CORNEA

Infection and inflammation subdivision)

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

thourgh Na K pump in endothelial

cells

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

Corneal opacity
Dystrophy
Infiltrate : inflammation

infection
Scar : nebula

macula

leucoma

leucoma adheren

staphyloma cornea
Edema
Degeneration

Corneal dystrophy
disturbance during
development phace

Granular, macular, lattice, gelatinous

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 (Herpes Simpleks Keratitis)
Foreignbody sensation, photophobia
Lacrimation, blurred vision
Pericornea injection / ciliary flush
Rose bangal, fluoroscein Staining (+)
Reduced corneal sensation

Keratitis herpes simpleks

HZ0 (Herpes Zooster

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

(Herpes Simpleks Keratitis)

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.
2.
3.
4.

Atopic keratoconjunctivitis
Steven Johnson syndrome
Ocular cicatrical Pemphigoid
Mooren Ulcer
1

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

Corneal scar

Macula
nebula

Corneal scar, leucoma

adheren,
staphyloma cornea

reconstruction

Corneal degeneration
Band keratopathy

arcus senile

THANK YOU
FOR
ATTENTION

The Red Eye

Subconjungtival hemorrhagie
Conjungtivitis : Acute

Chronic
Episcleritis
Scleritis
Acute keratitis
Iritis
Iridocyclitis
Acute congestive glaucoma
Neovascular glaucoma