Miscellaneous keratitis 09.03.16,dr.k.jha
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Transcript of Miscellaneous keratitis 09.03.16,dr.k.jha
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Interstitial keratitis
It is an inflammation affecting chiefly the stroma of the cornea.
Cause : infectious or autoimmune.
Infections: syphilis, M. leprae and tuberculosis, EB virus, Lyme disease, sarcoidosis, Cogan syndrome, mumps and rubeola keratitis, Chlamydia, LGV, Acanthamoeba, Leishmania.
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Interstitial Keratitis due to syphilis
Majority are due to congenital syphilis, with bilateral involvement in 80% cases.
Acquired adult syphilis produces IK much less frequently, and it is unilateral.
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Clinical featuresPain, CCC, lacrimation, photophobia, and
blepharospasm
Diffuse corneal haze ( Nonulcerative stromal keratitis )and neovascularization, uveitis.
Acute inflammatory edema resolves with the progressive vascular invasion
Deep opacities and ghost vessels
Hearing impairment and chorioretinal scarring
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ManagementDiagnosis is confirmed with blood tests: FTA-ABS or
MHA-Treponema pallidum (MHA-TP)
Follow-up with VDRL
Test also for HIV
Treat syphilis on usual lines.
Topical steroid therapy: Prednisolone 1% qid to 8id for 1 m to 2 m then tapered.
Cycloplegics
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Exposure and Neurotrophic Keratitis
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Exposure KeratopathyExposure keratopathy can result from any
disease that limit eyelid closure
VII nerve palsy, cicatricial ectropion, Parkinson disease, proptosis, comatose patients
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Lagophthalmos
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Clinical features
Punctate epithelial keratopathy involving lower third of the cornea
May involve whole of the cornea in ulceration, melting and perforation
Symptoms of corneal ulcer unless cornea is anaesthetic
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Management of Exposure KeratopathyMedical therapy: non-preserved tear
substitute, eye ointment and taping of eyelids at night.
Surgical therapy:
- Lateral tarsorrhaphy
- Insertion gold or platinum weight in the upper eyelid
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Neurotrophic KeratopathyNeurotrophic keratopathy results from
damage to cranial nerve V
Etiology: Surgery, CVA, Viral infections of cornea,topical medications, Hansen disease
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Clinical featuresUsually involves central or inferior
paracentral cornea
Sterile persistent epithelial defect with rolled up, elevated edges
May lead to ulceration, perforation and loss of eye
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Neurotrophic ulceration
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Management Treat the cause and treat lagophthalmos
Topical tear substitute, and eye ointment
Tetracycline and Medroxyprogesterone ointment
Autologous serum drop
Bandage contact lenses
Amniotic membrane grafting.
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Points to rememberInterstitial Keratitis
Neurotrophic keratitis
Lagophthalmos: Cause, complication and Treatment