1. Cornea Dr. Chandrakanth

2. Transparent, avascular, Watch glass- like Anterior 1/6 th of outer fibrous coat Elliptical [dia. H( ~11.5mm )>V( ~11mm )] K-value: 40-44D - Radius of curv. [H>V] Thickness: Central 0.5mm; Periphery 1mm AnatomyAnatomy

3. Micro-anatomy

4. Physiology Transparency (Factors) (A- Avascular / Lamellar arrangement / Epithelial integrity) (P- Hydrophobic epithelium / Na- K pump endothelium) Metabolism mostly aerobic Nutrition Aqueous / Limbal capillaries(O2- tear film) Nerve Supply 5 th CN Functions 1. Transmition of light 2. Refraction 3. Structural integrity 4. Protection

5. Investigations Measurments – Scale Curvature – keratometer Thickness – Pachymeter Surface(Topography) – Placido disc / Orbscan Details – Slit-Lamp Epithelium – flourescein stain Endothelium – Specular microscope

6. Inflammations( Keratitis / Corneal Ulcer) Infective 1.Bacterial 2.Fungal 3.Viral (HS/ HZ) 4.Acanthemoeba Non-Infective 5. Phlyctenular 6. Mooren’s 7. Neurotrophic / Neuroparalytic / Nutritional 8. Stromal Keratitis( interstitial / Disciform)

7. Dystrophies & Degenerations 9. Spheroidal Degeneration 10.Band-Shaped Keratopathy Ectatic conditions 11. Keratoconus Miscelaneous 12. Corneal opacity 13. Keratomalacia 14. Refractive corneal surgeries -Keratoplasty

8. Symptomatology Pain / Lacrimation / Photophobia / Diminition of Vision / Opacification / Redness / FB Erosion – epithelial defect Keratitis – Infiltration Corneal Ulcer – E + K Corneal Edema – Water Imbibition Opacity – Scar ( loss of transparency) Kp’s- cellular deposits on endo. Hypopyon – Pus in AC

9. Corneal Ulcer / Keratitis Def. Classification – a)Etiological – Infective / Non-Infective b)Anatomical – Superficial / deep ( Endothelitis) c)Location – Central / Peripheral d)+/- Hypopyon e) SOURCE OF INFECTION - endogenous, exogenous, local

10. Bacterial / Fungal Keratitis Def. Etiology – a)Bacterial – Staph. / Pneumo. ( Serpegenous ) / Pseudo. / Gonorr. / C. dip. b)Fungal – filamentous ( Fuserium / Aspergilous), Candida Predisposing Factors – Trauma ( N / V), Exposure, Sac infections, Trichiasis, Contact lens, Poor Hygeine

11. Pathology - Stages 1.Stage of progressive infiltration 2.Stage of active ulceration 3.Stage of regression 4.Stage of cicatrization

12. Clinical Features – Symptoms - Pain/Redness/lacri./Photophobia/<VA/Opacity Signs – Lid Edema/matted Lashes Diffuse + Cilliary (CCC) – Congestion --- Discharge Ulcer – a)Epithelial defect – Size, Shape & Location b)Infiltrate - Size, Shape, Location, Depth, Margins, Surface, Base c)Surrounding Cornea- Edema/Satellite Leisions Iritis +/- Hypopyon

13. Bacterial 1.>Symptoms 2.Infiltrate – wet/regular margins 3.No Satellite Lesions 4.Hypopyon – Yellowish White /mobile /sterile Fungal 1.<Symptoms 2.Infiltrate – Dry/irregular margins/ deep 3.Satellite Lesions + 4.Hypopyon – Greyish White/immobile/fungus+

14. Complications 1.Iridocyclitis 2.Secondary Glaucoma 3.Corneal Perforation- subluxation of lens & Vitreous/ HaemorrhagePerforation- 4.Anterior Staphyloma 5.Scarring 6.Complicated cataracts 7.Endophthalmitis / Panophthalmitis

15. Management – Clinical Impressions+ Investigations Inv. – 1.Syringing 2.Corneal scrappings for A.Staining –Gram’s / KOH 10% Mount B.Culture – B- Blood / nutrient Agar, F- SDA

16. Management Plan – Inv. Bact.FungalNO Stain clinical Severe/nonsevere

17. Bacterial – Severe – fortified AB e/d (G+ Cephazoline 5%) (G- Gent./Tobra. 1.4%) Non Severe- Broad spectrum AB e/d Fungal- Topical- Natamycin/ Flucanozole / Nystatin Severe- Topical + Oral antifungal

18. Non specific Rx- Cycloplegic – ( relieve pain, prevent post syneche, increases antibiotic circulation,decreases exudation decreases hyperemia.) Atropine / Cyclopentolate Systemic Analgesics Vitamins Dark glasses Treatment of Complications Perforation – glue/ Keratoplasty Glaucoma – Anti-glaucoma e/d Complicated cataract – cat surg. Endophthalmitis – Intrviteal AB