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introduction

The corneal diseases are one of the leading


causes of blindness in the world. in most
cases, these infections are preventable or
treatable.
This seminar provides an overview of the
anatomy and physiology of the cornea, as well
as an overview of common conditions.

Anatomy

The cornea is a highly specialised structure


which possesses the following vital functions:
a clear refractive interface,
tensile strength,
and protection of the intraocular contents
from
the external environment.
It has an elliptical shape with the dimensions
10.6 mm vertically and 11.7 mm horizontally

the cornea consists of five


layers

Function of the Cornea


The cornea shields the rest of the eye from
dust, germs and other harmful foreign matter.
It also controls and focuses incoming light but
contains no blood vessels to nurture or protect
it against infection.

Protection.
Refraction.
Transmission of light

MICROBIAL
KERATITIS
BACTERIAL INFECTION
FUNGALE INFECTION
VIRAL INFECTION
PARASITIC INFECTION

BACTERIAL INFECTION
Most common microorganism/
Staphylococci G+

- aureus
- epidemidis
streptococci G+
- pneumoniae
- pyogenes
Pseudomonas aeruginosa
Neisseria

Signs and symptoms


painful red eye with a localised

abscess in the cornea


accompanied by stromal
ulceration should arouse clinical
suspicion.
There may be an acute uveitis
with hypopyon.
Photophobia.

Diagnosis
Clinical history.
Physical examination.
Cultures of corneal scrapings

(for identification the organism)


Corneal biopsy .

Treatment
Hospitalization
Topical administration (rout of

choice)
Subconjuntival injection .
I.V antibiotic .
Oral antibiotics (low efficacy)

FUNGALE
INFECTION
A fungal keratitis is an inflammation

of the eye's cornea that results from


infection by a fungal organism.

Symptoms of Fungal
Symptoms of fungal keratitis include:
Keratitis
Eye pain and redness
Blurred vision
Sensitivity to light
Excessive tearing or discharge

If you experience any of these symptoms,


remove your contact lenses (if you wear them)
and call your eye doctor right away. Fungal
keratitis is a very rare condition, but if left
untreated, it can become serious and result in
vision loss or blindness.

Riske factors
Fungal keratitis most commonly occurs in
tropical and sub-tropical regions of the world.
In temperate areas of the world, risk factors
for developing fungal keratitis include:

Recent eye trauma.


Underlying ocular (eye) disease.
Weakened immune system.
Contact lens use.

Fungal Keratitis Diagnosis


History.
Physical examination.
culture from corneal scrapings is

considered to be the standard for


definitive diagnosis of fungal keratitis.

Fungal
Keratitis

Treatment for Fungal


Fungal keratitis must be treated with prescription
Keratitis
antifungal medicine for several months.
Natamycin is a topical ophthalmic antifungal

medication that works well on superficial corneal


infections, particularly those caused by filamentous
fungi such as Aspergillus and Fusariumspecies.
However, corneal infections that are deeper and more
severe usually require treatment with systemic
antifungal medication such as amphotericin B,
fluconazole, or voriconazole.

VIRAL
INFECTION
Herpes simplex
zoster

Herpes

The DNA viruses, herpes simplex and herpes

zoster, are the commonest viral infections of


the cornea.

Herpes simplex
Clinical presentation
Primary infection

usually in children, involving the eyelids


and lips. Corneal involvement is rare. A
minor follicular conjunctivitis may occur.

Recurrent infection
1 Acute stage:

a unilateral painful red eye with


superficial ulceration taking the form of
club shaped finger-like processes
(dendritic /dendritiform). Fluorescein
stains the epithelial defect and Rose
Bengal identifies dead epithelial cells
along the edge of the defect.

Chronic stage:

the disease may progress to


ulceration, scarring, or perforation.

Symptoms:
Red eye.
Pain.
Photophobia.
Epiphora(tearing).
History of previous episodes.
May complain ofblurred vision.

Diagnosis
Assess visual acuity.
Examine lids and conjunctiva for evidence of

inflammation. Involvement here is less common


in secondary infection although conjunctival
injection (red eye) is almost universal. There
may be erosions around the lid margin with the
presence of small vesicles or pustules.
Observe cornea: any opacities or haziness?
This may suggest stromal involvement.
Test corneal sensation this can be reduced in
epithelial disease.
Stain the cornea and look for evidence of ulcers
by staining with fluorescein.

Treatment
Antiviral medications including:
acyclovir (the drug of choice )
trifluridine, vidarabine, and
idoxuridine.

Steroids in chronic oedema.


keratoplasty for perforations and

scarring.

Herpes zoster
The pathological features of
herpes zoster infection of the
cornea are very similar to those
described for chronic.

PARASITIC INFECTION
Various parasitic infections are
important causes of ophthalmic
diseases worldwide.
Most parasitic infections are spread by
insect vectors or consuming or
getting contact with contaminated
water

Various organisms
producing keratitis are the
:following
Acanthamoeba
Microsporidia
Onchocerca
LeishmaniaTrypanosoma

bruci

Acanthamoeba
Acanthamoeba was first established as a
keratitis

case of human disease in 1973


This vision threatening corneal disease was
first recognized in contact lens wearers.
There was a sharp increase in the
recognition(and perhaps incidence ) of this
disease in the late 1980s.
First case of Acanthamoeba keratitis from
India was reported in 1987 from Aravind
Eye Hospital, Madurai

Clinical signs
are discussed in three stages

1. Early stage / Epithelial defects, epithelial


haze pseudodendrites
2. Late stage / Epithelial defects, stromal
infiltrates, nummular keratitis
3. Advanced stage/ Ring infiltrate, satellite
lesions, stromal abscess

Other features
- Severe anterior and posterior uveitis
- Nodular or Diffuse scleritis
- Corneal stromal infiltrates (single,multiple,ring

shape)

- Anterior uveitis (transient hypopyon)


- Radial keratoneuritis

- Disciform keratitis

Treatment
There is no consensus on treatment.

Various regimens are described.


Treatment is required for 6-12

months.
Prolonged medication results in

corneal vascularisation and toxic


keratitis.