Corneal degenerative

changes
 Corneal degenerative
changes
Diferentiated from the dystrophies
by:
Non-hereditary
U/L usually
 Corneal degenerative
changes
3 types:
Primary degenerations
Secondary degenerations depending
on long-standing changes in the eye
itself
Infiltrations associated with
metabolic disturbances
 Arcus senilis
Lipoid infiltration of cornea
Seen in elderly (>40yrs)
Universal in >60yrs
Commence as crescentic grey line
or whitish arc concentric with upper
& lower margins of cornea, the
extremities of which finally meet, an
opaque line thicker above & below is
completely formed round the cornea
 Arcus senilis
Characterized by being separated
from the margin by a narrow zone of
comparatively clear cornea, being
sharply defined on the peripheral
side, fading off on the central
Never > 1mm broad
No importance in the point of vision
or vitality of cornea & unrelated to
secondary forms of
hypercholesterolemia
 Arcus juvenilis
Exactly like arcus senilis
Rare condition
Appears <40 yrs
+nce of a line of clear cornea
between opacity & limbus
(characteristic)
Serum lipid profile is indicated to
rule out hereditary anomaly with a
serious prognosis for life
 DD where occasionally
characteristic feature is seen
Sparing of marginal cornea
Old sclerosing keratitis: opacity is
localised to one part of cornea &
extends further towards the center
 Terrien Marginal
degeneration
Usually B/L
But may be U/L
Often asymptomatic
Slow progressive thinning of peripheral cornea
Sparing the limbus
Typically manifests superiorly
More frequently seen in men
Quiet eye with no redness or inflammation
A fine vascularized pannus over thinned area
with yellowish deposit of lipid in the affected
area
 Complications of terrien
marginal degeneration
May extend circumferentially
Lead to either myopia or irregular
astigmatism
Intact epithelium over thinned area
but
Perforation with minor trauma
 Band-shaped
keratopathy
Blind Shrunken eyeball
Still disease (children)
Chronic uveitis
Aphakic eyes undergone vitrectomy with
silicone oil if oil allowed to remain in eye for
long time
Hyperparathyroidism
Vitamin D poisoning
Sarcoidosis (ABCD of band-shaped
keratopathy)
 Band-shaped
keratopathy
Rarely B/L in healthy eyes
A horizontally oval area in palpebral fissure
(whitish band in interpalpebral area)
Commence at inner & outer sides
Progress until it forms a continuous band across
cornea interspersed with holes or cleaves in band
Clear near limbus (like in other degenerative
conditions) owing to better nutrition close to
blood vessels
Due to hyaline infiltration of suprficial parts of
stroma followed by deposition of calcareous salts
 T/t of Band-shaped
keratopathy
Improved vision by
Scrapping off quite superficial &
calcareous opacity
Dissolving it with Na edetate (Na salt
of EDTA)
Removed with excimer laser
(phototherapeutic keratectomy)
 Climatic droplet
keratopathy
Climatic/oil/actinic droplet keratopathy
Common in those exposed to hot, dry, dusty
environment & outdoor activity in sun like farmers
Affects exposed interpalpebral portion of cornea
sparing limbal area
Superficial layers predominantly affected
Superficial non-vascularized corneal opacity with
focal lesions in epithelium resembling droplets of
oil (characteristic)
If severely affected vision: lamellar keratoplasty
or excimer laser phototherapeutic keratectomy
 Salzmann Nodular
degeneration
Degenerative condition characterized
by
Bluish-white
Avascular nodules
Appear in sup stroma & BM
Occur in those with previous corneal
d/s
Slowly progressive
t/t: lamellar keratoplasty
 Other degenerative
changes
Frequently met with old leucomata or
anterior staphylomata consisiting of
hyaline infiltration, lipoid changes &
calcification
Such scars are liable to undergo a
serious form of ulceration called an
atheromatous ulcer