Topic

#Cornea and External Eye Diseases

34 articles
  1. Articles 1 Apr 2021 14 min read

    Recurrent Corneal Erosion Syndrome - A Review

    Introduction: Recurrent corneal erosion syndrome (RCES) is a chronic, relapsing condition first described by Hansen1, who termed it as ‘‘intermittent neuralgic vesicular keratitis.’’ Stood in 1901 suggested that trauma to the corneal epithelium and anterior stroma resulted in an inability of the new epithelium to form normal attachments to the injured anterior Bowman’s layer 2. Despite more than a century of advances in corneal science, RCES remains one of the most challenging conditions to manage3. Most patients have a history of epithelial trauma or associated corneal dystrophy and respond initially to a conservative regimen of lubrication. However, they often experience frequent and debilitating recurrences. In this review, we will investigate the etiology and pathogenesis of this challenging disorder, discuss the histopathological changes with a highlight on ASOCT findings, current therapies, and present future directions for research. Etiology and epidemiology: Recurrent corneal e

    Dr. Rishi Swarup D.O · Dr. Divya Jain M.S
  2. Articles 1 Apr 2021 14 min read

    Corneal Trauma and its Management

    Introduction The cornea is prone to a variety of injuries by virtue of its location as the window of the eye. Apart from chemical injuries, physical trauma to the cornea can range from epithelial abrasions to loss of integrity of the stroma. Corneal injuries of this nature can occur in two distinct populations – in young children from play-related activities, and in young adults from due to their work environment. Although the general principles of management are not too different, special consideration in the pediatric population must be given to the timing of appropriate surgical interventions as the developing visual system in children is prone to amblyopic visual loss. Males are usually more prone to ocular injury than females; this is seen clearly in children, while the ratio of boys vs girls involved in accidents with ocular trauma is 4:1 [1]. The injuries can be caused by large blunt objects often resulting in ruptures of other parts of the ocular coats as well. On the other han

    Dr. Sanjeev P Srinivas · Dr. Amanda Mohanan · +1 other
  3. Articles 1 Apr 2021 8 min read

    A New Paradigm for Refractive Surgery: SMILE-Small Incision Lenticule Extraction

    Automated lamellar keratoplasty (ALK) was a technique to physically remove a refractive lenticule (the lenticule was merely a disc of corneal tissue) from the cornea after lifting a hinged flap and exposing the stroma. A mechanical microkeratome was used to do both steps of the ALK procedure. In the LASIK procedure, the refractive lenticule was ablated with the excimer laser, while the hinged flap was still created with the mechanical microkeratome. In a later iteration, Femto-LASIK involved creation of the hinged flap with a femtosecond laser, and an excimer laser was used to ablate the refractive lenticule. SMILE, a relatively new technique of performing refractive surgery, uses a femtosecond laser for all steps of the keratomileusis procedure. SMILE involves the creation of a refractive lenticule within the cornea using a femtosecond laser, and subsequent extraction of the refractive lenticule from within the cornea. The refractive error that needs to be treated defines the shape of

    Dr. Rupal Shah M.S
  4. Articles 1 Apr 2021 6 min read

    Ten Pearls for Corneal Scrapping

    The management of microbial keratitis requires corneal scraping material for smear and culture. Scraping is a superficial keratectomy procedure to procure samples from central infiltrates or any infiltrate more than 2 mm in size. Stain/ wet mount gives a rapid clue to the diagnosis to initiate appropriate therapy. Inoculation of the sample on culture media help identify the offending organism and antibiogram help choose an appropriate therapeutic agent. Erasmus Darwin the grandfather of Charles Darwin was the first to suggest corneal therapeutic debridement to try and make cornea transparent in 1795. 1. Proper documentation of corneal ulcer should be done before going ahead with corneal scraping Before corneal scraping is planned it is important to document the corneal ulcer either diagrammatically or by photo documentation as this helps in showing progression or worsening of the therapeutic management. Areas of clinically active margins should be noted and always check the area of max

    Dr. Manokamna Agarwal · Dr. Meena Lakshmipathy
  5. Articles 1 Apr 2021 11 min read

    Ten Tenets One Should know on Conjunctival Hooding

    Ocular surface anatomy The ocular surface, in a strict sense, consists of the cornea and its major support tissue, the conjunctiva. In a wider anatomical, embryological, and also functional sense, the ocular mucosal adnexa (i.e. the lacrimal gland and the lacrimal drainage system) also belong to the ocular surface. The ocular surface occupies approximately 2.2 cm2 of the human body surface area [1]. The homeostasis of this small area is, however, extremely important for clear vision and comfort. The cornea is one of the most densely innervated structures in the body and hence, surface changes can result in significant discomfort apart from vision loss. The clarity and tectonic integrity of the cornea are maintained by a number of mechanisms, and one of the most important of these is the intactness of the surface epithelium. The limbus provides a constant source of epithelial cells to maintain the normal turnover of the corneal surface but can be impacted by multiple noxious influences

    Dr. Sanjeev P Srinivas · Dr. Amanda Mohanan · +1 other
  6. Articles 1 Apr 2021 11 min read

    Ten Tenets on Corneal Collagen Crosslinking

    Corneal collagen crosslinking (CXL) is a minimally invasive procedure that is currently the gold standard treatment to arrest the progression of corneal ectatic conditions. It promotes the induction of crosslinks in stromal collagen of the cornea, thereby strengthening and stiffening the cornea in ectatic conditions. 1.HISTORY It was observed that corneas in diabetic patients were stiffer due to the natural crosslinking occurring from glycosylation and hence had a lower incidence of keratoconus. Based on this observation, various experiments were conducted to crosslink the cornea manually using chemical agents and sugar aldehydes. Following multiple trials, it was found that this could be safely done by making use of the photochemical reaction induced by the absorption of UV light by riboflavin.1 The first in vivo study was done by Wollensak et al., and they reported in 2003 that CXL was effective in stopping the progression of moderate to advanced progressive keratoconus, in 23 eyes f

    Dr. Amanda Mohanan · Dr. Sanjeev P Srinivas · +1 other
  7. Articles 1 Apr 2021 15 min read

    Learn from the Masters: Endothelial Keratoplasty

    Endothelial keratoplasty involves selective replacement of the diseased host endothelium with a healthy tissue. Because of its advantages over traditional penetrating keratoplasty, it has become the procedure of choice for corneal endothelial disorders. In last two decades the technique of endothelial keratoplasty has underwent tremendous modifications to improve visual outcome and reduce complications. When we think of endothelial keratoplasty, various terms come to our mind like DLEK ,DSEK,DMEK etc. These can be confusing not only for a resident in training but to a general practitioner as well. To improve our understanding in the field of endothelial keratoplasty, we have invited some prominent endothelial keratoplasty surgeons of our country. Dr. Jagadeesh Kumar Reddy, MS. is the Director (Technical) Sankara Eye Centre, Coimbatore. He has done Fellowship in Cornea and has 30 years of clinical practice. He has performed over 80,000 surgeries and his area of interest is new designs o

    Dr. Prateek Gujar
  8. Articles 1 Apr 2021 14 min read

    Ten Pearls for The Management of Pseudophakic Corneal Edema

    Corneal edema refers to the accumulation of excess fluid in the corneal layers, with a loss of corneal clarity, resulting in vision loss. The normal cornea maintains a state of 78% hydration due to a complex interplay between stromal swelling pressure, the barrier function of the epithelium and endothelium, endothelial pump, tear evaporation and intraocular pressure [1]. Any condition that interferes with this balance causes a loss of homeostasis and accumulation of fluid. 1. The Natural History of Corneal Edema In the early stages of corneal edema, reduced vision is often related to an irregular corneal surface and can interfere significantly with daily activities. This impact on vision is often underestimated by quantitative visual acuity measurements in standard lighting conditions using high contrast charts, as in a refracting lane. Initially, these patients often experience blurred vision on awakening, owing to the accumulation of fluid in the closed eye state during sleep. As the

    Dr. Sanjeev P Srinivas · Dr. Amanda Mohanan · +1 other
  9. Articles 1 Apr 2021 6 min read

    Learn from the Masters : Tips & Tricks of Managing Dry Eye

    As we all know that India is on the brink of a dry eye disease epidemic, this interview with the maestros in this field will help us to streamline our approach in managing the increasing number of dry eye patients. The availability of innumerable diagnostic tests always baffles us about how to use what in which time. The need for an integrated scheme in assessing and prognosticating dry eye cases is of utmost importance for a successful treatment outcome. Some of the very basic but most important areas are discussed by the unparallels in their field to clear the doubts of young ophthalmologists. Dr. Srinivas K. Rao DO, DNB, FRCSEd has worked as a Senior Consultant at Sankara Nethralaya for 15 years before joining as Professor in the Chinese University of Hong Kong from September 2004 till August 2006. Since October 2006 he is Director of Darshan Eye Care and Darshan Surgical Centre, Chennai. He is also Visiting Professor, Sri Ramachandra Medical University, Cornea Head at Sankara Hospi

    Dr. Sumana Chatterjee
  10. Articles 1 Apr 2021 24 min read

    Corneal Dystrophy: A Ready Reckoner for Postgraduates

    Corneal dystrophies are classically defined as a group of inherited disorders of the cornea which is bilateral, symmetric, slowly progressive, and not related to any environmental or systemic factors.1,2 Most of the corneal dystrophies begin in the early decades of life and progress gradually. The effect of these changes in some of the dystrophies may not be clinically apparent till the later years. The underlying basis of all corneal dystrophies are genetic mutations some of which have been mapped, while others are yet to be identified.1-3 Most of these mutations result in the transcription of aberrant proteins. These proteins are deposited in various corneal layers and give rise to the characteristic clinical features. The pace of deposition also determines the natural history of the corneal dystrophy. Corneal dystrophies were first reported by Groenouw in his article published in 1890.1 He described one patient with granular corneal dystrophy and another patient with macular corneal

    Dr. Samrat Chatterjee

Other topics

Review Vitreoretina Top Ten Series Tips & Pearls Made Easy Macular Diseases Must Read Preferred Practise Pattern Learn from Masters Treatment Uvea and Intraocular Inflammation Case Discussion Cataract Surgery i-File Pediatric Ophthalmology Glaucoma Imaging Grand Rounds infection