Common Ocular Surface Disorders and their Management

Cornea And Anterior Segment

Abstract

Introduction: Ocular surface is a complex, integrated system involving the cornea, conjunctiva, tear film, lacrimal gland, nasolacrimal system and the eyelids. Its physiological function depends on the interaction of these different components to maintain a clear optical  surface, keeping the eye moist, and protect it from trauma and infection. Changes in the structure and function of any of its components can disrupt this delicate balance and lead to pathology.

Clinical Features: Common symptoms include reduced vision; redness; irritation; itching; pain; discharge; and watering. Detailed  histories of these symptoms are essential. Clinical examination of the ocular surface using a stepwise approach to assess the vision  followed by examination of eyelids for position and closure; the lid margin and meibomian gland openings for abnormal positions, inflammation and plugging with secretions. Tears are also examined for quality and quantity. Conjunctiva is assessed for inflammation,  scarring, haemorrhages and abnormal swellings and possible malignancies, foreign body defects, inflammatory  membranes, papillae and follicles. Cornea is examined for foreign bodies, infiltrates, oedema and deposits. Corneal sensation is tested.  Stromal opacity is assessed for size, location, pattern and depth. It is necessary to look for active or inactive blood vessels,  guttata, Descemet folds and deposits.