Ectatic conditions

Ectatic conditions
May result from:
a) inflammation: keratectasia, anterior
staphyloma
b) Non-inflammatory origin (ectatic
corneal dystrophies): keratoconus,
keratoglobus, pellucid marginal
degeneration
 Keratoconus (conical
cornea)
Aetiology:
Congenital weakness of cornea
Usually manifest following:
a) Puberty
b) Secondarily like in
- trauma: U/L
- vernal keratoconjunctivitis: due to repeated
rubbing of eye
- Down syndrome: due to repeated rubbing of
eye
 Signs
Thin cornea near center
Forward bulged cornea
Apex of cone: slightly below center of cornea
Initially transparent cornea but impaired vision
due to myopic astigmatism
Munsen sign: marked & recognised conical shape
by the acute bulge given to lower eyelid when the
pt looks down
Distortion of corneal reflex: see with Placido
disc or corneal topography in less advanced cases
Keratometer: mires are malformed, malaligned,
malfocussed
 Corneal topography: in early stage diagnosis,
cone & typical astigmatic pattern
Distorted corneal image of external objects due
to loss of surface regularity
Corneal thinness : measured via ultrasonic
pachymeter, orbscan II corneal topography
system
Pt becomes myopic which can be corrected with
glasses owing to parabolic nature of curvature
which leads to irr astigmatism in later stages
 b/l (more advanced on one side than the
other); may be slight or slowly progressive or
reverse
Later stages: apex shows fine, more or less //el
striae (Vogt striae) see thru slit-lamp; confluent
discrete opacities
Brownish ring due to haemosiderin form in ep
encircling the cone (Fleischer ring)
Rupture develops in DM & stroma becomes
suddenly edematous & opaque (acute hydrops)
 Ophthalmoscope or plain mirror at
1m distance: a ring of shadow,
concentric with margin, is seen in red
reflex resembling a droplet of oil,
altering its position on moving the
mirror; it is due to zone thru which
rays pass into observers eye as
emergent rays in center are
convergent & on periphery are
divergent
 T/t of keratoconus
Early stage: vision improved with spectacles
but CL more beneficial as they have
supporting efffect & eliminate irregular
corneal curvature
Corneal collagen cross-linking by 0.1%
riboflavin eye drops instilled every 3 mins for
30 mins after epo removed----after cornea
saturated with riboflavin----exposed to
quantitative dose (3mW/cm2) of UVA
----follwed by bandage of soft CL to permit ep
healing: to tract progression
 Riboflavin: photosensitizing agent
Photosensitized oxidation by UVA
Acute hydrops: corneal transplantation
(keratoplasty) in progressive stages when
visual loss is considerable
Deep anterior Lamellar keratoplasty spares
DM & endothelial
Penetrating keratoplasty: most common
surgical t/t
Intracorneal ring segments (INTACS) selected
situations to flatten cornea
 Keratoglobus
Congenital anomaly
Hemispherical protrusion of whole
cornea
Occur B/L
Familial & hereditary
Normal IOP, clear cornea, with-the-
rule RE, normal AC angle, no cupping
of OD
DD: bupthalmos
 pellucid marginal
degeneration
Painless B/l corneal thinning
Affect inf cornea from 4-8 o clock position
With no conjunctival injections, lipid
depositions, corneal vascularization
Intact ep
No AC reaction
Cornea above area of thinning ectatic with
myopic against-the-rule astigmatism
Slowly progressive thinning; rarely/occasionally
associated with acute hydrops (keratoconus)