Inflammation of cornea (keratitis)
- Keratitis is characterised by corneal oedema, cellular infiltration (collection of death cell) and ciliary congestion (redness circular to cornea).
- In infective conditions, severe eye pain, watering, light intolerance and dimness of vision are the more common symptoms.
Types of keratitis
- Bacterial, fungal, or viral keratitis, as well as parasitic diseases.
- For the bacterial keratitis antibiotics eye drops prescribed.
- Treatment of fungal keratitis anti fungal eye drops and for the viral anti viral eye drops with the combination of oral antiviral medicine.
- The other supplementary treatment is cycloplegic drugs with vitamin supplements and artificial tears for soothing effect.
It is a eye conditions in which the normal corneal cells undergo some degenerative changes with age or some pathological condition.
- Age related degeneration
- Arcus senilis
- Vogt’s white limbal giedle
- Hassall henle bodies
- Mosaic degeneration
- Pathological degeneration
- Fatty degeneration.
- Calcific degeneration.
- Salzmann’s nodular degeneration.
- Furrow degeneration
- Spheroidal degeneration
- Pellucid marginal degeneration
- Mooren’s ulcer
For the age related degeneration treatment is unsatisfactory.
For the pathological corneal degeneration some laser treatment is effective (photo-therapeutic keratectomy PTK with excimer laser) and the case of severe visual disturbance keratoplasty surgery advices.
Corneal dystrophies are inherited disorders in which some corneal cells have inborn defects due to which some pathological changes with time cause corneal haze in normal eye.
No associated systemic disease.
Dystrophies are bilaterally (involves both eyes), manifesting occasionally at birth but more after 10 to 20 years of life.
Classification of corneal dystrophies on base of location.
- Epithelial and sub epithelial dystrophies.
- Bowman layer dystrophies.
- Stromal dystrophies.
- Descemet membrane and endothelial dystrophies.
- Watery eye sensation.
- Decrease vision if the dystrophies in visual area ( pupillary area).
- F. B sensation.
- salty (hypertonic saline) eyedrops or ointments that help prevent accumulation of fluid within the cornea at oedematous stage.
- Bandage soft contact lens provide some relief in bullous keratoplasty (corneal oedema because failure of the corneal endothelium to maintain the normally dehydrated state of the cornea).
- Artificial tears.
- Keratoplasty operation either full thickness or lamellar keratoplasty depending on the involvement of corneal layer is the treatment of choice when vision reduced.
Vitamin A deficiency
Vitamin A deficiency develops corneal xerosis, corneal ulcer and corneal scars.
- Corneal xerosis
- Corneal xerosis is a punctate keratopathy (eye conditions caused by death of small groups of cells on the surface of the cornea).
- Involves lower nasal (nose side) area of cornea.
- Cause haziness and/or granular pebbly dryness like cornea lacks lustre.
- Corneal ulceration(keratomalacia)
- After involves 3 layer of cornea (stroma).
- It is accumulation of death cells of stromal layer and it take severe form in circular pattern with steep margins and sharply demarcated.
- At this stage ulcer involves whole cornea including central area cause vision dimness.
- Corneal scars
- Healing of stromal defect results scar.
- This cause of corneal opacity.
- Vitamin supplements.
- Artificial tears eye drops.
- At the stage of keratomalacia: antibiotics eye drops with cycloplegic eye drops.
- At the stage of corneal scar, involves pupillary area keratoplasty surgery should be advise.
1. Vernal keratoconjunctivitis
2. Atopic keratoconjunctivitis
- It is recurrent (very often), bilateral (both eyes involved) and seasonal inflammation of conjunctiva associated with cornea.
- Hypersensitivity reaction to pollen.
- More common in summer.
- Common in boys than girls at the age of 4 to 20 years.
- Severe burning and itching.
- Mild light sensitivity.
- Watering and ropy discharge and heaviness of eyelids.
- Inflammatory conditions of conjunctiva associated with cornea often associated with atopic dermatitis (skin rashes) in Adult rather in children.
- Itching, soreness, dry sensation.
- Mucoid (white) discharge.
- Light intolerance.
Treatment of allergic corneal disease
- Topical anti inflammatory with steroids.
- Antihistamines eye drops.
- Topical lubrications.
- Topical cyclosporine.
- Pterygium means a wing.
- It is wing shaped fold or degenerative epitheliam of conjunctiva encroaching upon cornea.
- More common in people living in hot climates like farmers or construction site workers.
- It is responce of the prolonged effect of environmental factors such as sun exposure, dry heat, high winds and abundance of dust.
- Usually seen in old age and also in nasal side or some of the time on temporal (opposite to nose side).
- Usually asymptomatic in early stage
- Defective vision after it comes in seeing area (pupillary area).
- Irritation and redness in direct exposure of wind.
- Surgically removed after it comes in the middle of the cornea or symptoms are more dominant.
- Now a days after pterygium operation less of the changes of recurrence. Because of conjunctival limbal autographs that taken from the conjunctiva of same eye.
There is two technique available for conjunctival limbal autograft transplantation to cover the defect after pterygium excision.
1. With the sutures
2. With the fibrin glue to stick the autograft.
- It is a corneal transplant operation in which patient’s diseased cornea is replaced with clear cornea.
- Individuals with poor vision due to a diseased or cloudy cornea, with healthy optic nerve and retina, may benefit from a corneal transplant to see well.
- In auto keratoplasty patient no need of any donor cornea.
- In this keratoplasty perform by the patient same eye’s cornea or other eye’s.
- Whenever vision is reduced from corneal disorders like infections, corneal injuries/scars and degenerative diseases, a corneal transplant can be an effective means of restoring vision.
- Rotational keratoplasty
- This is perform in case of small central opacity.
- In rotational keratoplasty, surgeon rotate the central opaque cornea on peripheral side (marginal side) by rotation of clear peripheral cornea towards centre.
- Contralateral keratoplasty
- This is advisable in case of one eye of patient is complete opaque and other eye of same patient is blind due to some other cause, some other retinal disease (renita - the area at the back of your eye that is sensitive to light and sends an image of what is seen to your brain) and cornea is clear.
- In this condition surgeon may advise to, the opaque cornea of one eye is replace with the clear cornea of other eye of same patient.
In this patient’s diseased cornea is replaced with donor healthy cornea.
- Penetrating keratoplasty (PK) or full thickness grafting.
- When the entire cornea or all layers of cornea is replaced by donor cornea it is called full thickness grafting or PK.
- Lamellar keratoplasty or partial thickness grafting
- Half of the cornea or some of the corneal layer replaced by donor cornea is lamellar keratoplasty.
- In LK, only diseased corneal layers are replaced, preserving healthy corneal tissue.
- Deep anterior lamellar keratoplasty (DALK): it is performed when descemet’s membrane and endothelium (lower two layers) are normal
e.g keratoconus in which defective anterior (upper) layers are replaced.
- Descemet’s stripping endothelial keratoplasty (DSEK): it is performed when only endothelium is demage (lower most layer of cornea)
e.g. surgical trauma during cataract surgery with ‘phaco’ technique. In this the lower layer of cornea the descemet’s membrane and endothelium is replaced by doner cornea.
Centre dark-blue and red area’s are donor cornea.
When the corneal transplant require
- Optical purpose
- Improve vision in case of corneal opacity, bullous keratopathy, corneal dystrophies, advance keratoconus.
- Therapeutic purpose
- To replaced inflamed (infectious) cornea not responding to medicine.
- Tectonic graft
- To restore integrity of eyeball after thinning of cornea because of corneal perforation (damaged corneal surface).
- To improve the appearance of the eye in some case of abrasion (scratch on the cornea) or opacity of cornea where after replacement of cornea no chance of vision improvement.
- Early complication is chances of secondary glaucoma, epithelial (upper most layer of cornea) defects and primary graft failure.
- Late complications are graft rejection (chances to fail operation) recurrence of disease and astigmatism (cross power generation).