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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,,,