THEME: Disorders of cornea. Diseases of uveal tractus.

Lecturer Nykoluk Angela Mykolaivna

Anatomy of cornea
1. Epithelium - multilayer, nonkeratinized; - protective function. 2. Bowmans layer (membrane) - randomly dispersed collagen fibrils, - homogenous. - poorly elastic, - well resistant to trauma, - permeable to infectious agents, - does not regenerate, - replaced by scar tissue, - tightly connected with stroma, is in fact a condensation of its superficial layer.

Anatomy of cornea
3. Stroma - constitutes 90% of total corneal thickness, - composed of parallel oriented keratocytes and collagen lamellae.
4. Descemets membrane - homogenous, - transparent, - very elastic, - is a condensation of endothelial cells, - loosely connected with stroma, may detach, - regenerates, - resistant to infectious agents, - not resistant to damage. 5. Endothelium - regenerates, - loss of more than 40% leads to corneal dystrophy.

Properties of cornea and methods of examination

1. Spherical (size10 11 mm, curv.rad. = 7,8 mm) keratoscopy 2. Smooth 1% fluorescein solution stains superficial defects; 3. Wet, shiny corneal xerosis (Vit.A deficiency) Sjogrens syndrome 4. Transparent focal, bifocal examination biomicroscopy 5. Very sensitive Freus hair algesimetry
5-dot 13-dot

5-dot

SOURCES OF CORNEAL NUTRITION

- tear liquid - anterior chamber humour - diffusion from perilimbal vessels Innervation n. ophthalmicus, sympathetic nerves

Pathology of corneal size: microcornea, megalocornea Pathology of corneal shape: keratoconus, keratoglobus, keratotorus

Corneal topographic map at keratoconus

Corneal dystrophy (Lattice lines)

Macular dystrophy

Arcus senilis (corneal arc)

Classification of keratitis
. Exogenous 1. Post-traumatic: mechanical, physical, chemical agents. 2. Infectious, bacteria's: coccal flora, diphtheria ulcer. 3. Viral: trachomas ulcer, varicella ulcer, epidemic keratoconjunctivitis. 4. Fungal. 5. Due to infections of conjunctiva, eyelids, meibomian glands.

Classification of keratitis
II. Endogenous. 1. Infectious: syphilitic, tuberculous: - tuberculous hematogenous, - allergic tuberculous (phlyctenulosis), malarial, brucellosis, laeprae. 2. Neurogenous: neuroparalytic herpetic: - Herpes Simplex (punctate subepithelial, dendritic, stromal disciformic) - Herpes Zoster

3. Caused by vitamin deficiency.

4. Unknown etiology.

Corneal syndrome
Subjective symptoms:
Foreign body sensation
Photophobia Blepharospasm Tearing visual impairment

Objective symptoms:
Corneal infiltrate
Loss of transparency Perilimbal injection Vascularization Loss of spherisity

Tissue defect

Corneal infiltration

Superficial vascularization (grow of vessels)

Differential diagnostics
Infiltrate
Perilimbal injection Signs of eye irritation (tearing, blepharospasm, photophobia) Corneal surface Color Limits + +

Old opacification
-

not shiny, rough grey, yellow indistinct

smooth white-grey distinct

Corneal creeping ulcer

- Characterized by progressive and regressive edges, that spread along the surface and deep into stroma Complicated by iridocyclitis inflammation of vascular layer Hypopion pus in the anterior chamber

Descemetocele (stretching of Treatment of bacterial corneal ulcer Descemets membrane), 1) Before descemetocele corneal perforation Lacrimal sac irrigation
Treatment of ulcer ground with antiseptic solutions Eyedrops of wide-spectrum antibiotics every 1-2 hours (fluoroquinolons, cephalosporins, macrolids) Epithelizing agents Midriatics 2) After descemetocele Supine position Miotics Antibiotics Medications for the reduce of intraocular pressure Keratoplasty fibrin films, conjunctival sealing, corneal transplantation
-

Amoebic keratitis

Herpes-simplex dendriformic superficial keratitis

Herpetic disciformic deep keratitis

Herpes zoster keratitis

Tuberculosis keratitis

1) tuberculosis-allergic superficial keratitis (flyctenulotic) 2) Tubercuclosishematogenous deep keratitis

Deep diffuse sclerotizing keratoiridocyclitis

Outcomes of keratitis

nubecula (cloudiness)

macula (spot)

leucoma - simple - adherent

Keratoplasty
Lamellar and fullthickness By purpose: -optical -tectonic -cosmetic -refractive

Disorders of the uveal tractus

1. Congenital anomalies:
-

Classification of uveitis:
1. Exogenous (penetrating injuries, corneal ulcer) 2. Endogenous: infectional (metastatic), toxic, allergic, metabolic (gout, diabetes mellitus). By clinical course: acute, chronic (non-granulematous, granulematuos). By extension: focal, multifocal. By the type of exudate: serous, fibrinous, purulent, hemorrhagic.

aniridia heterochromia iris coloboma corectopia policoria albinism remaining pupillary membrane

2. Uveopathies 3. Inflammation uveitis

Anterior uveitis iritis, iridocyclitis Posterior uveitis choroiditis Panuveitis

4. Tumors

Iris coloboma

Heterochromia externa

Aniridia

Heterochromia interna

Symptoms of anterior uveitis

Subjective symptoms:
Severe pain in the eye, increases at night Photophobia Blepharospasm Tearing Decrease of vision

Objective symptoms:
Perilimbal injection of sclera Iris color change Pupil constriction Precipitates Exudate in the anterior chamber hypopion, hyphema Anterior chamber flare (Tindals symptom) Posterior synechia Intraocular pressure fluctuation Exudate in the vitreous body

Perilimbal injection, precipitates, exudate in the anterior chamber

Hypopion

Posterior synechia, iris bombe

Secclusio pupillae

Occlusio pupillae

Symptoms of posterior uveitis

Subjective symptoms: Objective symptoms:
Infiltrate, localizing in choroid and retina (corioretinal lesion) white Central localization or gray color, indistinct measures, decrease of vision, edema and prominent into vitreous photopsia, metamorphopsia, central body scotomas Peripheral localization Retinal vessels hemorrhages visual field depression, Exudate into vitreous body hemeralopia (vitreitis) (multifocal), peripheral scotomas, photopsia Signs of optical nerve involvement (optical neuritis)

Recent chorioretinal lesion

Old multifocal chorioretinal lesions

CMV - chorioretinitis

Toxoplasmosis chorioretinitis

Thank you for your attention!