corneal opacity

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  1. 1. Approach to a case of Corneal Opacity
  2. 2. Loss of transparency of cornea due to scarring. Any disease which interferes with corneal clarity leads to an opacity.
  3. 3. History Congenital or Acquired Onset and duration Unilateral or bilateral Trauma or chemical injury Recurrent episodes of pain and redness Long term topical medication Contact lens use Previous ocular surgery Systemic illness Socioeconomic status
  4. 4. STUMPED Classification S Sclerocornea T Tears in descemets membrane Congenital Glaucoma Birth trauma U Ulcer Herpes simplex virus Bacterial Neurotrophic M Metabolic (rarely present at birth) Mucopolysaccharidoses Mucolipidoses Tyrosinosis
  5. 5. Classification continued P Posterior corneal defect Peters anomaly Posterior keratoconus Staphyloma E Endothelial dystrophy Congenital hereditary endothelial dystrophy Stromal : Congenital hereditary stromal dystrophy D- Dermoid
  6. 6. Symptoms Diminution of vision Pain, Redness Photophobia
  7. 7. Examination Of Corneal Opacity- Clinical Assessment Assessment of vision-Refraction Systemic Evaluation Torch Light Examination Ocular Movements Fixation , nystagmus Deviations
  8. 8. Depending upon the density, corneal opacity is graded as: Nebular: faint opacity due to superficial scar involving bowmans layer and superficial stroma
  9. 9. Macular: Semi dense opacity d/t scar involving half of stroma.
  10. 10. Leucomatous: Dense white opacity d/t scarring of more than half of stroma
  11. 11. Examination Of Corneal opacity - Overview Evaluation Of Visual Potential And Prognostication Laboratory Investigations And Corneal Imaging Bedside Tests Clinical Evaluation Of Cornea And External Eye Clinical History
  12. 12. Examination of Corneal Opacity- Clinical Assessment
  13. 13. Adnexal Evaluation
  14. 14. Slit Lamp Examination- Corneal Opacity Location Size Depth Vascularisation Epithelial defect Infiltrates Focal thickening or thinning of cornea Edema Staining
  15. 15. Corneal Opacity- Slit lamp Examination Direct Illumination Diffuse Illumination Focal Illumination Indirect Illumination Sclerotic scatter Retro illumination Specular Reflection
  16. 16. Slit Lamp Examination- Diffuse Illumination
  17. 17. Slit Lamp Examination- Focal Illumination
  18. 18. Slit Lamp Examination- Retro Illumination
  19. 19. Slit Lamp Evaluation- Sclerotic Scatter Corneal opacities Interstitial deposits Perforating scars
  20. 20. Sclerotic Scatter Less transparent areas scatter the internally reflected light. Useful for detecting subtle corneal opacities.
  21. 21. Indirect Lateral Illumination
  22. 22. Slit Lamp Examination- Specular Reflection Morphology of endothelial cells Assessment for corneal decompensation
  23. 23. Documentation Generally corneal pathologies are documented as frontal view and in cross sectional view
  24. 24. Black colour is used to document Limbus Scars Degenerations Foreign bodies Sutures Contact lens Band keratopathy
  25. 25. . Brown colour is used to document Pigmentation-iron or melanin Pupil and iris Blue colour is used to document Oedema, Small circles for epithelial oedema Wavy lines to document folds in Descemets membrane
  26. 26. . Red colour is used to document Blood vessels (see figures) Rose Bengal staining Haemorrhages
  27. 27. . Orange colour is used to document (in many centres, yellow colour is used instead of orange) Hypopyon Keratic precipitates Green colour is used to document Fluorescein staining of cornea Punctuate epithelial keratopathy (dots) Filaments (small lines) Lens and vitreous haze
  28. 28. Alternatively a monochromatic system of lines can be used for documentation of corneal diseases.(Adapted from Bron AJ. Br J Ophthalmol1973;57:62934.)
  29. 29. Documentation Of Corneal Opacity
  30. 30. Vascularisation: Superficial and deep
  31. 31. Examination of Corneal Opacity- Tear Film Evaluation Tear Film Function Test TBUT Schirmers test Tear Meniscus Height Tear Clearance rate Tear Osmolarity And Composition
  32. 32. Tear Film Evalaution- Schirmers Test Tear production Aqueous component Basal Schirmer Test Schirmer I - < 15 mm Schirmer II- < 10 mm < 5 mm - severe dry eye
  33. 33. Tear Film Evalaution- Tear Film Breakup Time
  34. 34. Tear Film Evaluation- Tear Meniscus Height Pathological