Transcript of Corneal Opacity
- 1. Approach to a case of Corneal Opacity
- 2. Loss of transparency of cornea due to scarring. Any disease
which interferes with corneal clarity leads to an opacity.
- 3. History Congenital or Acquired Onset and duration Unilateral
or bilateral Trauma or chemical injury Recurrent episodes of pain
and redness Long term topical medication Contact lens use Previous
ocular surgery Systemic illness Socioeconomic status
- 4. STUMPED Classification S Sclerocornea T Tears in descemets
membrane Congenital Glaucoma Birth trauma U Ulcer Herpes simplex
virus Bacterial Neurotrophic M Metabolic (rarely present at birth)
Mucopolysaccharidoses Mucolipidoses Tyrosinosis
- 5. Classification continued P Posterior corneal defect Peters
anomaly Posterior keratoconus Staphyloma E Endothelial dystrophy
Congenital hereditary endothelial dystrophy Stromal : Congenital
hereditary stromal dystrophy D- Dermoid
- 6. Symptoms Diminution of vision Pain, Redness Photophobia
- 7. Examination Of Corneal Opacity- Clinical Assessment
Assessment of vision-Refraction Systemic Evaluation Torch Light
Examination Ocular Movements Fixation , nystagmus Deviations
- 8. Depending upon the density, corneal opacity is graded as:
Nebular: faint opacity due to superficial scar involving bowmans
layer and superficial stroma
- 9. Macular: Semi dense opacity d/t scar involving half of
stroma.
- 10. Leucomatous: Dense white opacity d/t scarring of more than
half of stroma
- 11. Examination Of Corneal opacity - Overview Evaluation Of
Visual Potential And Prognostication Laboratory Investigations And
Corneal Imaging Bedside Tests Clinical Evaluation Of Cornea And
External Eye Clinical History
- 12. Examination of Corneal Opacity- Clinical Assessment
- 13. Adnexal Evaluation
- 14. Slit Lamp Examination- Corneal Opacity Location Size Depth
Vascularisation Epithelial defect Infiltrates Focal thickening or
thinning of cornea Edema Staining
- 15. Corneal Opacity- Slit lamp Examination Direct Illumination
Diffuse Illumination Focal Illumination Indirect Illumination
Sclerotic scatter Retro illumination Specular Reflection
- 16. Slit Lamp Examination- Diffuse Illumination
- 17. Slit Lamp Examination- Focal Illumination
- 18. Slit Lamp Examination- Retro Illumination
- 19. Slit Lamp Evaluation- Sclerotic Scatter Corneal opacities
Interstitial deposits Perforating scars
- 20. Sclerotic Scatter Less transparent areas scatter the
internally reflected light. Useful for detecting subtle corneal
opacities.
- 21. Indirect Lateral Illumination
- 22. Slit Lamp Examination- Specular Reflection Morphology of
endothelial cells Assessment for corneal decompensation
- 23. Documentation Generally corneal pathologies are documented
as frontal view and in cross sectional view
- 24. Black colour is used to document Limbus Scars Degenerations
Foreign bodies Sutures Contact lens Band keratopathy
- 25. . Brown colour is used to document Pigmentation-iron or
melanin Pupil and iris Blue colour is used to document Oedema,
Small circles for epithelial oedema Wavy lines to document folds in
Descemets membrane
- 26. . Red colour is used to document Blood vessels (see
figures) Rose Bengal staining Haemorrhages
- 27. . Orange colour is used to document (in many centres,
yellow colour is used instead of orange) Hypopyon Keratic
precipitates Green colour is used to document Fluorescein staining
of cornea Punctuate epithelial keratopathy (dots) Filaments (small
lines) Lens and vitreous haze
- 28. Alternatively a monochromatic system of lines can be used
for documentation of corneal diseases.(Adapted from Bron AJ. Br J
Ophthalmol1973;57:62934.)
- 29. Documentation Of Corneal Opacity
- 30. Vascularisation: Superficial and deep
- 31. Examination of Corneal Opacity- Tear Film Evaluation Tear
Film Function Test TBUT Schirmers test Tear Meniscus Height Tear
Clearance rate Tear Osmolarity And Composition
- 32. Tear Film Evalaution- Schirmers Test Tear production
Aqueous component Basal Schirmer Test Schirmer I - < 15 mm
Schirmer II- < 10 mm < 5 mm - severe dry eye
- 33. Tear Film Evalaution- Tear Film Breakup Time
- 34. Tear Film Evaluation- Tear Meniscus Height
Pathological