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In The Name Of God. Cornea and Anterior Segment. MR SHOJA. MD Shahid sadoughi Medical School. TEACHING SET NO.4 PREVENTION OFCHILDHOOD BLINDNESS. INTERNATIONAL CENTRE FOR EYE HEALTH. . Causes of Childhood Blindness. Cloudy Cornea in infancy. Gonococcal keratitis.

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Mr shoja md shahid sadoughi medical school

Cornea and Anterior Segment

MR SHOJA.MD

Shahid sadoughi

Medical School


In the name of god

TEACHING SET NO.4 PREVENTION OFCHILDHOOD BLINDNESS

INTERNATIONAL CENTRE FOR EYE HEALTH

. Causes of Childhood Blindness


Cloudy cornea in infancy

Cloudy Cornea in infancy

Gonococcal keratitis.

Congenital Corneal Diseases.

Obstetrical Forceps Trauma.

Congenital Gluacoma.


Birth trauma forceps injury
Birth Trauma : (Forceps injury )



Sclero cornea corneal dermoid aniridia congenital rubella

Sclero Cornea

Corneal Dermoid

Aniridia

Congenital

Rubella



In the name of god

CYSTINOSIS

KAYSER FLEISHER

RING



Congenital hereditary endothelial dystrophy ched

Congenital Hereditary Endothelial Dystrophy (CHED)

Endothelial dysfunction .

Increased cornea thickness.

Cornea is edematous & bluish.

IOP is normal .

Primary treatment iskeratoplasty


Macro cornea

Macro Cornea

13 mm horizontal diameter

X-linked reccessive pattern

90% patients are male

No Cornea clouding , photophobia

Microcornea


Keratoglobus

Keratoglobus

Cornea is thinner

Deep anterior chamber

Spontaneous break in descemet,s M

Cornea easily ruptured by truma.

Part of Ehlers-Danols type 6 syndrome Paitient should wear protective lens.


Keratoconus

Keratoconus

Bilateral , twice in female

Central , paracentral thining.

Irregular myopic astigmatism.

Chronic eye rubbing is a factor

VKC is a risk factor .

Common in Down ,Osteogenesis imperfecta

Rapid progression occur in teanager


Acute keratoconus hydrops
Acute keratoconus (Hydrops)

Common in Down, s syndrome

Result from ocular message

Often at night,extremely painful

Rupture in Descemet,s membrane

Deep opacity at apex of cone

If hydrops happens, don’t lose heart


Cloboma of iris

Cloboma of Iris

Occur in inferonasal Iris.

Microphthalmia is common.

Cloboma of retina & choroid .

VA ranges is low.


Stromal dystrophies

Stromal Dystrophies

Granular

Macular

Lattice


Primary congenital glaucoma

Primary Congenital Glaucoma

Incidence in USA is 1:10000

Incidence in Saudia Arabic is 1:2500

75% have bilateral involvement

Occurs in 65% of male ,reccessive pattern

60% occur before 6 months

80% by 1 year of age


In the name of god

TEACHING SET NO.4 PREVENTION OFCHILDHOOD BLINDNESS

INTERNATIONAL CENTRE FOR EYE HEALTH

Congenital Glaucoma


Clinical triad

Clinical Triad

1-Epiphora

2 - Photophobia

3 – Blepharospasm


In the name of god

Signs:

  • Elevated IOP

  • Cloudy corneal

  • Buphthalmos

  • Optic nerve cupping

  • Descemet,s membrane tear

  • Increased axial length

blunt trauma . hyphema

Rupture of globe


In the name of god

Congenital

Glaucoma.

All infants with cloudy corneas must be evaluated for Congenital Glaucoma .

  • General practitioners especially obstetricians and paediatricians should know importance of early referral and intervention of congenital glaucoma.

  • Sporadic but mutation found in the CYPIBI gene on chromosome 2 p 21.


Systemic conditions with glaucoma

Systemic conditions with Glaucoma

Aniridia

Retinopathy of prematurity

Neuro fibromatosis

Sturge weber syndrome

Congenital Rubella


Congenital rubella syndrome
CongenitalRubella Syndrome

Invasion of lens by virus ( first trimister)

Dense bilateralnuclearCataract

PDA,deafness & mental retardation

Immature & poorly dilated Iris ,Microcornea.

1/3 hazy cornea due to Keratitis & Glaucoma

Elevated infant IgM antibody against rubella.

Extreme inflammation post-op

Complete removal of lens material.


Treatment

Treatment

Poor if present at birth

Poor if corneal diameter is> 14 mm

50% becomes legally blind

favourable prognositic group

onset 3-12 months

Amblyopia is major problems

Treatment is not sought until considerable damage has already occurred.


How is glaucoma treated
How Is Glaucoma Treated?

  • Medications

    • Prostaglandin analogs

    • Beta blockers

    • Alpha agonists

    • Carbonic anhydrase inhibitors

    • Cholinergic agents

  • Laser therapy

  • Surgery


Optic never damage corneal opacities corneal astigmatism surface irregularitis amblyopia

Causes of Visual Loss in Congenital Glaucoma

Optic never damage

Corneal opacities

Corneal astigmatism

Surface irregularitis

Amblyopia




In the name of god

Differential Diagnosisof

Congenital Glaucoma

Axial myopia

primary megalocornea

CORNEAL FINDINGS

slerocornea

congenital hereditary endothelial dystrophy

Keratitis

cystinosis

birth trauma

EPIPHORA

Nasolacrimal duct obstruction


In the name of god

Bacterial

keratitis


In the name of god

Clinical

presentation

Rapid onset of pain

Conjunctival injection (Redness)

Photophobia

Decreased vision

Discharge and lid edema


In the name of god

Ocular

infections


Corneal dismeters and axial lengths for glaucoma

Corneal Diameters Axial Length (mm)

Age Normal Possible Glaucoma normal Glaucoma

Newborns9.5-10.5 11.5-12.5 16-17 >20

1year 10-11.5 12.0-12.5 20.1 >22.5

2year 11.5-12 12.5-13.0 21.3 >23

Corneal Dismeters and Axial Lengths for Glaucoma



In the name of god

Complete Ocular Examination

Slit lamp Exam

Retinoscopy

Gonioscopy

Tonometry

Measurment of corneal diameter

Optic Never evaluation

Follow -up Evaluation (4-6 weeks)



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