cornea class 5
TRANSCRIPT
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CORNEA
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PERIPHERAL CORNEAL INFLAMMATION
1. Marginal keratitis
2. Rosacea keratitis
3. Phlyctenulosis
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Marginal keratitis
Subepithelial infiltrate separated by clear zone
Sup & Inf Limbus Circumferential spread
Bridging vascularization followed by resolution
• Hypersensitivity reaction to Staph. exotoxins• Associated with Staph. blepharitis• Unilateral, transient but recurrent
Progression
Treatment - short course of topical steroids
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Rosacea keratitis
Chronic progressive idiopathic condition
Facial skin Ocular involvement in 10%
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Rosacea keratitis
Peripheral inferiorvascularization
Subepithelial infiltration Thinning and perforation if severe
Progression
Treatment - topical steroids and systemic tetracycline or doxycyline
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Phlyctenular Keratoconjunctivitis Non specific delayed hypersensitivity
reaction to bacterial antigens Common in childhood
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Phlyctenulosis
• Small pinkish-white nodule near limbus• Usually transient and resolves spontaneously
• Starts astride limbus• Resolves spontaneously or
extends onto cornea
Conjunctival phlycten
Treatment - topical steroids, cycloplegics
Corneal phlycten
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Keratitis associated with Systemic collagen vascular disorders
Rheumatoid arthritis
Systematic vasculitidis
– wegeners granulomatosis
- polyartertitis nodosa
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Rheumatoid arthritis Sclerosing keratitis Peripheral corneal thinning Acute stromal keratitis Treatment
- topical : steroids
: cyclosporine
- systemic: cytotoxic
-keratoplasty
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Mooren’s ulcer Serpiginous ulcer/ rodent ulcer Rare, sup ulcer of degenerative type Elderly Starts at corneal margin spreads
over the whole of tissue. Epithelial erosion autoimmune
lysis due to release of collagenolytic enzymes
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Clinical features ¼ of the cases bilateral Cause –unknown Severe persistent pain and lacrimation Starts as grey infiltrates- ulcerates Ulcer undermines the epithelium and sup
lamellae at the advancing edge forming a whitish overhanging edge
The ulcer base – vascularized Rarely perforates
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Mooren’s ulcer
Progresses with intermission- nebula over the whole cornea
Vision is markedly affected
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Treatment Difficult – coz of ischemic aetiology Excision of 4-7 mm of adjacent conj strip Thus eliminating the conj sources of
collagenase and proteoglycanase Topical antibiotics and steroids ? Effective Perforation- cyanoacrylate glue and contact lens Lamellar keratoplasty+IV methotrexate therapy
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Keratomalacia Vitamin A def Bilateral Children are Extremely ill and die
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Night blindness-older children Conj- dry and xerosis- bitots spots Cornea dull and insensitive Yellow infiltrates- >necrosis+melting in
few hours Absence of inflammatory reaction Apathetic state- inability to close the eye
lids->exposure keratitis Treatment- Vit A supplementation