cornea examination, eye pictures, slit lamp, ophthalmic, eye, kerato,

1. How To Examine A Corneal
Pathology
Dr. Pooja Bandivadekar
Senior Resident
Dr. R. P. Center for Ophthalmic Sciences
AIIMS

2. Examination Of Corneal Pathology-
Overview
Evaluation Of Visual Potential And Prognostication
Laboratory Investigations And Corneal Imaging
Bedside Tests
Clinical Evaluation Of Cornea And External Eye
Clinical History

3. Examination Of Corneal Pathology-
Clinical History
• Age of onset
• Mode of onset
• Unilateral or bilateral
• History of trauma or
chemical injury
• Previous ocular
surgery
• Use of medications

4. Examination Of Corneal Pathology-
Clinical Assessment
• Assessment of vision,
Refraction
• Systemic Evaluation
• Torch Light Examination
– Ocular Movements
– Fixation
– Deviations

5. Examination of Corneal Pathology-
Clinical Assessment
Cornea And
Adnexal
Examination
Evaluation Of
The Lid
Slit lamp
Biomicroscopy
Tear Film
Evaluation

6. Corneal Pathology- Adnexal
Evaluation

7. Corneal Pathology-
Slit lamp Examination
Direct
Illumination
Diffuse
Illumination
Focal
Illumination
Indirect
Illumination
Sclerotic
scatter
Retro
illumination
Specular
Reflection

8. Slit Lamp Examination-
Diffuse Illumination

9. Slit Lamp Examination-
Diffuse Illumination

10. Slit Lamp Examination-
Focal Illumination

11. Slit Lamp Examination-
Retro Illumination

12. Slit Lamp Evaluation-
Sclerotic Scatter
• Corneal
opacities
• Interstitial
deposits
• Perforating scars

13. Slit Lamp Examination-
Specular Reflection
• Morphology of
endothelial cells
• Guttae and
excrescences
• Assessment for
corneal
decompensation

14. Slit Lamp Examination-
Fluorescein staining

15. Examination of Corneal Pathology-
Documentation Of Corneal Opacity

16. Examination of Corneal Pathology-
Documentation Of An Ulcer

17. Examination of Corneal Pathology-
Documentation of Decompensation

18. Examination of Corneal Pathology-
Tear Film Evaluation
Tear Film
Function Test
TBUT
Schirmer’s test
Tear Meniscus
Height
Tear Clearance
rate
Tear Osmolarity
And
Composition

19. Tear Film Evalaution-
Schirmer’s Test
• Tear production –
Aqueous component
• Basal Schirmer Test
• Schirmer I - < 15 mm
• Schirmer II- < 10 mm
• < 5 mm -

20. Tear Film Evalaution-
Tear Film Breakup Time
Tear Film Stability

21. Tear Film Evaluation-
Tear Meniscus Height
• Pathological
<0.3 mm height
• Aqueous deficiency
• Poor lid to globe
apposition
• Raised if naso-
lacrimal obstruction

22. Esthesiometry

23. Examination Of Corneal Pathology
Assessment Of Intraocular Pressure
• Irregular mires on
applanation tonometry
• Effect of
– Scarring
– Edema
– High astigmatism
• Tonopen

24. Examination Of Corneal Pathology
Assessment Of Fundus
• Optic nerve status-
Pupillary reactions,
Consensual reactions
• Ultrasound examination-
– Endophthalmitis
– Retinal Detachment
– Optic nerve head cupping

25. Examination of Corneal Pathology-
Laboratory Investigations
Keratometry
Pachymetry
Impression Cytology
Corneal Scraping

26. Laboratory Investigations-
Keratometry
• Assessment of
astigmatism
• Planning of surgery-
– DSAEK v/s PKP
– Triple procedures
• Contact lens trials for
visual rehabilitation

27. Laboratory Investigations-
Pachymetry
• Methods
– Ultrasonic
– ASOCT based
– Scheimflug and scanning
slit
– UBM
• Indications
– Corneal opacities
– Keratoconus and ectatic
disorders
– Ocular surface disorders-

28. Laboratory Investigations-
Impression Cytology
• Non-invasive
• Indications
– Limbal stem cell
deficiency and dry eye -
cell morphology and
goblet cells
– Diagnosis and
monitoring ocular
surface neoplasia-
metaplasia

29. Laboratory Investigations-
Corneal Scraping
Corneal Scraping
Smear
Gram’s stain
10% KOH
mount
Culture
Bacterial
Fungal
Others
PCR
Viral
Acanthamoeba

30. Examination of Corneal Pathology
Advanced Diagnostic Techniques
Advanced
Diagnostic
Techniques
Corneal
Topography
Confocal Scan
Specular Count
ASOCT
UBM

31. Advanced Diagnostic Techniques
Videokeratography
• Placido disc based
• Surface topography of
entire cornea
• Indications
– Corneal astigmatism
– Selective suture removal
in keratoplasty
– Contact lens
rehabilitation of patients
with corneal scars

32. Advanced Diagnostic Techniques
Slit Scanning Imaging
• Combined with placido
disc imaging
• Elevation based
topography
• Indications
– Corneal ectatic disorders-
keratoconus, PMD
– Post- LASIK ectasia
– Progression analysis

33. Advanced Diagnostic Techniques
Scheimflug Imaging
• Elevation based
• Pachymetric values
• Good repeatability
• Indications
– Corneal ectatic disorders-
keratoconus, PMD
– Post- LASIK ectasia
– Progression analysis

34. Advanced Diagnostic Techniques -
ASOCT
Indications
• Monitoring of corneal ulcers
• Lasik flaps
• Pannus morphology
• Planning and management of
lamellar keratoplasties
• Descemet membrane
detachment

35. Advanced Diagnostic Techniques
Ultrasonic Biomicroscopy
• Indications
• Keratoplasty work-up-
• Limbal mass
– Dermoids
– OSSN
• Ocular surface
diseases-
– Evaluation
– Planning of surgery

36. Advanced Diagnostic Techniques
Specular Count
• Indications
– Fuch’s endothelial dystrophy
– Posterior polymorphous
dystrophy
– Follow-up of keratoplasty
– Eyes with glaucoma, uveitis,
pseudo-exfoliation
• Assessment of
contralateral eye
important

37. Examination of Corneal Pathology
What Next?
Diagnosis
Prognosis
Management

38. Examination Of Corneal Pathology
Visual Potential Assessment
• Macular function tests
• Laser Interferometry
• Potential Acuity Meter
• Visually evoked potentials

39. Summary
• Accurate elicitation of history is important
• Detailed slit lamp examination is
necessary
• Fluorescein staining in all the cases
• Thorough assessment of corneal
sensations
• Tailored laboratory and imaging
techniques