CORNEA

PERIPHERAL CORNEAL INFLAMMATION

1. Marginal keratitis

2. Rosacea keratitis

3. Phlyctenulosis

Marginal keratitis

Subepithelial infiltrate separated by clear zone

Sup & Inf Limbus Circumferential spread

Bridging vascularization followed by resolution

• Hypersensitivity reaction to Staph. exotoxins• Associated with Staph. blepharitis• Unilateral, transient but recurrent

Progression

Treatment - short course of topical steroids

Rosacea keratitis

Chronic progressive idiopathic condition

Facial skin Ocular involvement in 10%

Rosacea keratitis

Peripheral inferiorvascularization

Subepithelial infiltration Thinning and perforation if severe

Progression

Treatment - topical steroids and systemic tetracycline or doxycyline

Phlyctenular Keratoconjunctivitis Non specific delayed hypersensitivity

reaction to bacterial antigens Common in childhood

Phlyctenulosis

• Small pinkish-white nodule near limbus• Usually transient and resolves spontaneously

• Starts astride limbus• Resolves spontaneously or

extends onto cornea

Conjunctival phlycten

Treatment - topical steroids, cycloplegics

Corneal phlycten

Keratitis associated with Systemic collagen vascular disorders

Rheumatoid arthritis

Systematic vasculitidis

– wegeners granulomatosis

- polyartertitis nodosa

Rheumatoid arthritis Sclerosing keratitis Peripheral corneal thinning Acute stromal keratitis Treatment

- topical : steroids

: cyclosporine

- systemic: cytotoxic

-keratoplasty

Mooren’s ulcer Serpiginous ulcer/ rodent ulcer Rare, sup ulcer of degenerative type Elderly Starts at corneal margin spreads

over the whole of tissue. Epithelial erosion autoimmune

lysis due to release of collagenolytic enzymes

Clinical features ¼ of the cases bilateral Cause –unknown Severe persistent pain and lacrimation Starts as grey infiltrates- ulcerates Ulcer undermines the epithelium and sup

lamellae at the advancing edge forming a whitish overhanging edge

The ulcer base – vascularized Rarely perforates

Mooren’s ulcer

Progresses with intermission- nebula over the whole cornea

Vision is markedly affected

Treatment Difficult – coz of ischemic aetiology Excision of 4-7 mm of adjacent conj strip Thus eliminating the conj sources of

collagenase and proteoglycanase Topical antibiotics and steroids ? Effective Perforation- cyanoacrylate glue and contact lens Lamellar keratoplasty+IV methotrexate therapy

Keratomalacia Vitamin A def Bilateral Children are Extremely ill and die

Night blindness-older children Conj- dry and xerosis- bitots spots Cornea dull and insensitive Yellow infiltrates- >necrosis+melting in

few hours Absence of inflammatory reaction Apathetic state- inability to close the eye

lids->exposure keratitis Treatment- Vit A supplementation