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212 Corneal Vascularization

Corneal Vascularization Client Education
Sheet
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DIAGNOSIS
BASIC INFORMATION
Adjacent ocular disease:
• Uveitis (p. 1023)
Definition Diagnostic Overview • Episcleritis/scleritis (p. 304)
The presence of blood vessels in the cornea Diagnosis is made on careful visual inspection • Orbital disease (p. 716)
of the corneal surface. Important features for • Glaucoma (p. 387)
Synonyms pinpointing the underlying cause and treatment
Corneal neovascularization, vascularized keratitis approach include the location and pattern Initial Database
of vascularization, and evaluation for other • Neuro-ophthalmic exam (p. 1136): evaluate
Epidemiology concurrent ocular disease. palpebral reflexes and completeness of eyelid
SPECIES, AGE, SEX closure
Varies, depending on underlying cause Differential Diagnosis • Ophthalmic exam (p. 1137): evaluate for
Corneal injury or inflammation: abnormalities mentioned above
ASSOCIATED DISORDERS • Corneal ulceration (p. 209)
Corneal ulceration, irritation, desiccation, • Chemical irritation TREATMENT
uveitis, glaucoma, pannus (chronic superficial • Mechanical irritation
keratitis), keratoconjunctivitis: eosinophilic, ○ Distichiasis/ectopic cilia/trichiasis (p. 273) Treatment Overview
cats, episcleritis, or scleritis ○ Entropion (p. 296) The goals of treatment are to address the
• Exposure underlying cause, halt progression, and reduce
Clinical Presentation ○ Large palpebral fissure ocular discomfort.
HISTORY, CHIEF COMPLAINT ○ Lagophthalmos (incomplete closure of the
Some or all may be present: eyelids) Acute and Chronic Treatment
• History ○ Ectropion Treatment will vary depending on the underly-
○ Ocular trauma ○ Buphthalmos (chronic glaucoma) ing cause. Treatment of the vascularization itself
○ Chronic ophthalmic disorder (e.g., ○ Exophthalmos is rarely indicated. After the underlying cause
keratoconjunctivitis sicca [KCS], indo- • Neuroparalytic keratitis (cranial nerve VII is treated, the vessels will recede.
lent corneal ulcer, pannus, eosinophilic lesion)
keratoconjunctivitis in cats) • Neurotrophic keratitis (cranial nerve V Possible Complications
• Chief complaint lesion) • Corneal vascularization may precede pig-
○ Reddish discoloration of the eye • KCS (p. 568) mentation and scarring.
○ Signs of ocular pain (e.g., blepharospasm, • Qualitative tear film abnormalities • Vascularization is often part of normal healing
rubbing eye, temperament change) • Pannus (dogs) (p. 748) and, in general, should not be suppressed.
• Eosinophilic keratoconjunctivitis in cats • Intracorneal stromal hemorrhage is uncom-
PHYSICAL EXAM FINDINGS • Corneal degeneration (corneal lipid infiltrates mon; however, risk of this increases with
• Focal to diffuse red discoloration of the [p. 205]) certain ocular and systemic diseases.
superficial or deep cornea
• New corneal vessels enter stroma at the
limbus:
○ May give the affected cornea a reddish
haze
○ Vessels are leaky and cause surrounding
corneal edema (bluish haze).
• Other findings vary, depending on the
cause.
Etiology and Pathophysiology
Blood vessel ingrowth occurs: A B
• As a response to injury of the corneal epi-
thelium or stroma as a normal component
of healing
○ Neutrophils, which enter the cornea
from the tear film and the limbus, are
important sources for angioblast and
fibroblast growth factors.
○ There is a 7-10 day delay before the
ingrowth of corneal blood vessels at the
limbus is easily visible.
○ Ingrowth then occurs at a rate of approxi-
mately 1 mm/day.
• As part of an ocular immune-mediated C D
inflammatory response CORNEAL VASCULARIZATION A, Superficial vascularization secondary to keratoconjunctivitis sicca (note
• Secondary to disease of adjacent ocular branching blood vessels). B, Deep vascularization secondary to uveitis (note the straight brush-border appearance
tissues, including uveitis, episcleritis, scleritis, of deep vessels). C, Vascularization and raised granulation tissue (star) due to chronic irritation caused by
and glaucoma and others entropion. D, Superficial vascularization with intracorneal stromal hemorrhage (arrowheads).

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