Prof, DR, dr Rukiah Sawal SpM (K)

Anatomy and Physiology

Ant part of the eye

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

Fig .Anatomy

Fig. Histology

Transparancy
Uniform Structure

Avascular
Deturgescence

Nutrition
Perilimbal capillaries

Air + tear film

Aqueous humor
Innervation : N V1

Desease of the cornea

Extremely serious
Permanent visual impairment
Blindness
Prompt diagnosis and prompt treatment

Pathology
Congenital
Inflamation : Keratitis
Trauma
Tumor
Degeneration

Keratitis
Keratitis : - Superficial

- Profunda (interstitial)
- Non ulceration
- Cornea Ulcer
Superficial : epithel and superficial stroma
Cornea ulcer: defect / discontinuity

Superficial
Keratitis
Fig histology
Ethiology :
- Infective
- Degenerative
- Allergic
- Toxic

Classification
Cornea Ulcer
1. Bacterial
2. Viral
3. Fungal
4. Hypersensitivity reaction
5. Neurothropic
6. Exposure
7. Idiopathic

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

Bacterial Corneal Ulcer

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 defect
Stromal edema
Suppurative Stromal inflamation
Ant chamber reaction : KP. Hypopyon

Viral Corneal ulcer

Clinical presentation
HSK
Foreignbody sensation, photophobia
Lacrimation, blurred vision
Pericornea injection / ciliary flush
Rose bangal, fluoroscein Staining (+)
Reduced corneal sensation

Keratitis herpes simpleks

HZ0
Zoster dermatitis affected N V1
Punctate or dendritic epithelial keratitis
50% decreared corneal sensation
Intestitial keratitis and anterior uveitis > HSK

Fungal Corneal ulcer

Rish 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

Hypersensitivity reaction
1. Atopic keratoconjunctivitis
2. Steven Johnson syndrome
3. 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 )

Complications
1. Corneal scar : nebula, macula, leucoma
2. Iridocyclitis : Synechia, complited cataract,
3.
4.
5.
6.

secondary glaucoma
Perforation
Endofthalmitis
Panophthalmitis
Atrophia bulbi

Visual impairment visual loss

Perforasi kornea