CORNEAL ULCER

Z A L D I

DEPARTEMEN ILMU KESEHATAN MATA

FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH SUMATERA UTARA
MEDAN
2011

Dengan menyebut nama Allah

Yang Maha Pengasih Maha Penyayang.

I. TUJUAN INSTRUKSIONAL UMUM

Setelah Proses Belajar Mengajar mahasiswa
mampu menegakkan diagnosa penyakit-penyakit
mata bagian kornea
dengan melakukan
pemeriksaan sederhana yang akan dipelajari
selama masa perkuliahan secara baik dan benar .

II. TUJUAN INSTRUKSIONAL KHUSUS

Setelah Proses Belajar Mengajar mahasiswa
mampu mengetahui gejala-gejala penyakit mata
bagian kornea , faktor resiko, menegakkan
diagnosa , prinsip pengobatan, komplikasi, dan
mengatasi komplikasi secara garis besar secara
baik dan benar sesuai dengan kompetensinya

THE CORNEA
Anatomy of the adult cornea
1112 mm horizontally
and 911 mm vertically
0.5mm thick centrally and
0.650.70 mm peripherally
Curvature is 7.58.0 mm centrally
and flatter peripherally.
The central 4 mm of the diameter
is optical zone.
Refractive power : 44 dioptres
Refractive index : 1,3375

HISTOLOGY
Five layers
1.
2.
3.
4.
5.

Epithelium
Bowmans membrane
Stroma
Descemets membrane
Endothelium.

Epithelium
The corneal epithelium comprises
56 layers of non-keratinising
squamous epithelium.
There is a basal monolayer of
columnar cells, two or three
layers of wing cells, and two or
three layers of superficial nonkeratinising squamous epithelial
cells.
Only the basal columnar cells
show mitotic activity

Epithelium

Dendritic cells are also found in the

peripheral corneal epithelium, but
not centrally.
The
collagen
fibrils
form
approximately 300 distinct lamellae,
each covering the entire area of the
cornea parallel to the surface.
Transparency of the cornea is
attributed to the extremely regular
spacing of the collagen fibrils which
are separated by glycosaminoglycans,
which are macromolecules with a
role in maintaining even hydration of
the stroma.

Bowmans layer
Bowmans layer is at the
interface
between
the
epithelium and the stroma
and comprises a compaction
of collagen fibres (mainly
types I and III) and
proteoglycans.
It is best considered as the
anterior layer of stroma and
has no regenerative powers.

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Stroma

The stroma provides 90% of the

corneal thickness.
It comprises collagen, principally
collagen I, and lesser amounts of type
III,V, and VI glycosaminoglycans,
mainly keratin sulphate.
It also comprises chondroitin and
dermatan sulphate, and cells mainly
corneal fibroblasts or keratocytes,
which synthesise collagen and
glycosaminoglycans, as well as
collagen degradative enzymes, such
as metalloproteases.

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Descemets membrane
About 57 microns thick, it
increases in thickness from
about 2 to 3 microns at birth
to 10 or 11 microns in old
age.
It comprises, principally,
collagen type IV and laminin,
but at least five types of
collagen have been reported.

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Endothelium

The endothelium is a
monolayer of hexagonal
cells which have an
important
role
in
pumping water from the
cornea and thus a major
role
in
maintaining
corneal transparency.

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PHYSIOLOGY
WINDOW OF THE
EYEBALL
REFRACTIVE MEDIA
BARRIER FROM
MICROORGANISMS

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LOSS OF TRANSPARANCY
EPITHELIAL DAMAGE
ENDOTHELIAL DAMAGE

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DEFINITION
Inflammation of cornea ,caused by
microorganism infection
antigen antibodies / allergic
reaction.
Descemets membrane as barrier for
bacterial infection to COA .(but not for
fungus)
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ETIOLOGY
Exogenous :
bacteria ,fungus , virus, parasite
Endogenous :
allergic reaction.

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ETIOLOGY
Bacteria :
-Pure Pathogen : Streptococcus pneumoniae,
Pseudomonas aeroginosa

-Opportunistic bacteria : Staphylococcus,Moraxella, Serratia(as flora at

conjunctiva
. Alcoholic/ B6 deficiency
.Topical steroid >>>

Pathogen bacteria

. Corneal abrasion

Corneal infection
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ETIOLOGY
Fungus (usually

opportunistic)

Candida, Fusarium, Aspergillus

Virus
VHS
VVZ

Parasite : Acanthamoeba
in Contact lens user

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SIGNS AND SYMPTOMS

Subjective (patients
pain
glare (photophobia)
blur vision
tearing (lacrimation)

Objective -

history

loupe or slit lamp examination

blepharospasme
ciliary injection
tearing (lacrimation)
superficial infiltrate or corneal ulcer
hypopyon- in advanced cases.

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SPECIAL EXAMINATION
Flourescein test for corneal ulcer
Seidel test for perforating cornea

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LABORATORIUM EXAMINATION
Etiologic diagnosis.
Scraping from:
infiltrate / edge of the ulcer
fornices of conjunctiva
Slide Staining :
Gram ( for bacteria)
Giemsa (for fungus )
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CLINICAL COURSE
Subepithelial /epithelial
keratitis
Recover
without scar
Recover
with scar
Nebula
Makula
Leukoma

Become
corneal ulcer

Perforating cornea,
accompanied bulging of the
cornea & iris prolaps
Recover with scar :
Leukoma adherent
staphyloma cornea

Advanced
inflamation
-endophtalmitis
-panophtalmitis
recover

Phtysis bulbi

Corneal blindness

Permanent blindness

Extirpation
of the
globe

Abulbi
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TREATMENT
Anti microorganisms depend on laboratory
finding (scraping & culture)
Antibiotic for bacteria
Anti fungus for fungal infection
Antiviral for viral infection

High dose Vit. A for keratomalacia

Steroid for Moorens ulcer

eye bandage

atropine eye drops

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 Prognosis depends on :

depth & width of the ulcer

Corneal scar

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PROGNOSIS
Prognosis depends on :

depth & width of the ulcer

corneal scar

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Nebula
Makula
Leukoma
Leukoma adherent

Central ,-->corneal
blindness
-Periphery (No visual
disturbance )

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PREVENTION
Avoid corneal trauma
Avoid overuse of topical steroid
Cure external eye infection as soon as
possible.
Avoid trigger factor for relapsing
H.simplex keratitis.

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REFFERENCES
Vaughn
D,
Asbury
T;
General
Ophthalmology, 15th edition, Appleton &
Lange
Miller S; Parsons Diseases of the eye, 17 th
Edition, Churcill Livingstone, 1984
Kanski JJ, Clinical Ophthalmology, 4th
edition,Oxford Butter Worth Heineman Ltd,
1999

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Segala puji bagi Allah, Tuhan semesta alam.

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