• Systemic : oral : IV

Subconjunctiva, subtenon

- Surgical ( complication )

Complications1. Corneal scar : nebula, macula, leucoma2. Iridocyclitis : Synechia, complited cataract,

secondary glaucoma3. Perforation4. Endofthalmitis5. Panophthalmitis6. Atrophia bulbi

Visual impairment – visual loss

Perforasi kornea