Desease of the cornea~Prof. Dr.dr.Rukiah Syawal by: Dr.EzyanAnatomy Nutrition Desease of the cornea

Perilimbal capillaries• Air + tear film• Aqueous humor

Innervation : N V1

Pathology

Keratitis Keratitis : - Superficial

- Profunda (interstitial) - Non ulceration - Cornea Ulcer

Superficial : epithel and superficial stroma Cornea ulcer: defect / discontinuity

Superficial KeratitisEthiology : - Infective - Degenerative - Allergic - Toxic

Extremely seriousPermanent visual impairment

BlindnessPrompt diagnosis and prompt treatment

CongenitalInflamation : KeratitisTumorTrauma

Degeneration

Classification Clinical Presentation Bacterial Corneal UlcerCornea Ulcer

1. Bacterial2. Viral3. Fungal4. Hypersensitivity reaction5. Neurothropic 6. Exposure7. Idiopathic

Pain Photophobia Lacrimation Blepharo spasme Blurred vision Pericorneal / ciliary injection Infiltrate, edem, defect cornea

Sight – threatening- Progressive stromal in flurocen - Progresive tissue destruction- Cornea perforation- Infection to adjacent tissue

Risk Factors Contact lens wear Trauma Contaminated ocular medication Impaired defense mechanism Altered structure of corneal surface

Clinical Persentation

Pain, photophobia, blepharospasme lacrimation, decreased vision

Pericorneal injection – red eye Sharply demarcated epithelial

defectStromal edema Suppurative Stromal inflamation

Ant chamber reaction : KP. Hypopyon

Viral Corneal ulcerClinical presentationHSK

Foreignbody sensation, photophobia Lacrimation, blurred vision

Pericornea injection / ciliary flush Rose bangal, fluoroscein Staining (+) Reduced corneal sensation

HZ0 Zoster dermatitis affected N V1 Punctate or dendritic epithelial

keratitis 50% decreared corneal sensation Intestitial keratitis and anterior

uveitis > HSK

Fungal Corneal ulcer Hypersensitivity reactionRish Factor :

Gardener : preplant or vegetable Contact lens wear Corticosteroid treatment topical /

systemic

Clinical Presentation Resemble with batecterial ulcer Gray-white infiltrate, irreguler and

filament margins Satelite infiltrate Anterior chamber reaction, hypopion

1. Atopic keratoconjunctivitis 2. Steven Johnson syndrome3. Ocular cicatrical Pemphigoid 4. Mooren Ulcer

Treatment cornea ulcer Etiology / cause Predisposing factors Potentially 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,

leucoma 2. Iridocyclitis : Synechia,

complited cataract, secondary glaucoma

3. Perforation4. Endofthalmitis 5. Panophthalmitis 6. Atrophia bulbi

Visual impairment – visual loss

Perforasi kornea