CORNEA

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)

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
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
Rish Factor :
Gardener
Contact

ulcer
: preplant or
vegetable
lens wear
Corticosteroid
treatment topical /

systemic
Clinical
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

Presentation

Local - cycloplegic : atropin 0.5%

- Specific : antibiotic, anti viral,
anti fungal,
anti inflamation /
immunosuppresive eye
drop /
ointment
Systemic : oral : IV
Subconjunctiva, subtenon
- Surgical ( complication )

Treatment cornea ulcer

Etiology / cause
Predisposing factors
Potentially sight threateming