ICD-10: H18.713

Corneal ectasia, particularly bilateral corneal ectasia classified under ICD-10 code H18.713, is a progressive condition characterized by the thinning and bulging of the cornea, leading to visual impairment. Understanding its clinical presentation, signs, symptoms, and patient characteristics is crucial for timely diagnosis and management.

Clinical Presentation

Definition and Overview

Corneal ectasia refers to a group of disorders where the cornea becomes progressively thinner and protrudes outward, resulting in distorted vision. Bilateral corneal ectasia indicates that both eyes are affected, which is common in conditions such as keratoconus and pellucid marginal degeneration[1][2].

Common Patient Characteristics

• Age: Typically diagnosed in adolescents or young adults, although it can occur at any age.
• Gender: There is a slight male predominance in cases of keratoconus, while pellucid marginal degeneration affects both genders equally[1].
• Family History: A family history of corneal ectasia or related conditions may be present, suggesting a genetic predisposition[1].

Signs and Symptoms

Visual Symptoms

• Blurred Vision: Patients often experience progressive blurring of vision, which may fluctuate.
• Distorted Vision: Straight lines may appear wavy or distorted due to irregular corneal shape.
• Increased Sensitivity to Light: Photophobia can occur, making bright lights uncomfortable[2].

Physical Signs

• Corneal Thinning: Examination may reveal localized thinning of the cornea, particularly in the central or inferior regions.
• Keratometry Findings: Corneal topography shows irregular astigmatism and a characteristic cone shape in keratoconus[3].
• Scarring: In advanced cases, scarring may develop on the corneal surface, further impairing vision[1].

Associated Symptoms

• Eye Strain: Patients may report discomfort or strain, especially after prolonged visual tasks.
• Frequent Changes in Prescription: Patients often require frequent updates to their eyeglass or contact lens prescriptions due to changing vision[2].

Diagnosis and Management

Diagnostic Tools

• Corneal Topography: This imaging technique is essential for diagnosing corneal ectasia, providing detailed maps of the corneal surface[3].
• Slit-Lamp Examination: A thorough examination can reveal corneal thinning and other structural changes[1].

Management Strategies

• Contact Lenses: Specialized contact lenses, such as rigid gas permeable lenses, may be used to improve vision.
• Corneal Cross-Linking: This procedure strengthens corneal tissue and may halt the progression of ectasia[4].
• Surgical Options: In severe cases, corneal transplantation may be considered if vision cannot be adequately restored through other means[4].

Conclusion

Bilateral corneal ectasia (ICD-10 code H18.713) presents with a range of visual disturbances and physical signs that can significantly impact a patient's quality of life. Early diagnosis through corneal topography and slit-lamp examination is vital for effective management. Understanding the clinical presentation, symptoms, and patient characteristics can aid healthcare providers in delivering appropriate care and interventions to those affected by this condition.

For further information or specific case management strategies, consulting with an ophthalmologist specializing in corneal diseases is recommended.

Corneal ectasia, bilateral, is classified under the ICD-10-CM code H18.713. This condition refers to a progressive thinning and bulging of the cornea in both eyes, which can lead to visual impairment. Understanding alternative names and related terms for this condition can enhance clarity in medical documentation and communication. Below are some alternative names and related terms associated with H18.713.

Alternative Names for Corneal Ectasia

1. Bilateral Corneal Ectasia: This is a direct synonym for H18.713, emphasizing the condition's occurrence in both eyes.
2. Bilateral Keratectasia: This term is often used interchangeably with corneal ectasia, highlighting the corneal thinning and bulging aspect.
3. Bilateral Pellucid Marginal Degeneration: While this is a specific type of corneal ectasia, it is sometimes referenced in discussions about bilateral ectasia due to its similar presentation and implications for vision[1][5].

Related Terms

1. Corneal Thinning: A general term that describes the reduction in corneal thickness, which is a characteristic of ectasia.
2. Keratoconus: Although primarily a unilateral condition, keratoconus can also present bilaterally and is often discussed in the context of corneal ectasia due to its similar pathophysiology.
3. Corneal Topography: This diagnostic tool is frequently used to assess corneal shape and thickness, aiding in the diagnosis of ectasia[3][4].
4. Gas Permeable Scleral Contact Lens: A treatment option for patients with corneal ectasia, these lenses can help manage visual impairment caused by the condition[9].

Conclusion

Understanding the alternative names and related terms for ICD-10 code H18.713 is essential for accurate diagnosis, treatment planning, and communication among healthcare providers. By familiarizing oneself with these terms, medical professionals can ensure better patient care and documentation practices. If you have further questions or need additional information on this topic, feel free to ask!

Corneal ectasia, bilateral, is classified under the ICD-10-CM code H18.713. This condition is characterized by a progressive thinning and bulging of the cornea, which can lead to visual impairment. Below is a detailed clinical description and relevant information regarding this diagnosis.

Clinical Description of Corneal Ectasia

Definition

Corneal ectasia refers to a condition where the cornea, the transparent front part of the eye, becomes irregularly shaped due to thinning. This irregularity can cause significant visual distortion and may lead to conditions such as keratoconus, where the cornea protrudes outward.

Bilateral Presentation

The term "bilateral" indicates that the condition affects both eyes. This can complicate treatment and management, as both corneas may require intervention to restore or improve vision.

Symptoms

Patients with bilateral corneal ectasia may experience a range of symptoms, including:
- Blurred or distorted vision
- Increased sensitivity to light
- Frequent changes in prescription glasses or contact lenses
- Eye strain or discomfort

Causes

The exact cause of corneal ectasia is not fully understood, but several factors may contribute, including:
- Genetic predisposition
- Eye rubbing
- Previous eye surgeries, such as LASIK
- Certain medical conditions, such as Down syndrome or Marfan syndrome

Diagnosis

Diagnosis typically involves a comprehensive eye examination, including:
- Corneal Topography: This imaging technique maps the surface curvature of the cornea, helping to identify irregularities.
- Slit-Lamp Examination: A detailed examination of the cornea and surrounding structures to assess the extent of ectasia.
- Visual Acuity Tests: To determine the impact of the condition on vision.

Treatment Options

Management of bilateral corneal ectasia may include:
- Contact Lenses: Specialized lenses, such as rigid gas permeable (RGP) lenses, can help improve vision.
- Corneal Cross-Linking: A procedure that strengthens corneal tissue to halt progression.
- Surgical Options: In severe cases, procedures such as corneal transplantation may be necessary.

Coding and Billing

The ICD-10-CM code H18.713 is specifically used for billing and coding purposes in healthcare settings. Accurate coding is essential for proper documentation and reimbursement for the treatment of this condition.

Related Codes

• H18.71: This code refers to corneal ectasia without specifying laterality, which may be used when the condition is not bilateral.

Conclusion

Bilateral corneal ectasia (H18.713) is a significant ocular condition that requires careful diagnosis and management. Understanding its clinical presentation, symptoms, and treatment options is crucial for healthcare providers to offer effective care and improve patient outcomes. Regular follow-ups and monitoring are essential to manage the progression of the disease and to adapt treatment plans as necessary.

Corneal ectasia, particularly when classified under ICD-10 code H18.713, refers to a condition characterized by the progressive thinning and bulging of the cornea, leading to visual impairment. The diagnosis of bilateral corneal ectasia involves several criteria, which are essential for accurate identification and management of the condition.

Diagnostic Criteria for Corneal Ectasia

1. Clinical Examination

• Visual Acuity Assessment: Patients typically present with decreased visual acuity, which may not improve with glasses or contact lenses. This is often one of the first indicators prompting further investigation.
• Slit-Lamp Examination: A thorough examination using a slit lamp can reveal corneal thinning, irregular astigmatism, and other characteristic changes in the corneal structure.

2. Corneal Topography

• Computerized Corneal Topography: This is a critical diagnostic tool that maps the surface curvature of the cornea. In cases of corneal ectasia, topography will show a characteristic pattern of steepening and irregularity, particularly in the central or paracentral areas of the cornea. The presence of a "cone" shape is often indicative of ectasia[2][3].

3. Pachymetry

• Corneal Thickness Measurement: Pachymetry is used to measure the thickness of the cornea. In ectasia, there is typically a significant reduction in corneal thickness, especially at the apex of the corneal cone. This measurement helps differentiate ectasia from other conditions like keratoconus[1][4].

4. History of Eye Surgery

• Post-Surgical Changes: A history of refractive surgery, such as LASIK, can be a contributing factor to the development of corneal ectasia. Patients with a history of such procedures should be evaluated for signs of ectasia, especially if they report visual changes post-surgery[5].

5. Patient Symptoms

• Visual Disturbances: Patients may report symptoms such as blurred vision, ghosting, or halos around lights. These symptoms can be indicative of the irregular corneal surface associated with ectasia[1][3].

6. Exclusion of Other Conditions

• Differential Diagnosis: It is essential to rule out other conditions that may mimic corneal ectasia, such as keratoconus or post-surgical ectasia. This may involve additional imaging studies or consultations with specialists in corneal diseases[4][5].

Conclusion

The diagnosis of bilateral corneal ectasia (ICD-10 code H18.713) relies on a combination of clinical findings, advanced imaging techniques like corneal topography, and a thorough patient history. Accurate diagnosis is crucial for determining the appropriate management and treatment options, which may include corneal cross-linking or other interventions aimed at stabilizing the cornea and improving visual outcomes. If you suspect corneal ectasia, it is advisable to consult an eye care professional for a comprehensive evaluation.

Corneal ectasia, particularly bilateral corneal ectasia, is a progressive condition characterized by the thinning and bulging of the cornea, which can lead to significant visual impairment. The ICD-10 code H18.713 specifically refers to this condition. Treatment approaches for corneal ectasia vary based on the severity of the condition, the patient's age, and their overall health. Below, we explore the standard treatment options available for managing bilateral corneal ectasia.

1. Observation and Monitoring

In cases where corneal ectasia is mild and the patient is asymptomatic, a conservative approach may be adopted. Regular monitoring through comprehensive eye examinations, including corneal topography, is essential to track the progression of the condition. This approach allows for timely intervention if the condition worsens.

2. Contact Lenses

For many patients, specially designed contact lenses can significantly improve vision. Options include:

• Rigid Gas Permeable (RGP) Lenses: These lenses provide a smooth refractive surface that can help correct vision by compensating for the irregular shape of the cornea.
• Scleral Lenses: These larger lenses vault over the cornea and rest on the sclera, providing comfort and improved vision for patients with more advanced ectasia.

Contact lenses are often the first line of treatment for managing visual symptoms associated with corneal ectasia.

3. Corneal Collagen Cross-Linking (CXL)

Corneal collagen cross-linking is a minimally invasive procedure aimed at strengthening the corneal structure. This treatment involves applying riboflavin (vitamin B2) to the cornea and then exposing it to ultraviolet (UV) light. The process creates new bonds between collagen fibers, which can halt the progression of ectasia and improve corneal stability. CXL is particularly beneficial for patients with progressive keratoconus or corneal ectasia and is often considered when contact lenses are insufficient for vision correction[1].

4. Intacs (Intrastromal Corneal Ring Segments)

Intacs are small, crescent-shaped devices that are surgically implanted into the cornea to flatten its curvature. This procedure can improve visual acuity and reduce the need for contact lenses in some patients. Intacs are typically considered for patients with moderate ectasia who are not candidates for corneal transplantation[2].

5. Corneal Transplantation

In cases where corneal ectasia leads to significant visual impairment and other treatments are ineffective, corneal transplantation may be necessary. There are two primary types of corneal transplants:

• Penetrating Keratoplasty (PK): This involves replacing the entire cornea with donor tissue.
• Endothelial Keratoplasty (EK): This is a more recent technique that replaces only the innermost layer of the cornea, which can be beneficial for patients with endothelial dysfunction.

Transplantation is generally considered a last resort when other treatments have failed or when the cornea is severely compromised[3].

6. Pharmaceutical Interventions

In some cases, topical medications may be prescribed to manage symptoms associated with corneal ectasia, such as inflammation or discomfort. These may include:

• Anti-inflammatory drops: To reduce inflammation and discomfort.
• Lubricating eye drops: To alleviate dryness and irritation.

Conclusion

The management of bilateral corneal ectasia involves a multifaceted approach tailored to the individual needs of the patient. From conservative monitoring and contact lenses to more invasive procedures like corneal cross-linking and transplantation, the choice of treatment depends on the severity of the condition and the patient's specific circumstances. Regular follow-up with an ophthalmologist is crucial to ensure optimal management and to adapt treatment plans as necessary. If you or someone you know is experiencing symptoms of corneal ectasia, consulting with a specialist is essential for appropriate diagnosis and treatment planning.

[1] Medical Policy - Corneal Collagen Cross-linking
[2] Clinical Policy: Keratoplasty
[3] Corneal Transplant; Endothelial Keratoplasty