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In The Name Of God

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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In The Name Of God

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  1. In The Name Of God

  2. Cornea and Anterior Segment MR SHOJA.MD Shahid sadoughi Medical School

  3. TEACHING SET NO.4 PREVENTION OFCHILDHOOD BLINDNESS INTERNATIONAL CENTRE FOR EYE HEALTH . Causes of Childhood Blindness

  4. Cloudy Cornea in infancy Gonococcal keratitis. Congenital Corneal Diseases. Obstetrical Forceps Trauma. Congenital Gluacoma.

  5. Birth Trauma : (Forceps injury )

  6. Horizontal Tear in Descemet M in Congenital Glaucoma

  7. Sclero Cornea Corneal Dermoid Aniridia Congenital Rubella

  8. MUCOPOLYSACCHARIDOSE

  9. CYSTINOSIS KAYSER FLEISHER RING

  10. Peter,s anomaly

  11. Congenital Hereditary Endothelial Dystrophy (CHED) Endothelial dysfunction . Increased cornea thickness. Cornea is edematous & bluish. IOP is normal . Primary treatment iskeratoplasty

  12. Macro Cornea 13 mm horizontal diameter X-linked reccessive pattern 90% patients are male No Cornea clouding , photophobia Microcornea

  13. 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.

  14. 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

  15. 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

  16. Cloboma of Iris Occur in inferonasal Iris. Microphthalmia is common. Cloboma of retina & choroid . VA ranges is low.

  17. Stromal Dystrophies Granular Macular Lattice

  18. 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

  19. TEACHING SET NO.4 PREVENTION OFCHILDHOOD BLINDNESS INTERNATIONAL CENTRE FOR EYE HEALTH Congenital Glaucoma

  20. Clinical Triad 1-Epiphora 2 - Photophobia 3 – Blepharospasm

  21. Signs: • Elevated IOP • Cloudy corneal • Buphthalmos • Optic nerve cupping • Descemet,s membrane tear • Increased axial length blunt trauma . hyphema Rupture of globe

  22. 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.

  23. Systemic conditions with Glaucoma Aniridia Retinopathy of prematurity Neuro fibromatosis Sturge weber syndrome Congenital Rubella

  24. 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.

  25. 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.

  26. How Is Glaucoma Treated? • Medications • Prostaglandin analogs • Beta blockers • Alpha agonists • Carbonic anhydrase inhibitors • Cholinergic agents • Laser therapy • Surgery

  27. Causes of Visual Loss in Congenital Glaucoma Optic never damage Corneal opacities Corneal astigmatism Surface irregularitis Amblyopia

  28. Anti Glaucoma Drops

  29. TRABECULOTOMY-GONIOTOMY

  30. Differential Diagnosisof Congenital Glaucoma Axial myopia primary megalocornea CORNEAL FINDINGS slerocornea congenital hereditary endothelial dystrophy Keratitis cystinosis birth trauma EPIPHORA Nasolacrimal duct obstruction

  31. Bacterial keratitis

  32. Clinical presentation Rapid onset of pain Conjunctival injection (Redness) Photophobia Decreased vision Discharge and lid edema

  33. Ocular infections

  34. 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

  35. THANKS FOR YOUR ATTENTION

  36. Complete Ocular Examination Slit lamp Exam Retinoscopy Gonioscopy Tonometry Measurment of corneal diameter Optic Never evaluation Follow -up Evaluation (4-6 weeks)

  37. Aqueous Outflow Pathway

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