Degenerations and Dystrophies

Dr. Ibrar Hussain

Assistant Professor Ophthalmology

Khyber Medical College

Peshawar

Degenerations and Dystrophies

Corneal degeneration is a secondary, pathologic change within the cornea with dense white, grayish-white or crystalline and sharp demarcated borders.It could be unilateral or bilateral.

DEGENERATIONS
1.

ARCUS SENILIS

Very common corneal degeneration of old age.

May be associated with hyperlipoproteinemias. Usually bilateral but occasionally unilateral e.g. in ipsilateral carotid artery disease, hypotony etc. Lipid deposition starts superior & inferior perilimbal cornea. Finally & circumferential band with a clear cornea around. No treatment

2. VOGTS WHITE LIMBAL GIRDLE Bilateral, crescent, chalk like flecks running along nasal & temporal limbus. 3. CORNEA FARINTA 4. CROCODILE SHAGREEN 5. CORNEA GUTTATA Focal accumulation of collagen in post surgace of descemets membrane, in central cornea. May lead to corneal decomposition in few patients after
cataract surgery.

6. LIPID KERATOPATHY Accumulation of fat particles in corneal stroma. Usually secondary to corneal vascularization after injuries or infection. On SL examination yellowish fat deposts in corneal stroma. Treatment: Control of primary disease. Argon laser photocoagulation of feeder vessel. Corneal grafting.

7. Band Keratopathy
Deposition of calcium salt in subepithelial space and anterior portion of bowmanns membrane.

Causes

Chronic Iridocyclitis Idiopathic Phthisis bulbi

Increase serum ca and po4 level.

Symptoms & Signs

DV

White raised & rough lesion involving interpalpebral portion of

cornea.
SL examination shows small holes in Ca-plaques.

Treatment Indicated for visual and cosmetic reasons.

a. Scrapping b. Chelation with sodium versenate c. Excimer laser kertectomy

8. Spheroidal Degeneration
Affect people who live in outdoor environment for

longer time. Amber coloured spheroidal granules deposited in anterior stroma. Interpalpebral strip Causes visual impairment Treatment

Superficial keratectomy Lamellar or penetrating keratoplasty

9. Saltzmanns Nodularar Degeneration

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Band Keratopathy

A. Senilis

Corneal Dystrophies
A group of spontaneous appearing, usually inherited stationary or progressive bilateral corneal alterations that develop in the absence of inflammation.

Classification Anterior Dystrophies

Microcystic Reis-bucklers Meesmann Lattice Macular Granular Fuchss endothelial Posterior ploymorphous

Stromal Dystrophies

Endothelial Dystrophies