Corneal opacity results in loss of corneal transparency due to scarring. It occurs when a corneal wound or ulcer involves Bowman's membrane. Causes include healed corneal injuries or ulcers from infections, congenital disorders, or dystrophies. Clinically, corneal opacity can cause vision loss or blurriness depending on density and location. Treatment options include optical iridectomy, phototherapeutic keratectomy, keratoplasty, cosmetic lenses, or tattooing for appearance. Pannus is extensive superficial vascularization with infiltration and may be progressive or regressive depending on vessel and infiltration activity locations.

1. CORNEAL OPACITY

2. CORNEA :
• Transparent , avascular structure .
• Layers of cornea anterior to posterior are :
• epithelium
• bowman’s membrane
• Corneal stroma
• Pre Descemet’s membrane ( dua ‘s layer)
• Descemet’s membrane
• endothelium

3. CORNEAL TRANSPARENCY
• Anatomical
• Homogeneity of refractive index throughout the epithelium
• Peculiar arrangement of corneal lamellae
• Peculiar regular refractive index of corneal lamellae
• Avascularity of cornea

4. • Physiological
• Barrier function of limiting layers (epithelium and endothelium )
• Endothelium pumps :Na/k ATPase , bicarbonate dependent ATPase ,Na/H pump
• Evaporation from corneal surface
• Normal IOP
• Swelling pressure of stroma which counters imbibition effect of IOP .
• Corneal crystallins , ie ..water soluble protein of keratocytes

5. CORNEAL OPACITY
• The word corneal opacification means loss of normal transparency of
cornea , which can occur in many conditions.
• Therefor the term corneal opacity is used particularly for loss of
corneal transparency due to scarring .
• Corneal opacity result when the corneal wound or ulcer involves
bowman’s membrane

6. Causes
1 Congenital causes : STUMPED
2 Healed corneal wounds , following mechanical , chemical or thermal injuries
3 Healed corneal ulcers , infective as well as non infective
• Sclerocornea
• Tear in descemets membrane ,congenital glaucoma , birth trauma
• Ulcer : HSV , bacterial ,neurotropic
• Mucopolysaccaridosis, mucolipidosis
• Posterior corneal defects like peter’s anomaly , post . Keratoconus
• Endothelial dystrophy : congenital hereditary posterior polymorphous
• dermoid

7. CLINICAL FEATURES
• Corneal opacity may produce
A. loss of vision (when dense opacity covers the pupillary area )
B. blurred vision ( due to astigmatic effect)

8. TYPES OF CORNEAL OPACITY
• Nebular corneal opacity : faint opacity due to superficial scars involving
bowman’s layer and superficial stroma
• Macular corneal opacity : semi – dense opacity produced when scarring
involves about half of corneal stroma
• Leucomatous corneal opacity : dense white opacity which results due to
scarring of more than half of stroma
• Adherent leucoma : results when healing occurs after perforation of cornea with
incarceration of iris

10. • Corneal facet : sometimes the corneal surface is depressed at site of
healing (due to less fibrous tissue )
• Kerectasia : corneal curvature is increased at site of opacity
• Anterior staphyloma : an ectasia of pseudocornea which results after total
sloughing of cornea with iris plastered behind it
• Secondary changes in corneal opacity in long standing cases : hyaline
degeneration , calcareous degeneration , pigmentation and atheromatous
ulceration .

11. Treatment :
• Optical iridectomy : in central macular or leucomatous corneal
opacity , provided vision improves with pupillary dilation .
• Phototherapeutic keratectomy PTK : superficial (nebular)
corneal opacity
• Keratoplasty : in uncomplicated cases
• Cosmetic coloured contact lens : good cosmetic appearance in
ugly scars having no potential for vision
• Tattoing of scar : for cosmetic purpose
Suitable for firm scars without vision

12. • Indian black ink , gold or platinum
• First epithelium covering opacity is removed under topical anesthesia
(2 -4 % xylocaine )
• Blotting paper of same size and shape , soaked in 4 % gold chloride
(brown) or 2 %platinum chloride (dark) applied
• After 2-3 min piece of filter paper is removed and drops of 2 %
hydrazine hydrate soln poured
• Irrigate with normal saline and patched after instilling antibiotic and
atropine eye ointment.
A. Tattoing of scar

13. PANNUS :
• When extensive superficial corneal vascularization is associated with
white cuff of cellular infiltration , it is termed as pannus .
• Based on activity of pannus it may be progressive or regressive
• Progressive pannus : here corneal infiltration in ahead of vessels
• Regressive pannus : here corneal infiltration logs behind vessels

14. Based on location pannus may be :
• Superior pannus :occur in trachoma and in contact lens wearers
• Inferior pannus : in rosacea keratitis and patients with exposure
keratopathy
• Generalised pannus : steven- johnson syndrome , chemical
burns and moorens ulcer

15. Treatment
• Corticosteroids may have vasoconstrictive and suppressive effect on
permeability of capillaries .
• Intra stromal anti-VEGF injection in regressive corneal vascularization
• Application of irradiation
• Surgical treatment in form of peritomy may be employed for superficial
vascularization.

16. Thank you