Corneal Opacity
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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