金台診所醫學美容的部落格



Corneal signs aids to diagnosis capsule

✍️ 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