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68 Cards in this Set
- Front
- Back
How long does the epithelium take to heal if the basement membrane is damaged? If the BM is not damaged?
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Damaged = 6-8 days
Not damaged = 2-3 days |
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Corneal scarring occurs if...
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Interrupt bowman's membrane and below
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You see a narrow, crescent-shaped white line in the interpalpebral zone of the peripheral cornea, made of small, chalk-like flecks below the epithelium...
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Limbal girdle of Vogt
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You see bilateral small grayish-white flecks in the deep corneal stroma, in the interpalpebral limbal region. Endothelium is normal...
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Corneal farinata
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You see vertically linear striations in Descemet's membrane...
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Descemet's striae
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Your 10 year-old pt has small, circular dark areas projected into the endothelium from Descemet's...
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Hassal-Henle Bodies (Descemet's Warts)
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You see a polygon pattern of gray-white opacities separated by clear spaces at the level of Bowman's layer and the Basal epithelium; VAs are normal.
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Anterior Mosaic Shagreen (crocodile shagreen)
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You see a faint brownish-green deposition in the lower 1/3 of the cornea in the interpalpebral region...
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Deposits of iron - Hudson-Stahli line
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You see a yellow-white ring in the peripheral cornea, localized in the stroma; there is a clear area between the ring and the limbus...
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Corneal arcus (cholesterol deposition)
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You see dessication and corneal thinning at the base of a pterygium. Fluorescein pools in the affected area but does not stain...
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Dellen
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You see thinning of the superior cornea; the epithelium is intact, and NaFl pools but does not stain the area...
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Terrien's marginal degeneration
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You notice a hazy "swiss cheese" appearance across the interpalpebral zone of the cornea; the patient complains of decreased vision and FB sensation. You localize the lesion at the superficial cornea, at Bowman's layer...
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Calcific Band Keratopathy
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How do you Tx calcific band keratopathy?
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EDTA - removes calcium, then scrape gently. CAP eye if epithelium involved. If mild, use artificial tears. Can also use PTK.
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T/F - Salzmann's nodular degeneration is inflammatory.
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False - noninflammatory deposition of hyaline plaques between epithelium and Bowman's
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You see bluish-white spots around the pupillary area, which was preceded by phlyctenules...
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Salzmann's nodular degeneration
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You see a slowly progressive marginal ulcer; the eye is red, painful, and the ulcer appears to be spreading from a point in the periphery...
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Mooren's degeneration
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Mooren's degeneration in older people is (severe/benign), (unilateral/bilateral), and (hard/easier) to manage vs Mooren's in younger folks.
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Benign, unilateral, easier
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You see a small corneal opacity indicating the presence of a previous foreign body; the opacity contains calcium deposition...
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Coat's white ring - can also have iron deposit
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T/F - Dystrophies are assoc w/ an acquired loss of function assoc w/ aging, inflammation, infection, or systemic disease.
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False - Degenerations
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T/F - Sx in Map-Dot-Fingerprint dystrophies tend to decrease as the pt ages.
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False - Sx tend to get worse as the pt ages.
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Map-Dot-Fingerprint is due to areas of (thinning/thickening) of (epithelial/endothelial) basement membrane.
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thickening, epithelial
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Recurrent erosions due to poor hemidesmosomal or desmosomal attachments?
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Hemidesmosomal
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T/F - Recurrent erosions often associated w/ MDF dystrophy.
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True; also assoc w/ metaherpetic lesions, bullous keratopathy, exposure keratitis, trichiasis.
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Recurrent erosions are worst in the AM/PM?
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AM
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What is the first step in treating recurrent erosions? What's next after that? How long do you treat?
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Topical cycloplegic, then topical antibiotic, then pressure patch.
Once healing complete, use hyperosmotic drops for 6-8 wks Can also use stromal puncture or PTK |
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Your pt has a fragmented bowman's and basement membrane in the central cornea; the patient has reduced VAs, pain, FB sensation, redness, lacrimation...
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Reis-Buckler (Bowman's Layer dystrophy)
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Name the types of stromal dystrophies and their causes.
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1. Macular (Groenow Type II) - MPS deposits
2. Granular (Groenow Type I) - Hyaline deposition 3. Lattice (Biber-Haab-Dimmer) - Amyloid deposition |
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How do you Tx stromal dystrophies?
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CLs (create regular optical surface), penetrating keratoplasty, excimer laser
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What is involved with the Central Crystalline Dystrophy of Schneider?
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Corneal arcus, diffuse central corneal opacification, central crystalline deposits (needle-like), stroma is clear; occasionally assoc w/ hyperlipidemia (hence arcus)
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What is Bullous Keratopathy?
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Cornea swells and opacifies, which causes epith to have gaps then vesicles form (w/ fluid inside)
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What is characterized by abnormal production of descemet's collagen by the endothelium, which causes areas of thickening in the central cornea?
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Corneal guttata
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T/F - Gutatta is usually asymptomatic.
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True
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How do you Tx guttata?
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No Tx indicated, watch for signs of Fuch's dystrophy
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How does Fuch's endothelial-epithelial dystrophy develop?
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- Central gutatta spreads towards periphery
- Increase in K edema, see folds in Descemet's - Bullae form (Bullous keratopathy), which can rupture - Subepithelial layers can become vascularized and scarred |
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Decrease in VAs seen in (Guttata/Fuch's/Both)?
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Fuch's only
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T/F - No pain involved w/ Fuch's dystrophy.
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False - pain is involved when bullae rupture and loss of epith
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How do you Tx Fuch's dystrophy?
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NaCl, bandage CL, hair dryer, penetrating keratoplasty, DSEK, antiglaucoma meds to decrease IOP.
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Fragmentation of Bowman's membrane, resulting in thinning cornea is characteristic of...
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Anterior keratoconus
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T/F - Vertical striae or ruptures in Bowman's membrane occur in anterior keratoconus.
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False - vertical striae or ruptures in DESCEMET's
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Fleischer's ring occurs (early/late) in _____. It is a deposition of ___.
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Late, keratoconus, iron in basal epithelium around base of cone.
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Corneal thinning occurs (late/early) in keratoconus.
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Late
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Acute hydrops is associated with...
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Keratoconus - ruptured Descemet's membrane, resulting in corneal edema
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What is Munson's Sign?
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Bulging of eye thru lid when look down in Keratoconus.
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What is characterized by an anteriorly placed Schwalbe's ring, and the eye is otherwise normal?
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Posterior embrytoxin (an AC dysgenesis)
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What is characterized by iris strands (anterior synechiae) extending across the AC angle inserting onto a prominent Schwalbe's ring?
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Axenfeld's anomaly (an AC dysgenesis)
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You see a prominent Schwalbe's ring, anterior synechiae, hypoplasia of the iris stroma, and glaucoma...
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Reiger's anomaly (an AC dysgenesis)
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You see a corneal leukoma with an anterior synechiae, and the lens is displaced anteriorly, which results in a narrow AC. The patient also has a cleft lip...
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Peter's anomaly (an AC dysgenesis)
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Melanin deposits on the endothelium arranged vertically...
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Kruckenberg spindle
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Iron deposits at lower 1/3 of cornea...
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Hudson-stahli line
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___ deposits at the leading edge of a pterygium is characteristic of ____.
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Iron, Stocker's Line
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Your patient has Wilson's Disease, and has ____ deposits at the level of Descemet's; this is characteristic of...
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Copper; Kayser-Fleischer ring
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What medications cause whorl-like deposits on the cornea?
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Amiodarone, Phenothiazine, Chloroquine, Indomethacin
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T/F - Staph aureus keratitis can result in diffuse SPK.
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True - but can also cause a band of SPK across the inferior cornea
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T/F - Staph aureus keratitis can result in SEIs.
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True, occasionally
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What med is NOT indicated for Strep keratitis?
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Aminoglycosides
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Your patient presents with diffuse SPK, pseudomembrane, conjunctival hemorrhaging, and mucopurulent exudate. What is the causative agent?
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Strep
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What is the most common pathogen in CL related bacterial ulcers?
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Pseudomonas aerunginosa
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T/F - Diabetes can predispose a pt to corneal ulcers.
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True
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T/F - Using steroids can predispose a person to develop corneal ulcers.
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True
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You see a gray-white, infiltrated, central ulcer with a distinct border. What is the causative agent?
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Staph aureus
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You see a gray ulcer originating from where the patient scratched his eye; it appears to grow towards the center and it has indistinct borders. What is the causative agent?
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Strep pneumoniae
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Your patient complains of a grayish mark in the line of his vision which grew since he scratched his eye about 20 hours ago. Under slit lamp you see a ground glass texture, and a severe AC rxn. What is the causative agent? What is the next step?
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Pseudomonas aeuringinosa; hit hard w/ Fluoroquinolones.
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Your patient's bacterial ulcer has resolved, but there is still considerable inflammation. Is it appropriate to use steroids?
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Controversial, but okay as long as after 96 hrs.
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An ulcer developing over time with a distinct border is a good or bad sign?
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Good sign (indistinct border = worsening)
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Are oral antibiotics used in the first line of Tx for corneal ulcers?
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Must use topical ABs initially, but can use Monocycline or Doxycycline PO - has anti-inflammatory properties.
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What med is indicated for gram negative cocci causing an ulcer?
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Ceftriaxone
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What med is indicated for gram negative rod causing an ulcer?
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Tobramycin or Gentamycin
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What is Cefazolin used for?
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Tx Gram (+) cocci causing ulcer (staph, strep)
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