Corneal Perforation & formation of False Cornea

by admin on May 26, 2010

The case we are going to present have very sad history, the guy you see in photo below was thrown out of a running train after a small quarrel to occupy seat. When he was thrown out of train, he felt on rail in such a way that his face acquired maximum injuries.
His left cornea was sloughed off by stones on rail track, generally when cornea is sloughed off a narrow rim at margin remains and all of iris (total) undergo prolapse, get highly inflammed narrowing the pupil, what ever opening of pupil is left is covered by exudates, slowly whole of iris is covered by exudates forming “false cornea”, ultimately organisation of exudates takes place and form a thin fibrous layer over which conjunctival or corneal epithelium grows leading to formation of pseudocornea.
The pseudocornea is thin and cannot tolerate high intraocular pressure, so it bulges forward along the plastered iris tissue, this is known as Anterior Staphyloma (word staphyloma means black grapes).
Pseudocornea also form due to perforation of corneal ulcer, which usually happenes when ulcerative process goes deep in corneal layers and reaches Descemet’s membrane. This Descemet’s membrane bulges outward forming Descemetocele, which can burst anytime due to increased intraocular pressure may be due to normal activities like straining for stool, sneezing, cough etc.
Below is the photograph of eye showing fungal corneal ulcer, this child gave a history of trauma on eye by a vegetative body ( a plant). This ulcer can also perforate if not treated leading to Pseudocornea.
Perforation or sloughing of cornea can also takes place due to vitamin A deficiency, below is the a child suffering from Vitamin A deficiency see the Bitot spot on his sclera, this is the early stage of vitamin A deficiency.
Bitot's Spot in Indian Child

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