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Corneal Opacity 2

This document discusses corneal opacity and its causes and types. It begins by describing the layers of the cornea and what maintains corneal transparency under normal conditions. Corneal opacity is defined as a loss of transparency due to scarring. Common causes of corneal opacity include congenital conditions, healed corneal wounds or ulcers. Types of opacity include nebular, macular, and leucomatous depending on the depth of scarring in the corneal stroma. Treatment options mentioned include optical iridectomy, phototherapeutic keratectomy, keratoplasty, cosmetic lenses, and tattooing of scars. Pannus, or corneal vascularization associated with inflammation, is also discussed.

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Ansif K
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77 views16 pages

Corneal Opacity 2

This document discusses corneal opacity and its causes and types. It begins by describing the layers of the cornea and what maintains corneal transparency under normal conditions. Corneal opacity is defined as a loss of transparency due to scarring. Common causes of corneal opacity include congenital conditions, healed corneal wounds or ulcers. Types of opacity include nebular, macular, and leucomatous depending on the depth of scarring in the corneal stroma. Treatment options mentioned include optical iridectomy, phototherapeutic keratectomy, keratoplasty, cosmetic lenses, and tattooing of scars. Pannus, or corneal vascularization associated with inflammation, is also discussed.

Uploaded by

Ansif K
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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CORNEAL OPACITY

CORNEA :
• Transparent , avascular structure .
• Layers of cornea anterior to posterior are :
• epithelium
• bowman’s membrane
• Corneal stroma
• Pre Descemet’s membrane ( dua ‘s layer)
• Descemet’s membrane
• endothelium
CORNEAL TRANSPARENCY

• Anatomical
• Homogeneity of refractive index throughout the epithelium
• Peculiar arrangement of corneal lamellae
• Peculiar regular refractive index of corneal lamellae
• Avascularity of cornea
• Physiological
• Barrier function of limiting layers (epithelium and endothelium )
• Endothelium pumps :Na/k ATPase , bicarbonate dependent ATPase ,Na/H pump
• Evaporation from corneal surface
• Normal IOP
• Swelling pressure of stroma which counters imbibition effect of IOP .
• Corneal crystallins , ie ..water soluble protein of keratocytes
CORNEAL OPACITY
• The word corneal opacification means loss of normal transparency of
cornea , which can occur in many conditions.
• Therefor the term corneal opacity is used particularly for loss of
corneal transparency due to scarring .
• Corneal opacity result when the corneal wound or ulcer involves
bowman’s membrane
Causes
1 Congenital causes : STUMPED
• Sclerocornea
• Tear in descemets membrane ,congenital glaucoma , birth trauma
• Ulcer : HSV , bacterial ,neurotropic
• Mucopolysaccaridosis, mucolipidosis
• Posterior corneal defects like peter’s anomaly , post . Keratoconus
• Endothelial dystrophy : congenital hereditary posterior polymorphous
• dermoid
2 Healed corneal wounds , following mechanical , chemical or thermal injuries

3 Healed corneal ulcers , infective as well as non infective


CLINICAL FEATURES
• Corneal opacity may produce
A. loss of vision (when dense opacity covers the pupillary area )
B. blurred vision ( due to astigmatic effect)
TYPES OF CORNEAL OPACITY

• Nebular corneal opacity : faint opacity due to superficial scars involving


bowman’s layer and superficial stroma

• Macular corneal opacity : semi – dense opacity produced when scarring


involves about half of corneal stroma

• Leucomatous corneal opacity : dense white opacity which results due to


scarring of more than half of stroma

• Adherent leucoma : results when healing occurs after perforation of cornea with
incarceration of iris
• Corneal facet : sometimes the corneal surface is depressed at site of healing
(due to less fibrous tissue )
• Kerectasia : corneal curvature is increased at site of opacity
• Anterior staphyloma : an ectasia of pseudocornea which results after total
sloughing of cornea with iris plastered behind it
• Secondary changes in corneal opacity in long standing cases : hyaline
degeneration , calcareous degeneration , pigmentation and atheromatous
ulceration .
Treatment :
• Optical iridectomy : in central macular or leucomatous corneal
opacity , provided vision improves with pupillary dilation .
• Phototherapeutic keratectomy PTK : superficial (nebular) corneal
opacity
• Keratoplasty : in uncomplicated cases
• Cosmetic coloured contact lens : good cosmetic appearance in ugly
scars having no potential for vision
• Tattoing of scar : for cosmetic purpose
Suitable for firm scars without vision
A. Tattoing of scar

• Indian black ink , gold or platinum


• First epithelium covering opacity is removed under topical anesthesia
(2 -4 % xylocaine )
• Blotting paper of same size and shape , soaked in 4 % gold chloride
(brown) or 2 %platinum chloride (dark) applied
• After 2-3 min piece of filter paper is removed and drops of 2 %
hydrazine hydrate soln poured
• Irrigate with normal saline and patched after instilling antibiotic and
atropine eye ointment.
PANNUS :
• When extensive superficial corneal vascularization is associated with
white cuff of cellular infiltration , it is termed as pannus .

• Based on activity of pannus it may be progressive or regressive

• Progressive pannus : here corneal infiltration in ahead of vessels

• Regressive pannus : here corneal infiltration logs behind vessels


Based on location pannus may be :

• Superior pannus :occur in trachoma and in contact lens wearers

• Inferior pannus : in rosacea keratitis and patients with exposure


keratopathy

• Generalised pannus : steven- johnson syndrome , chemical burns


and moorens ulcer
Treatment
• Corticosteroids may have vasoconstrictive and suppressive effect on
permeability of capillaries .

• Intra stromal anti-VEGF injection in regressive corneal vascularization

• Application of irradiation

• Surgical treatment in form of peritomy may be employed for superficial


vascularization.
Thank you

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