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)
Fig .Anatomy
Fig. Histology
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
Fig histology
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 ulcer
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
 Hypersensitivity reaction
1. Atopic keratoconjunctivitis
2. Steven Johnson syndrome
3. Ocular cicatrical Pemphigoid
4. Mooren Ulcer
1

2 3
4
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