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Cornea slides revisionAhmed Osama Hashem
PhD, MSc Ain Shams University
FRCS
Lecturer Ophthalmology Kafrelsheikh university.
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Test of corneal sensation lt eye
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(corneal abscess) with hypopyon
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(corneal abscess) with hypopyon (Fungal)
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(corneal abscess) with hypopyon (Fungal) hypopyon,Feathery edges,,
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Acanthamoeba Ring ulcer
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Herpetic blepharitis lt lower eyelid (vesicles)
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Dendretic ulcer Rose Bengal stain..
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Dendretic ulcer, FL stain
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Dendretic ulcer Rose Bengal stain..
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Herpes Zoster ophthalmicus,, Lt eye(ophthalmic of the trigeminal n.)
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Lt eye Inferior Temporal limbal Foreign body
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Post Trachomatous calcification ,,lower lid entropion trichiasis
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Penetrating keratoplasty interrupted sutures
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Protruding loose stitch of PKP
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Chemical injury , cornea vascularized and opacified
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Keratomalacia ,,anterior staphyloma vitamin A deficiency,,,
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Keratomalacia
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Keratomalacia
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Keratomalacia (Blind painful eye )
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+ Bitot spot,,,
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Xerosis,, vitamin A deficiency
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Neurotrophic ulcer
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Medial Tarsorrhaphy
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lagophthalmos• Definition: inability to close the palpebral fissure
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• Lagophthalmos lead to exposure keratopathy,
Bell’s phenomenon…,, the upper 2/3 covered by upper lid while the ulcer affect the lower third,,,,
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Bell’s phenomenon
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Peripheral ulcerative keratitis,, Mooren’s ulcer (Ischemia from peripheral vasculitis)
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Marginal Keratitis
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Marginal ulcer coalesce to form Ring ulcer
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2ry corneal ulcer
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Trachomatous ulcer
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Gonococcal conjunctivitis
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Diphtheritic conjunctivitis
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Phlyctenular ulcer
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Phlycten
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Hypersensitivity reaction
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PHLYCTENULOSIS
• Predominantly affects children
• Etiology – Tuberculosis – Delayed hypersensitivity reaction to staphylococcal or other bacterial antigen
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phlycten
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• 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.
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PRESENTATION
• Photophobia, lacrimation and blepharospasm.
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SIGNS
• Conjunctival: Pinkish-white nodule surrounded by hyperaemia
• Corneal: May resolve spontaneously or extend radially to the cornea. May cause severe ulceration or perforation.
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phlycten
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phlycten
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phlycten
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Causes:
• Tuberculous protein
• Staphylococcus protein-most common
• Others- Moraxella axenfeld bacillus and certain parasites
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• Predisposing factors:
• Age—3-15 yrs
• Under nourished
• Living conditions- over crowded and unhygienic conditions
• Season- more in spring and summer
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Fascicular ulcer
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• 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.
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DD Pinguecula
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DD,, Pterygium
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Degenerative corneal conditions
• Arcus Senilis
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Photophthalmia
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KERATOCONUS
• Onset at puberty
• Central or paracentral stromal thinning
• Apical protrusion
• Irregular astigmatism
• Autosomal dominant transmission with incomplete penetrance proposed
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CLASSIFICATION
• By keratometry: - Mild (< 48 D), - moderate (48-54 D) - severe (> 54 D)
• By morphology: - Nipple cones – Oval cones – Globus cones
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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).
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LATE SIGNS
• Decreased visual acuity
• Munson sign
• Fleischer ring
• Corneal scarring
• Acute hydrops
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Manson’s sign
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Iron deposition around base of the cone in keratoconus,Fleischer ring
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Rigid contact lens…
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Rigid contact lens
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Streak ,,retinoscopy
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Acute hydrops in keratoconus
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Oil droplet,,cone side view,,Manson sign in keratoconus,,,