Cornea Chronicles

DOWN 1 __________ keratitis is characterised by feathery margins 3 Stain used to stain corneal scrapings for Acanthamoeba 7 “River blindness” is caused by _______________ 8 Auto-immune ulcer characterised by progressive circumferential peripheral stromal ulceration 12 Ring-shaped infiltrates are a characteristic of __________ keratitis ACROSS 2 Ciprofloxacin: The common fluroquinolone that causes corneal drug precipitates 4 Stain commonly used to stain for fungus detection under a fluorescence microscope 5 Double staining for corneal lesions is typically seen in ___________ ulcers 6 Vertical striae in the Descemet’s membrane 9 Vitamin A deficiency causes _________________ 10 Organism that can penetrate intact cornea 11 A sign of delayed hypersensitivity to Staphylococcal antigen or maybe associated with rosacea 13 A syndrome with vesitibulo-auditory symptoms and bilateral anterior stromal corneal opacities, corneal neovascularisation, and often along with uveitis and scleritis 14 Immune-mediated endothelitis is called _____________ keratitis 15 Bubble-like herniation of the Descemet’s membrane that plugs a defect in the cornea preventing a perforation. ANSWERS OSCE A 5-year-old boy presented with recurrent episodes of watering, redness, and itching of both the eyes (OU) since a year. His unaided visual acuity was 6/7.5 OU. Anterior segment findings are as follows [Figure 1]. Posterior segment examination was within normal limits.Figure 1: Slit lamp picture of the anterior segment and the tarsal conjunctiva of the right (1a, 1c) and the left eye (1b, 1d), respectivelyQUESTIONS Describe the findings in Figure 1. What is the provisional diagnosis? What are the various types? Any role of systemic evaluation? Management? What are the ocular complications of this condition? ANSWERS Figure 1 shows multiple macropapillae on the tarsal conjunctiva, diffuse conjunctival pigmentation and congestion, and limbal Horner Trantas spots with clear cornea OU suggestive of vernal keratoconjunctivitis (VKC). Limbal, palpebral, and mixed forms based on the involvement of limbal region, tarsal conjunctiva, or both. Atopy with raised serum IgE levels and Vitamin D deficiency are known associations with VKC. Conservative treatment like cold compresses, avoiding allergens, lid scrubs, and dark goggles for photophobia is beneficial. Medical management includes topical mast cell stabilisers like sodium cromoglycate (2%), topical antihistaminic eye drops, which act on H1 receptors like olopatadine and alcaftadine, topical low potency corticosteroids, like fluorometholone, loteprednol, and steroid-sparing agents like cyclosporin (0.05 to 2%) and tacrolimus (0.1%) are useful in recalcitrant cases. Systemic anti-atopy agents like leukotriene receptor antagonists or IgE monoclonal antibodies may be needed in a few cases where there is associated atopic dermatitis or asthma. Shield ulcer, central corneal scars, and limbal tissue hyperplasia, steroid-induced cataract, steroid-induced glaucoma, irregular astigmatism, keratoconus, and acute hydrops. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.