✍️ epithelial signs
✍️ stromal signs
✍️ endothelial signs
Epithelial signs
✍️ Punctate epithelial erosions
☝️ Multiple fine areas of epithelial loss
☝️ stain well with Flurescene and poorly with Lissamine Green
☝️ causes
👁Superior
• VKC
• superior limbic keratitis
• floppy eyelid syndrome
• poor CL fit)
👁 Interpalpebral
• KCS
• UV exposure
• corneal anaesthesia
👁 Inferior
• MGD
• exposure keratopathy
• ectropion
• poor blink
• poor Bell’s phenomenon
• rosacea
• preservative toxicity
✍️ Corneal filaments
☝️ Mucus strands adherent to cornea, with mobile
free tails
☝️stain poorly with F and well with LG
☝️ causes
• KCS
• recurrent erosion syndrome
• corneal anaesthesia
• exposure keratopathy
• herpes zoster ophthalmicus (HZO)
✍️ Punctate epithelial keratitis
☝️Tiny white spots of epithelial and inflammatory cells
☝️ stain poorly with F and well with LG
☝️ causes
• Viral keratitis (adenovirus, HSV, molluscum contagiosum)
• Thygeson’s superficial punctate keratopathy
✍️ Epithelial Oedema
☝️ Loss of lustre + translucency
☝️ microvesicles and bullae
☝️ causes
• high IOP
• post-operative
• CL overwear
• aphakic or pseudophakic bullous keratopathy
• Fuchs’ endothelial dystrophy
• trauma
• acute hydrops
• herpetic keratitis
• congenital corneal clouding
✅Stromal signs
✍️ Pannus
☝️ Subepithelial fibrovascular ingrowth
☝️ causes
• Trachoma
• tight CL
• phlycten
• herpetic keratitis
• rosacea keratitis
• chemical keratopathy
• marginal keratitis
• VKC
• atopic keratoconjunctivitis
• superior limbal keratoconjunctivitis
✍️ Stromal infiltrate
☝️ Focal opacification due to leucocyte aggregations
☝️causes
• CL-related (sterile)
• microbial colonization
(bacteria, fungi, viruses, protozoa)
✍️ Stromal oedema
☝️ Thickened, grey opaque stroma
☝️ causes
• Post-operative
• keratoconus
• Fuchs’ endothelial dystrophy,
• herpetic disciform keratitis
✍️ Cornea farinata
☝️Deep stromal faint Flour-like opacities
☝️Idiopathic (innocuous)
✍️ Crocodile shagreen
☝️ Reticular polygonal network of stromal
opacity
☝️Idiopathic (innocuous)
Endothelium signs
✍️ Descemet’s Folds
☝️ in intact DM
☝️ causes
• Post-operative
• low IOP
• disciform keratitis
• congenital syphilis
✍️ Descemet’s Breaks
☝️ DM breaks associated oedema of overlying
stroma
☝️ causes
• Birth trauma
• keratoconus ( hydrops)
• keratoglobus
• infantile glaucoma (Haab’s striae)
✍️ guttata
☝️ Wart-like protuberances
☝️Peripheral:
Hassall–Henle bodies (physiological in the elderly)
☝️Central: Fuchs’ endothelial dystrophy
✍️ Pigment
☝️ Dusting of pigment from iris
☝️ causes
• Pigment dispersion syndrome (PDS)
• post-operative
• trauma
✍️ Keratic precipitates (KPs)
☝️ Aggregates of inflammatory cells on endothelium
☝️ causes
👁 Keratitis
• disciform
• microbial
• marginal
👁 Anterior uveitis
• idiopathic
• HLA-B27
• Fuchs’ heterochromic cyclitis
• sarcoidosis, etc