Corneal and scleral dellen after an uneventful pterygium surgery. This cornea has a small dellen thinning of the corneal stroma that occured after cataract surgery. This can be accomplished by prescribing artificial tears, lubricating ointments, bandage contact lenses or punctal occlusion. Corneal dellen occurs in quiet eyes and does not involve epithelial loss. A conventional contact lens was not suitable since the conjuctival chemosis made its fitting impossible. Dellen were first described in 1911 as saucerlike excavations of the corneal margin. Cultures or smears of cornea, contact lens, contact lens case, and contact lens solutions if infiltrate exists to rule out infection. Areas of corneal thinning secondary to corneal drying from adjacent areas of tissue elevation. Dellen occur when the tear film does not cover the eye. The choice of table and stand should also be considered in the selection of a particular instrument.
The mission of the profession of optometry is to fulfill the vision and eye care needs of. The next day corneal dellen had already began to retreat and four days later the contact lens was removed since there was no sign of dellen in the slit lamp examination. Pdf this paper presents results of an analysis on patients operated on for strabismus in order to. This photo shows a dellen thinning of the cornea that occurs from dehydration. Fluorescein pools in the depression, and at times there is overlying staining. Corneal dellen definition of corneal dellen by medical. To begin the treatment of a corneal delle, the eye doctor must rehydrate the cornea.
Pdf we describe a patient with corneal and scleral dellen, which occurred after an uneventful pterygium excision without adjunctive therapy and a. This can be accomplished by prescribing artificial tears, lubricating. Pdf corneal and scleral dellen after an uneventful pterygium. Choose from 500 different sets of cornea flashcards on quizlet. Usually good except for severe or central corneal infections. The cornea is your eyes clear, protective outer layer. Kymionis gd1, plaka a, kontadakis ga, astyrakakis n. We bring great people to you before, during, and after an incident to help automate data flows, and improve data quality.
You can also see the funny reflection it causes on the iris underneath. They occur most often following processes which produce a paralimbal elevation that is able to induce a localized break in the precorneal oily layer of the tears which, in turn, causes a localized dehydration and thinning of the cornea. Corneal delle secondary to conjunctival chemosis decision. Dellen are small, saucerlike excavations at the margin of the cornea. Basics papilla vascular response if giant, the differential includes atopy, vernal, gpc, prosthesis, suture follicles lymphatic response acute chronic ekc, pharygoconjunctival fever adult inclusion conjunctivitis medicamentosa epinephrine, neosynephrine toxic.
Corneal dellen have been reported post strabismus surgery 3 and also after trabeculectomy 4 and pterygium surgery 5. Corneal dellen as a complication of strabismus surgery eye. The case where the initial treatment may have delayed the. Corneal dellen from subconjunctival hemorrhage after strabismus surgery. Stromal hydration can usually be restored with frequent ocular lubrication. They typically occur at the corneal limbus near areas of adjacent elevation. The patient was given bacitracin and vigamox moxifloxacin and was pressurepatched. Request pdf treatment of corneal dellen with a large diameter soft contact lens a 58yearold man presented with corneal dellen twelve days after pterygium removal on his left eye. The application of the bandage contact lens resulted in safe and fast treatment of corneal dellen. Full text dellen formation as a complication of subconjunctival. Overall, corneal dellen usually heal within 1015 days.
In conclusion, the use of a large diameter soft contact lens was an effective alternative solution for the treatment of corneal dellen in our patient. Corneal dellen as a complication of strabismus surgery eye nature. You can see it at the limbus in the bottomright of this picture. Ocular surface disorders community eye health journal. Ppt o pen eyeopen eye 55 m m h g o2 o 2 oo 2 coc o 2 155 m m hg 5l o cm corneah 2 2 21 l co 2 cm corneah 2 o2 9407191s. They occur most often following processes which produce a paralimbal elevation. Kpro implantation, particularly in those patients with corneal blindness from alkali. Corneal dellen are located near areas of tissue growth, inflammation or eyelid. This uncommon condition may be misconstrued as a corneal ulcer. This provides an invaluable means of assessing the lenscornea alignment relationship. Wagoner, md, phd july 29, 2009 introduction corneal stromal dystrophies are a group of inherited disorders of the cornea that are caused by progressive accumulation of deposits within the stroma. Overrefraction can also be used to judge lens flexure when an optimal visual result cannot be obtained with spherical lenses or overrefraction. The corneal epithelium is hydrophobic and, in the absence of mucin, will repel water and produce a dry spot. Corneal dellen are small saucerlike excavations at the margin of the cornea.
Articles appearing here may contain statements, opinions, and information that have errors in facts, figures, or interpretation. Ocular surface disorders american optometric association. The cornea is a complex structure which, as well as having a protective role, is responsible for about threequarters of the optical power of the eye. The dry epithelial surface then allows for a local deturgesence. Thomsitt moorfields eyehospital, city roadbranch, london marginal ulceration of the cornea represents a common ophthalmic problem dukeelder and leigh i965 described two main topographical types. We describe a patient with acute scleral dellen sd after pterygium excision with. Possible postoperative corneal complications after strabismus surgery were investigated. The condition involves compacted corneal stroma rather than true necrosis.
The thinned area was initially thought to be a corneal dellen resulting from the large amount of adjacent chemosis. It is accompanied by an adjacent focal conjuctival or corneal elevation and is usually asymptomatic although it may cause light irritation and foreign body sensation. In the absence of inflammation, one of the more likely causes of the thinning is a dell, or an area of nonwetting that thins and then breaks down, observes sadeer hannush, md, a corneal specialist and attending surgeon at the wills eye institute. It protects the iris and lens and helps focus light on the retina. Pdf corneal dellen secondary to conjunctival chemosis. Click here for the professional version click here for the professional version the cornea is the clear layer in front of the iris and pupil. Introduction to corneal disorders eye disorders merck. Dellen is the result of topical stromal dehydration caused by reduced tear film spread over a focal corneal area. Treatment of corneal dellen with a large diameter soft contact lens. Jan 28, 2015 the cornea is the transparent part of the eye that covers the front portion of the eye. Mar 28, 2014 corneal dellen are small saucerlike excavations at the margin of the cornea. In this case because of subconjunctival hemorrhage you notice how red that eye looks that has raised the conjunctiva. It covers the pupil the opening at the center of the eye, iris the colored part of the eye, and anterior. Corneal dellen is characterized by corneal thinning, usually at the limbus with an elliptical shape.
The cornea thins when it is dehydrated, and in this case, a localized area of conjunctival edema next to the limbus interfered with the normal tearblink. Dellen are caused by a cascade of events, incited by a focal absence of the mucin layer over the epithelium. Therefore, scso should be evacuated as early as possible to avoid longterm peripheral corneal morbidity. No complications occurred until 14 days after surgery when corneal and sclera dellen appeared.
Rearrange individual pages or entire files in the desired order. Corneal graft dellen in a patient implanted with a. The cornea thins when it is dehydrated, and in this case, a localized area of conjunctival edema next to the limbus interfered with the normal tearblink mechanism. A central corneal dellen may be associated with longterm, overnight use. Corneal dellen from subconjunctival hemorrhage after. Rigid contact lens fitting 6 latter lens, the tear lens, can be calculated by overrefraction.
Practitioners will benefit from the slit lamp being mounted on a combi unit which can easily be moved in front of the patient to carry out the examination. The etiology, clinical management and the possible differential diagnosis of the central cornea dellen are discussed. Clinical features include a round or oval depression in the cornea, typically located in the periphery or mid periphery. The next day the area of thinning was largely unchanged, although it now stained with fluorescein. Pdf corneal dellen as a complication of strabismus surgery. Trantas, n on two cases of local intense and transitory corneal.
Treatment of corneal dellen with a large diameter soft. Large corneal burn following accidental exposure to ammonia. It is suggested that this paralimbal elevation induces a localized break in the precorneal oily film layer of the tears which, in turn, causes a localized dehydration and thinning of the cornea. Dellen are areas of corneal thinning secondary to stromal dehydration. Fortunately, this thinning quickly resolved with aggresive lubrication. Severe scleral dellen as an early complication of pterygium excision. They are caused by interruptions of the tear film and local dehydration of the cornea. We supplement your expert judgment with verified and relevant information, allowing you to focus on the things which really matter, not superfluous data. A retrospective analysis of the files of 875 private. Fuchs, a pathological dimples dellen of the cornea, amer j ophthal 12.