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CORNEA
INTERSTITIAL KERATITISDef –Inflammation of the corneal stroma without primary involvement of the epithelium or endothelium
Causes
Syphilis Tuberculosis Cogan's syndrome
SYPHILITIC INTERSTITIAL KERATITIS
Bilateral Manifests between 5-15 years of age Manifestation of local antigen antibody
reaction
SYPHILITIC IKClinical featuresHutchisons triad IK Hutchisons teeth Vestibular deafness.
SYPHILITIC IK3 stagesInitial progressive stage -2 weeks Corneal Edema: periphery – center Anterior uveitis
Pain , lacrimation, photophobia, circumcorneal congestion
Ground glass appearance
INTERSTITIAL KERATITIS
SYPHILITIC IKFlorid stage- 2 months Eye is acutely inflamed Deep vascularization covered by hazy
cornea appear dull reddish pink- salmon patch appearance
Epaulette- superficial vessels and conjunctiva heap at the limbus
INTERSTITIAL KERATITIS
SYPHILITIC IK
SYPHILITIC IKStage of regression -1-2 years
Acute inflammation resolves Clearing of cornea from periphery to center Resolution with some opacities and ghost
vessels- non perfused vessels
INTERSTITIAL KERATITIS
Non-perfused "ghost" vessels.
SYPHILITIC IKDiagnosis- positive VDRLTreatmentLocal Topical steroids Atropine Keratoplasty if dense opacities
Systemic – high dose of penicillin
INTERSTITIAL KERATITISEnd stage- scarring
TUBERCULOUS IK Features similar to syphilitic IK
Unilateral
Sectoral- lower sector
Treatment- systemic antitubercular drugs, topical steroids and cycloplegics
INTERSTITIAL KERATITISCogan’s syndrome
Interstitial keratitis – idiopathic Tinnitus Vertigo Deafness
Exposure keratitis Improper wetting of the ocular surface by the
tear film due to inability to close the eyes on blinking despite normal tear production
Causes Lagophthalmos Proptosis Orbital tumor Facial nerve paralysis
Exposure keratitisSigns
Inferior punctate epithelial erosion Secondary infectionSevere ulceration
Exposure keratitis
Exposure keratitis
Exposure keratitisTreatment Lubricant eye drops Taping of lids Antibiotics Tarsorraphy
Treat the cause
Neurotrophic Keratitis
Occurs in anesthetic cornea
Paralysis of sensory nerve supply of the cornea Trigeminal nerve
Altered metabolic activity of epithelium in the absence of sensation
Neurotrophic KeratitisCauses Congenital- Riley-Day syndrome Acquired
Trigeminal nerve dysfunction- infection, destruction, surgery, injury to gasserian ganglion
Leprosy
Neurotrophic Keratitis Clinical features –
No pain , no lacrimation Complete loss of corneal
sensations Ciliary congestion Punctate epithelial erosion
to severe ulceration Treatment
As an ulcer Tarsorrhaphy
Tarsorrhaphy
THANK YOU
Keratitis associated with diseases of skin and mucous membraneRosacea keratitis Chronic progressive
idiopathic condition Facial skin and eyes Irritation, burning , tearing,
redness Inferior PEE, marginal
keratitis, peripheral neovascularisation
Treatment
Keratitis associated with diseases of skin and mucous membraneRosacea keratitis Chronic progressive idiopathic condition Facial skin and eyes
Keratitis associated with Systemic collagen vascular disorders
Rheumatoid arthritis
Systematic vasculitidis
– wegeners granulomatosis
- polyartertitis nodosa
Rheumatoid arthritis Scelrosing keratitis Peripheral corneal thinning Acute stromal keratitis Treatment
- topical : steroids
: cyclosporine
- systemic: cytotoxic
-keratoplasty