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Desease of the cornea~Prof. Dr.dr.Rukiah Syawal by: Dr.

Ezyan
Anatomy Nutrition Desease of the cornea

Perilimbal capillaries
Air + tear film
Aqueous humor
Innervation : N V1


Pathology

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 Clinical Presentation Bacterial Corneal Ulcer
Cornea Ulcer
1. Bacterial
2. Viral
3. Fungal
4. Hypersensitivity reaction
5. Neurothropic
6. Exposure
7. Idiopathic
Pain
Photophobia
Lacrimation
Blepharo spasme
Blurred vision
Pericorneal / ciliary injection
Infiltrate, edem, defect cornea
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
defectStromal 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
HZ0
Zoster dermatitis affected N V1
Punctate or dendritic epithelial
keratitis
50% decreared corneal sensation
Intestitial keratitis and anterior
uveitis > HSK


Fungal Corneal ulcer Hypersensitivity reaction
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
1. Atopic keratoconjunctivitis
2. Steven Johnson syndrome
3. Ocular cicatrical Pemphigoid
4. Mooren Ulcer




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, secondary
glaucoma
3. Perforation
4. Endofthalmitis
5. Panophthalmitis
6. Atrophia bulbi
Visual impairment visual loss

Perforasi kornea