Corneal Degenerations and Dystrophies

Degenerations and DystrophiesDegenerations and Dystrophies

Dr. Ibrar Hussain

Assistant Professor Ophthalmology

Khyber Medical College

Peshawar

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 and DystrophiesDegenerations and Dystrophies

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. VOGT’S WHITE LIMBAL GIRDLE Bilateral, crescent, chalk like flecks running along nasal

& temporal limbus.3. CORNEA FARINTA4. CROCODILE SHAGREEN5. CORNEA GUTTATA Focal accumulation of collagen in post surgace of

descemet’s 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 KeratopathyDeposition of calcium salt in subepithelial space and anterior portion of bowmann’s 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. Saltzmann’s Nodularar Degeneration

Band KeratopathyBand Keratopathy

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A. Senilis

Corneal DystrophiesCorneal DystrophiesA group of spontaneous appearing, usually inherited stationary or progressivebilateral corneal alterations that develop in the absence of inflammation.Classification

– Anterior Dystrophies Microcystic Reis-bucklers Meesmann

– Stromal Dystrophies Lattice Macular Granular

– Endothelial Dystrophies Fuchs’s endothelial Posterior ploymorphous