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Most common reason for corneal infection in youngsters

Most common reason for corneal infection in youngsters. herpes simplex keratitis blotchy opacification secondary to stromal involvements permanent scarring leads to: induced astigmatism. when you hear the word “dystrophy” …. Almost always has genetic component

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Most common reason for corneal infection in youngsters

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  1. Most common reason for corneal infection in youngsters • herpes simplex keratitis • blotchy opacification secondary to stromal involvements • permanent scarring leads to: • induced astigmatism

  2. when you hear the word “dystrophy” … • Almost always has genetic component • Most are bilateral, one eye progressing more than other. • Not inflamatory; most do not require steroidal treatment.

  3. epithelial basement membrane dystrophies (EBMD) • recurrent erosions  effects basement membrane of cornea  “foundation to house is weak…” • usually patient in 20’s • Looks like SEI’s However, eye is quiet! • Ask the right questions  red eye in past? photophobia?

  4. Meesmann dystrophy • AD • occurs early in life (1—3 years old) • tiny intraepithelial cysts more densely packed centrally • acuities usually pretty good in early presentations • VERY RARE

  5. Reis-Buckler’s Dystrophy • AD • Bowman’s layer • Easily confused with Thiel-Behnke or Schnyder dystrophy

  6. Stromal Dystrophies • Lattice dystrophy • granular dystrophy • Avellino dystrophy • AD • Usually presents in kids with recurrent erosions. • Treatment: lamellar PK usually by 40s

  7. Endothelial dystrophies • treatment options limited to full PK • Fuchs, posterior polymorphous dystrophy • Is central guttata Fuchs? • Depends on pt age • Does it progress? no  observe over time • LASIK candidate? • NO! any endothelial dystrophy is a contraindication!!!

  8. Fuch’s progression • cyst formations • lead to cloudy cornea • lead to bullae • if the bullae pop near corneal nerves  PAINFUL! • Treatment • hyperosmotics • lower IOP w/prostaglandin • dehydrate front of eye  HAIR DRYER • pain relievers • ultimately PK

  9. when you see prominent corneal nerves, think??? • keratoconus • Refsome’s disease

  10. keratoconus signs • “Oil droplet” pupillary reflex on direct ophthalmoscopy • scissor reflex on retinoscopy • Early SL signs: • deep stromal lines (Vogt’s stria) • prominent corneal nerves • Late SL signs • epithelial iron deposits (Fleischer ring) • stromal scarring • bulging of lower lid on downgaze (Munson sign)

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