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308 Cards in this Set
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pt presents with red eyes, mp discharge, blurred vision, pain,& photophobia. Child is also complaining of earache...what am I?
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hyperacute bacterial conj
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etiology of hyperacute bacterial conj
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N. Gono - adults
H. Inf - kids both gram - |
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what lab finding are indicative of a bacterial infection?
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PMNs
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what type of bacterial conj is assoc with preaur.lymph?
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hyperacute bacterial conj
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trx of bacterial conjunctivitises..
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lid scrubs
ocular antibiotics |
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pt presents w/ red fornices & complains of mp discharge & lids sticking in the morning...what am I?
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acute bacterial conj.
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what symptoms differentiate chronic vs. acute bacterial conj?
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chronic - chronic burning
& blepharitis |
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in what type of bacterial conjunctivitis is blepharitis always found?
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chronic bacterial conj
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etiology of acute bacterial conj
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staph, strep - (+)
Haemophilus (-) |
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etiology of chronic bacterial conj
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staph (+)
Moraxella (-) |
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pt presents with redness in either canthi (angles) & complains of burning & tearing. what am I...
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angular blepharoconjunctivitis
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what signs to you expect to see with angular blepharoconjunctivitis?
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hyperemia
lid crusts fissures/sores of skin at canthi |
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etiology of angular blepharoconj
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staph A
Moraxella |
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trx of angular blepharoconj
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lid scrubs
topical antibiotics |
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acne rosacea keratoconj is assoc with what type of keratitis?
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SEI
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at what age do we mostly see acne rosacea keratoconj?
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30-50
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this is a chronic skin disease of sebaceous glands in skin and lids
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acne rosacea keratoconj
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trx of acne rosacea keratoconj
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oral antibiotics
lid hygiene refer to dermie |
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papillary conjunctivitises are most commonly seen in conjunctivitises caused by...
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bacteria
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pt presents w/ mild redness, watery discharge, and FBS; you find mild diffuse punctate staining, preaur. lymphadenopathy, & follicular conj. what does the pt have?
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nonspecific follicular conj
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etiology of nonspecific follicular conj
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multipe adenoviruses (similar to those causing flu)
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trx of nonspecific follicular conj
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decongestants
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what type of lab finding are indicative of a viral infection?
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lymphocytes and monoctyes
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are bacterial conjunctivitises usually unilateral or bilateral?
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bilateral
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what type of bacterial conjunctivitis is assoc with pain?
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hyperacute bacterial conj
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adenovirus 8 causes...
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EKC epidemic keratoconj
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this type of conj is considered to be a sick eye in a well body
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EKC epidemic keratoconj
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is EKC unilateral or bilateral?
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can be either...second eye is never as bad as first
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Explain the disease course of EKC
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Rule of 8's
-inoculation/incubation 8 days -Stage 1: 8 days of follicular conj, hyperemia, chemosis, & watery discharge -Stage 2: 8 days of PEK, SPK, photophobia, FBS, & pain -Stage 3: 16 or more days of SEI, blurred vision (stage of infection clearing; pt no longer contagious) |
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for how long is a pt with EKC severly contagious?
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2 weeks
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Is SEI more commonly found in EKC or PCF?
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EKC (it's rare in PCF)
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what condition is considered to be a sick eye in a sick body?
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PCF-pharyngoconjunctival Fever
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based on symptoms only, how can you differentiate EKC from PCF?
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PCF is assoc with pharyngitis & fever (sick body)
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is PCF unilateral or bilateral?
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begins unilaterally
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etiology of PCF?
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Adenovirus 3,4,7
Found in dirty swimming pools |
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Adenoviruses 3,4,& 7 are found where and cause...
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cause PCF; found in dirty swimming pools
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Enterovirus 70 is found where and causes...
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found in GI tract
causes acute hemorrhagic conj |
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this type of conj is aka 'Apollo disease'
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acute hemorrhagic conj
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pt presents with acute red eye - so red it appears to be bleeding; eye is scary looking and appears to be swollen shut... what type of conj is suspected?
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acute hemorrhagic conj
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this type of conj is assoc with bad N&V and diarrhea
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acute hemorrhagic conj
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is acute hemorrhagic conj contagious?
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highly
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trx of acute hemorrhagic conj
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cold compress
(no steroids) will clear in 2-3wks |
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this virus is considered to be the leading cause of infectious corneal blindness
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HSV (I and II)
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pt presents complaining of fever, sore throat, FBS, and has a watery discharge. You find vesicles on the lids, a follicular conj, and dendritic ulcers. What do I have...
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Primary HSV conj
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what is the characteristic sign of HSV?
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dendritic ulcers
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what lab test can be done to test for HSV?
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monoclonal antibody test
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trx of HSV conj
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antivirals
NOT STEROIDS! |
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poxvirus causes...
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molluscum contagiosum
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etiology of molluscum contagiosum
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poxvirus
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characteristic sign of molluscum contagiosum
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umbilicated lesion on lid
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pt presents with follicular conj, mild punctate staining, and a mass on the lid margin which appears to have a dimpled center. What am I...
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molluscum contagiousum
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trx of molluscum contagiousum
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referral or excision
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the leading cause of infertility in US is due to..
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chlamydia trachomatis
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prevelance of adult inclusion conjunctivitis
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1/300 - usually young adults
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most common cause of neonatal conj is due to
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chlamydia trachomatis (D-K)
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based on symptoms alone, how can we differentiate Adult Inclusion Conj from Trachoma?
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Trachoma - dec vision in end stages & pain
Adult Inclusion Conj - pts will have cervities, urethritis, and mild symptoms |
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Chlamydia causes corneal infiltrates...found superiorly or inferiorly?
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superiorly
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This organism causes what is known as "The Silent Epidemic"
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Chlamydia
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pt presents with bilateral red eye, mp discharge, & FBS. you find superior corneal infiltrates, superior pannus, follicles of upper tarsal and along the superior limbus. You also find a horiz line of white scar tissue under the upper lid. What am I...
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trachoma
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Arlt's line - a horiz line of white scar tissue under the upper lid - is a sign of what eye anomaly?
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trachoma
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characteristic signs of adult inclusion conj
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-PEK
-superior pannus - mixed papillary follic conj - Superior Corneal infiltrates |
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characteristic signs of trachoma..
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-Arlt's line
-superior follicles of the lids and limbus -Herbet's pits (depressions along superior limbus) - superior pannus |
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Herbet's pits...what are they and in what condition are they found?
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they are depressions along the superior limbus found in trachoma
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etiology of adult inclusion conj
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Chlamydia trachomatis (D-K)
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lab finding in case of adult inclusion conj
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neutrophils & basophilic inclusion bodies
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pt presents with adult inclusion conj and also has arthritis....what disease oughtta be suspected?
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Reiter's
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etiology of trachoma
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chlamydia trachomatis (A-C) damn 3rd world flies...
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pt presents complaining of extreme itching... what should be suspected?
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acute allergic conj or vernal conj
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lab findings in case of acute allergic conj
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eosinos
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trx of acute allergic conj
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remove allergen, antihistamine, topical steroids
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Type I hypersens rxs to insect bites, pollen, dust, animal dander, drugs, or food could cause what eye anomaly?
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acute allergic conj
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pt presents with red swollen eyes, and complains of itching and burning. you find stringy mucous discharge, chemosis, and an occassional dellen. what am I..
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acute allergic conj
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pt presents with GPC of the upper tarsus, with a milky mucous layer over top (mmmm...) pt complains of itching, burning, & FBS. What does the pt have?
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palpebral form of vernal conj
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upon examination, you find upper lid papillary conj & papillae along the upper limbus. you also find small white chalky opacifications along the upper limbus. pt complains of itching. pt is black 15yo male. what is it?
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limbal form of vernal conj
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etiology of vernal conj
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type I hypersens
pt Hx of eczema, hay fever, or asthma usually black male 10-20yo |
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trx of vernal conj
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cold compresses
move to colder climate antihistamines decongestants |
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lab finding in vernal conj
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eosinos
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differential diagnonsis of vernal conj...
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GPC due to CL wear
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Tranta's dots- superficial small chalky white concretions - are a sign of what eye anomaly?
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vernal conj
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etiology of drug hypersens rxn conj
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Type IV hyp (delayed)
to cosmetics, soaps, nail polish, CL Soln, or topical drops or ung (neosporin) |
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what drug is the #1 drug causing drug hypersens rxn conj?
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neosporin
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pt presents with red eyes, FBS, mild pain, water discharge, & photophobia. you find pannus, limbal follicles and inferior diffuse punctate staining. pt says he has been using his roommates eye drops to treat his dry eye. what does this pt most likely have?
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medicamentosa toxic rxn conj
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signs of GPC in CL wearer
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stringy mucous discharge
mild itching lens instability reduced CL wearing mild red eye giant papillae of uuper tarsus stringy milky white film over papillae bilateral |
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etiology of pinguecula
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hyperplasia of conj due to env irriatation (UV & wind)
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after following pt, you note a progressive increase in WTR astig. you suspect...
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pterygium
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pt presents with an obvious large hemorrhage on surface of eye..you suspect subconj hemorrhage...what can you tell the pt this is caused from and what will you do to trx it?
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due to valsalva's maneuvers
reassure pt it will go away like a bruise |
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what would you do in the case of recurring subconj hemorrhages?
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send pt for lab work investigating clotting probs in conditions such as anemia or leukemia
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'dysgenesis' is a ...
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congenital malformation due to a developmental disorder
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absence of the cornea
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cryptophthalmos (dysgenesis)
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cornea plana is ...
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flat cornea
(25-35D) Assoc with High hyperopia inherited trait |
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complications assoc with cornea plana
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diffuse stromal opacities
shallow anterior chamber iris coloboma ectopia lentis blue sclera glaucoma assoc with sclerocornea or microcornea |
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cornea diameter < 10 mm is known as..
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microcornea
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what dysgenesis dev abnormalities are assoc with Rubella?
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Microcornea
congenital glaucoma |
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microcornea complications...
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cornea plana
glaucoma coloboma leukoma congenital glaucoma corectopia microphakia |
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megalocornea
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corneal diameter > 13mm
-bilateral non-progressive 90% cases are sex linked |
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megalocornea differential diagnosis..
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megalocornea must be distinguished from corneal enlargement due to congenital glaucoma
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etiology of congenital glaucoma
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due to malformation of anterior chamber in early newborn to first few years of life (dysgenesis)
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you're baby pt has some corneal edema, megalocornea, & buphthalmos. parents say baby has great big beautiful eyes. you may be concerned of..
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congenital glaucoma
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differential diagnosis of congenital glaucoma...
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forceps delivery
corneal endo dystrophy interstitial keratitis Rubella |
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keratoglobus
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thin cornea (normally 0.45mm, kerato 0.30mm)creates outward buldging
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you notice a thick white centrally displaced bow shaped Schwalbe's line in your pt...you suspect...
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posterior embryotoxin
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is posterior embryotoxin seen more nasally or temporally?
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temporally
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in how much of the normal popl will we find posterior embryotoxin?
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15%
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upon gonio eval, you note iris strands extending across the angle and inserting into a prominent Shwalbe's line. you also not hypertelorism and your pt has Marfan's Syndrome. fortunantly, you don't find elevated IOPs. what am I...
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Axenfel's Anomaly
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pt has Lowe's Syndrome and juvenile glaucoma. you notice abnormal iris processes inserting into Shwalbe's Ring. What am I...
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Axenfeld's syndrome
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what is the difference btw Axenfelds syndrome and Axenfelds Anomaly?
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Anomaly only refers to anatomical features, syndrome refers to anatomical features + glaucoma
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what Ocular Defect will we commonly find in all Anterior Chamber Cleavage Syndrome Dysgenesis?
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glaucoma
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what % of pts with Axenfelds anomaly will dev glaucoma?
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50%
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assoc systemic anomalies of Axenfelds Anomaly/Syndrome..
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hypertelorism
congenital glaucoma Marfan's Lowe's Pierre-Robin Hallerman-Strieff |
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Autosomal dominant disorder characterized by a prominent Schwalbe's ring, iris strand attachments, iris hypoplasia, & corectopia
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Reiger's Anomaly/Syndrome
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pt presents with corectopia, pseudopolycoria, and hyaline opacities in Descemet's...what am I
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Reiger's anomaly (syndrome if pt has glaucoma)
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skeletal anomalies, chromosomal anomalies, and Down's syndrome are assoc with what ocular anomaly?
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Reiger's anomaly/syndrome
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what percentage of Reiger's pts will dev glaucoma?
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60% age 5-30
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upon eval you find a localized crater on the posterior corneal surface (concavity toward ant chamber)of one eye only
you find no inflamm and pt does not complain of any vision loss. what do you suspect? |
circumscribed posterior keratoconus
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Fleisher's ring is a defect found in what ocular anomaly?
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circumscribed posterior keratoconus
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your pt has a broad, flat bridge, a bull neck, and stunted growth. you note a thinning of the pts cornea & no inflamm. you suspect...
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circumscribed posterior keratoconus
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anterior displaced lens, resulting in shallow ant chamber and peripheral ant synechiae. you note glaucoma and microphthalmia. pt has cleft plate. you also note posterior cloudy cornea & leukoma. what am i..
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peter's anomaly
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absence of cornea and pupil
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sclerocornea
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defn of degeneration...
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chem elements of corneal tissue is converted to some abnormal less functional form
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Primary degenerations vs secondary degenerations...
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primary - no known cause
secondary - of known cause |
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etiology of spheroid central/diffuse degeneration
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non-heriditary
Uv/wind primary - maybe age/hereditary secondary - due to ocular dz or climatic insult |
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spheroid central/diffuse degeneration is aka
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climatic degeneration
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pt presents with spherical brown oil drops at 3 and 9:00. you suspect...
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spheroid(climatic)central/diffuse degeneration
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pt comes in with a small granular white oval ring around the location of a removed foreign body...this is called...
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Coat's White Ring (central/diffuse degeneration)
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pt presents with bluish superficial nodules arranged in a circle around the pupil area. pt has a history of recurrent Herpes. you suspect...
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Salzmann's central/diffuse degeneration
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you find band shaped deposits in Bowman's area separated from the sclera by a lucid interval. the deposits have a swiss cheese appearance. pt also has hypercalcemia. you suspect...
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band keratopathy
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pt presents with dense yellow opacities. you suspect..
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lipid (central/diffuse) degeneration
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etiology of Terrien's marginal degeneration
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unknown
slowly progressive uncommon marginal thinning usually young males |
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is Terrien's found on the inferior or superior cornea?
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superior
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t/f terriens is considered an ulcer b/c it's painful
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false - no pain, no ulcer
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your young male pt has progressing ATR astig...you suspect..
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Terrien's Marginal Degeneration
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Differential of Terrien's Marginal Degeneration
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PMD pellucid marginal degen.
PMD appears clear, no veiling, & thinning of inferior cornea vs. Terrien's which has marginal opacities, veil cloth like appearance, and superior cornea involved |
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pt presents with bilateral superior marginal opacities. you see a veil like cloth appearance which looks like early arcus. you suspect..
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Terrien's Marginal Degeneration
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what is the difference btw Terrien's marginal degeneration and Mooren's ulcer?
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Terrien's is no pain, no inflamm, not an ulcer
Mooren's is... |
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your old pt presents with a unilateral painful inflammed eye. you notice the case history reads that the pt has a history of hepatitis. what do you suspect?
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(benign) Mooren's ulcer (marginal degeneration)
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etiology of Moorens ulcer (marginal degeneration)
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possible immune rxn, assoc with hepatitis
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diff btw the benign form and severe form of Mooren's ulcer (marginal degeneration)
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benign: older, unilateral, better response to trx
severe: young, bilateral, worse response to trx |
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differentials of Mooren's ulcer(marginal degeneration)
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*Terrien's Marginal degen: terriens is not inflamm, not painful, not an ulcer (Mooren's is)
*Staph Marginal Ulcer: -Mooren's is assoc with Hepatitis, Staph is not... |
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are pingueculas more common nasally or temporally?
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nasally
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trx of pingueculas
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steroids if inflamm
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what is the difference btw phlyctenules and pterygium?
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phylctenules are painful, pterygia aren't
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Stocker's line is an indication of...
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it's a pigmented line seen prior to the growth of a pterygium
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an idiopathic thinning of cornea in elderly in the area of arcus senilus is called..
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furrow degeneration
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this senile degeneration consisting of salt depositions is found in 80% of the popl > 40yo
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White Limbal Girdle of Vogt
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pt presents with a white chalky opacity at 3 & 9 in Bowman's. you see no vascularization, no inflamm, and pts vision is not affected. the opacity seems to be arc shaped and has a swiss cheese appearance. what am I?
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white limbal girdle of vogt (senile degeneration)
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senile degeneration is defined as...
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flattening of vertical meridian
thinning of periphery lack of luster |
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etiology of anterior crocodile shagreen
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unknown
60-80yo |
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pt presents with bilateral anterior cornea mosaic pattern opacities separated by clear tissue. you note the cornea is hazy but the vision is not affected. you suspect...
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anterior crocodile shagreen
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a bilateral mosaic pattern of deep stroma & Descemet's...
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posterior crocodile shagreen
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etiology of corneal farinata
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autosomal dominant
due to a senile change |
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pt presents with small grayish dusty flecks in stroma, no vascularization, and no visiual problems. you suspect..
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corneal farinata (senile degeneration)
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differential diagnosis of corneal farinata
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pigment on posterior cornea which could indicate pigmentary glaucoma
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cholesterol deposition in limbal cornea is known as...
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arcus senilus (senile degeneration)
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etiology of arcus senilus
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due to abnormal bld lipids
35-40yo very common |
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in which layer of the cornea is arcus senilus located?
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begins in Descemet's, progresses to Bowman's
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is arcus deposition of lipids found on the inferior or superior cornea or both?
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begins inferior, moves superiorly to form entire ring
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upon examination, you note a perilimbal whitish hazy opacity. you do not notice any corneal thinning, no inflamm, no staining, and no pain. you suspect...
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arcus senilus (senile degen)
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a yellow/brown horiz line formed by iron deposition due to shearing force of lids...
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Hudson Stahli line (a senile degeneration)
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diff btw hudson stahli line and fleisher's ring... other than it's shape!
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line- iron due to shearing force of lids
ring-iron around base of keratoconic cone |
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dry spots on cornea due to incomplete blinking...
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dellen (a senile degeneration)
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defn of dystrophies...
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hereditary
tend to start early in life, though age is not a factor men = women (x Fuchs) |
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anterior membrane dystrophies involve which layers of the cornea?
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epi, bm, bowman's
(cosists of map-dot, Meesman's, Reis-Buckler's, Grayson-Wilbrandt, and Reccurent Erosions) |
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the most common anterior membrane dystrophy...
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mapdot fingerprint dystrophy
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mapdot fingerprint dystrophy is aka...
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-Cogan's microcystic dyst.
-Non-traumatic recurrent erosion -EBMD-epi BM disorder |
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what sign is indicative of mapdot fingerprint dystrophy?
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monocular diplopia
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monocular diplopia is indicative of...
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mapdot fingerprint dystrophy
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pt presents with bilateral microcyts. you note ghosting, a reduced TBUT, and negative staining. pt complains of painful FBS and you suspect recurrent erosions. what am I?
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mapdot-fingerprint dystrophy
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etiology of mapdot-fingerprint dystrophy
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not-genetic
15-20% popln 30-70 yo may be a degeneration |
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trx of mapdot-fingerprint
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hypertonic drops
lubricants epi scraping pressure patching soft CLs |
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Meesman't Juvenile Dystrophy is aka
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Stocker Holt dystrophy
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t/f mapdot fingerprint pts are often asymmptomatic
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true - symptomatic only when recurrent erosions or if microcysts are papillary, then will have decreased VA
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etiology of Meesman's Juvenile dystrophy (Stocker Holt)
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inherited dominant
first few mos of life runs in the family |
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signs of Meesman's Juvenile Dystrophy...
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bilateral
symmetrical central cornea opacity blebs with retro, gray round opacities with direct can cause erosions |
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you note a bilateral symmetrical central corneal opacity that appears as a patchy ring-like honeycomb pattern in Bowmans. I have...
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Reis-Bucklers ring shaped dystrophy
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in which of the cornea do we find Reis-Bucklers ring shaped dystrophy?
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Bowman's
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etiology of reis-bucklers ring shaped dystrophy
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rare
autosomal dominant first few years of life onset |
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symptoms of a five year old with reis-bucklers ring shaped dystrophy
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recurrent erosion
conj injection & redness episodes of severe pain photophobia |
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symptoms of a thirty year old with reis-bucklers ring shaped dystrophy
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erosions infrequent
VA very affected decreased corneal sensitivity |
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etiology of Grayson-wilbrandt dystrophy
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similar to reis-bucklers
rarely see recurrent erosions onset at 10yo |
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pt presents with an irregular epi surface, normal corneal sens, and a gradual dec in VA. you note gray white opacities in Bowman's. you suspect...
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grayson wilbrandt dystrophy
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differences btw Reis-Buckler's ring shaped dystrophy & Grayson-Wilbrandt dystrophy...
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*Reis = recurrent erosion & decreased corneal sens
*Grayson=no erosions, no dec in corneal sens **both are found in Bowman's! |
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etiology of granular stromal dystrophies...
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autosomal dominant
onset in early years of life HYALINE opacities |
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you note bilateral symmetrical central sharply demarcated dense milky opaque opacities that look like bread crumbs...what am I?
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granular stromal dystrophy
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most common stromal dystrophy...
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lattice stromal dystrophy
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etiology of lattice stromal dystrophies...
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autosomal dominant
AMYLOID opacities |
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symptoms of a pt with lattice stromal dystrophy...
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corneal erosions & pain from 0-10yo
central stromal opacification & dec in VA by 40-50 No red, no inflamm |
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differentials of lattice stromal dystrophy
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-ghost vessels due to neo
...lattice is central, ghost will go out to limbus... -posterior amyloid degeneration (amyloid deposits in cornea) |
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etiology of macular stromal dystrophy
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autosomal recessive
MUCOPOLYSACCHARIDE opacities |
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at what point is keratoplasty indicated in the case of macular stromal dystrophy?
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when VA becomes < 20/50
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pt presents with bilateral central poorly demarcated large gray opacities in stroma. you find haziness btw the opacities and the pts VA has decreased over time. you find no irritation, no inflamm, and no redness. I am...
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macular stromal dystrophy
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etiolgy of fleck stromal dystrophy
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autosomal dominant
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is vision affected in pts with fleck stromal dystrophy?
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no
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pt presents with bilateral well demarcated small round gray donut-like opacities. what am I?
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fleck stromal dystrophy
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is vision affected in case of primary pre-descemet dystrophy?
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no
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you see something that looks like farinata, but you note that there are more opacities and they're larger than what you'd expect to find with farinata. what could it be?
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primary pre-descemet dystrophy
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there are six types of opacities possible to find in primary pre-descemet's dystrophy. what are they?
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dendritic
boomerang circular comma linear filiform |
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corneal guttata is what type of dystrophy?
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endothelial dystrophy
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pt presents with a decreased VA. upon examination, you find what looks like a beaten metal appearance of Descemet's. what am I...
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corneal guttata (endothelial dystrophy)
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corneal guttata found in conjunction with edema is called...
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Fuch's endothelial dystrophy
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guttata found in peripheral cornea are called...
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Hassal Henle Bodies
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your pt complains that their vision is blurry for a few hours in the morning after they wake up. they also complain of attacks of sever pain & glare. you suspect...
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Fuch's endothelial dystrophy (due to the corneal edema)
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trx of Fuch's endothelieal dystrophy
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hypertonic drops
one of the leading indications for keratoplasty |
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etiology of Fuch's endothelial dystrophy
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guttata pushes inward into anterior chamber, displacing the endo & causing edema
-autosomal dominant -female > male age 40-60 post menopausal |
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is Fuch's endothelial dystrophy more common in men or women?
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women (esp 40-60; post menopausal)
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bullous keratopathy is assoc with what ocular anomaly?
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Fuch's endothelial dystrophy
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what are the three stages of Fuch's endothelial dystrophy?
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1. guttata, endo pigment
2. edema, ground glass appearance, Descemet's folds, dew drop pattern w/ bullae (lg cysts) 3. grey swirling sheets of scar tissue & neovasc. |
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is vision affected in case of posterior polymorphous dystrophy?
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no
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posterior polymorphous dystrophy affects which layer of the cornea?
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Descemet's (it's an endothelial dystrophy)
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pt presents with bilateral, asymmetrical, multi-shaped opacities in Descemet's. the opacities seem to be surrounded by gray halos & are randomly scattered across the cornea...you suspect..
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posterior polymorphous dystrophy (endothelial dystrophy)
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etiology of posterior polymorphous dystrophy
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born with (early onset)
autosomal dominant usually non-progressive |
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in what dystrophy might we find opacities aligned like "train tracks"?
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posterior polymorphous dystrophy (choo...choo...)
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of all the dystrophies, degenerations, and dysgenesis, which is the only one specific anomaly that is autosomal recessive (vs dominant?)
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macular stromal dystrophy
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Chandler's syndrome, essential iris atrophy, and Cogan-Reese iris nevus syndrome (all together? are called...
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iridocorneal endothelial syndrome (ICE)
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of all the dystrophies, degenerations, and dysgenesis, which specific anomaly is found UNILATERALLY?
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ICE - iridocorneal endothelial syndrome
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pt presents with unilateral endo abnormalities, glaucoma, iris atrophy, and you note a few iris nevi...what am I?
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Iridocorneal endothelial syndrome (ICE)
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what does ICE iridocorneal endothelial syndrome look like?
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looks like guttata, but it's pseudoguttata...damn lying guttata!
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where on the cornea is corneal verticillata located?
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where the hudson-stahli line would be...
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corneal verticillata is aka
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whorl or vortex keratopathy
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etiology of corneal verticillata...
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1. Favre's (?) disease
-lipid storage disease; genetic or dystrophic 2. Drug Related -Amiodarone or chloroquine - effects stem cells (in limbus - which migrate toward center. in this case, they're pigmented and create a whorl or vortex pattern) |
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trx of corneal verticillata
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refer/inform PCP
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5 types of keratitis:
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PEE
PEK SPK SEI Filamentary |
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this type of keratitis consists of slighly depressed gray spots that stain brightly with fluor but poorly with Rose B.
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PEE punctate epithelial erosions
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this type of keratitis consists of transparent 'spots', which are hard to see with direct illum.
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PEE punctate epithelial erosions
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this type of keratitis consists of gray opaque spots which are seen easily with direct illum. The spots stain brightly with Rose B, but poorly with Fluores.
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PEK punctate eipthelial keratitis
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____ stains brightly with Fluor., while ____ stains brightly with Rose B.
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PEE-Fl (pee is the same color as fluorescein!)
PEK-RB |
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this type of keratitis is often found in conjunction with PEE
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PEK punctate epithelial keratitis
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this type of keratitis is the Hallmark of a Viral Infection
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PEK - punctate epithelial keratitis
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this type of keratitis is often misused for PEE and is a term used to describe a specific type of keratitis described by Thygeson..
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SPK (superficial punctate keratitis)
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this type of keratitis is composed of leukocytes from limbal vessels (fluffy)
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SEI - punctate subepithelial infiltrates
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This type of keratitis is indicative of Active Inflamm
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SEI-punctate subepithelial infiltrates
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this type of keratitis results from PEE or PEK
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SEI-punctate subepithelial infiltrates
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this type of keratitis is characterized by gray white opacities in stroma, usually superficial stroma..
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SEI - punctate subepithelial infiltrates
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this type of keratitis is composed of mucous threads & hypertrophied epi cells attached to abnormal epi
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filamentary keratitis
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this type of keratitis shows slit lamp appearances of coma shaped opacities...
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filamentary keratitis
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causes of filamentary keratitis
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KCS
SLK neurotrophic Herpes Zoster Recurrent Erosions Eye Patching |
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etiology of abrasions causing keratitis (usually PEE)
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CL's
trauma FB Fingernails UV burns Chemical Burns |
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trx of abrasions
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remove CL or FB
non-preserved lube drops if large, antibiotic |
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trx of recurrent epi erosions
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lubricants
CL bandage antibiotic ung pressure patching hypertonic soln. |
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etiology of Thygeson's keratitis
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unknown
possible but rare - viral |
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Thygeson's is what type of keratitis?
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SPK
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trx of Thygeson's keratitis
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lube drops
topical steroids |
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where on cornea do we find Thygeson's keratitis?
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centrally
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pt presents with a severe FBS & complains of severe burning. you note a bulbar conj corridor redness, fine PEK, papillary rxn of tarsus, and a cloudy superior cornea. you suspect...
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SLK (superior limbic keratoconj)
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etiology of SLK
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unknown
female > male possibly due to Hx of Graves |
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trx of SLK
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heals without scarring
chronic 1-10year course topical steroids |
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what type of keratitis is noted in 50% of pts with SLK?
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filamentary keratitis
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what part of cornea will you find staph/toxic SPK?
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Inferior cornea
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pt presents with complaints of sandy irritation, photophobia, dryness,& FBS. you find SPK on inferior cornea, PEE, papillary conj, and vessel dilation from 4 to 8:00. you suspect...
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staph/toxic SPK
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etiology of staph/toxic SPK
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20% pts have a form of staph-blepharo-kerato-conjunctivitis
-staph infection/staph toxins |
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trx of staph/toxic SPK
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lid scrubs
non-preserved lube antibiotic ung |
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pt presents with a sectored redness, FBS, pain, and photophobia. you note an oval infiltrate near the limbus, separated from the conj by a clear strip of cornea. you suspect...
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staph marginal infiltrate
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lucid interval is indicative of ...
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staph marginal infiltrate
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will you find staining in case of staph marginal infiltrate? why or why not?
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no, b/c overlying epi is intact
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etiology of staph marginal infiltrate
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worse rxn to staph toxins than staph/toxic spk
-not an active infection, its an antigen-antibody rxn to Staph exotoxins (secondary to blepharitis in CL pts) |
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trx of staph margingal infiltrates
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steroids to trx inflamm (must rule out marginal herpetic keratitis first!)
lid hygeine |
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are staph marginal infiltrates usually unilateral or bilateral?
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unilateral
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what is the diff btw staph marginal infiltrates and staph marginal ulcers?
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infiltrates - overlying epi still intact (no staining)
ulcer - overlying epi is dmgd (will stain) |
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what is the difference btw an ulcer and an abrasion?
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ulcer is epi breakdown with infiltrate
abrasion is epi breakdown without infiltrate |
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are phlyctenular ulcers usually unilateral or bilateral?
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unilateral
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what is a characteristic symptom of phlyctenular ulcers?
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severe photophobia
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phlyctenule vs pinguecula
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pinguecula doesn't progress onto cornea; phlyctenule does
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t/f in the case of phlyctenular ulcers, you will see a corneal lesion near limbus with a lucid interval
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false - NO lucid interval
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etiology of phlyctenular ulcers
|
Type IV delayed hypersens to re-exposure to Staph (or Tb - classic cause)
-usually mainly younger females (children/teens) |
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what systemic disease should we be concerned of when we see a pt with recurring phlyctenular ulcers?
|
Tb
|
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phlyctenular ulcers vs pterygium
|
pterygium is usually nasal & no pain/ phlyctenular ulcer is painful
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phlyctenular ulcer vs marginal infiltrates
|
marginal grows deep in stroma, growing outward...phlyctenule is more superficial growing out from conj.
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is herpes simplex keratoconj usually unilateral or bilateral?
|
UNILATERAL
|
|
|
5 disease entities of HSV keratoconj
|
1.primary epi disease
2.recurrent epi disease 3.metaherpetic disease 4.disciform keratitis 5.infiltrative stromal disease |
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which layer of the cornea is affected in the case of metaherpetic disease?
|
bowman's - causing recurrent erosions
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|
|
etiology of disciform keratitis
|
Type IV hypersensitivity to dead Herpes simplex viral particles. *characterized by a round swollen lesion in stroma
*can trx with steroids - not active infection. |
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etiology of infiltrative stromal (herpetic) disease
|
-active invasion & destruction of stroma
-cornea becomes opque-like due to repeated herpes attacks -necrosis of stroma due to liberated digestive enzymes from dead wbc's |
|
|
trx of infiltrative stromal (herpetic) disease
|
must use steroids to trx
good indication for corneal transplant |
|
|
Rogue Herpes
|
peripheral dendritic ulcers (on limbal area)
|
|
|
Staph Marginal ulcer vs herpes simplex (rogue)keratoconjunctivitis
|
rouge means herpes dendritic ulcer in limbal area
-staph marginal ulcer won't stain with rose B., herpes will -dendrites appear with herpes, not with staph marginal ulcer - if not sure, wait 3 days: *if staph, will look better *if herpes, will look worse (don't use steroids till you're sure it's not herpes!) |
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pt presents with flu-like symptoms, unilateral lid edema, ptosis, water discharge, and blurred vision. you notice pt has vesicles on scalp, upper lid, and side of nose. you suspect..
|
herpes zoster ophthalmicus (the great mimicer)
|
|
|
etiology of herpes zoster ophthalmicus
|
-reactive varicella virus
(shingles) -usually in immunocomp.elderly |
|
|
how would we differentiate HSV keratoconj from Herpes zoster ophthalmicus?
|
Zoster will have vesicles all over face; HSV won't
|
|
|
trx of herpes zoster ophthalmicus
|
topical steroids (won't spread b/c it's not an active infection - it's an immune response)
Therefore, topical antivirals are completely ineffective! |
|
|
an immunological rxn to Treponema Pallidum
|
Congenital Syphilitic Interstitial Keratitis
|
|
|
etiology of congenital syphilitic interstitial keratitis
|
unknown, but presumed to be immunological rxn to Treponema Pallidum
5-20yo history of severe childhood ocular inflamm that lasted several months |
|
|
is congenital syphilitic interstitial keratitis unilateral or bilateral?
|
bilateral 80% time
|
|
|
pt presents complaining of pain and lacrimation. upon examining, you finld bilateral infiltrates, KPs, miosis, & a "salmon patch" look to cornea. pt has a history of severe ocular inflamm that lasted for several months. you suspect...
|
congenital syphilitic interstitial keratitis
|
|
|
etiology of atopic dermatitis (eczema)
|
-predispositional or hereditary hypersens.
-pts usually have personal or family Hx of allergies, asthma, or hay fever |
|
|
where is atopic dermatitis located?
|
diffuse superior
|
|
|
trx of atopic dermatitis
|
topical steroids and antihistamines
|
|
|
etiology of vernal keratoconj
|
uncommon
chronic allergic disorder more common in warm climates more common in prepube males (3:1) more common in pts w/ allergies (50%) |
|
|
stimuli that cause or worsen an ulcer
|
immune deficient
old age diabetics alcohol prolonged steroid use ruptured bullae chemo pts previous herpes KCS daily EW CL wear corneal abrasion FBs erosion penetrating orgs (N.gono, Corynebac diphtheria, H. inf., strep pneum. |
|
|
trx of bacterial ulcers
|
aggressive
fortified antibiotics quinolones for 10days -2wks |
|
|
sequela of bacterial ulcers
|
perforation
loss of eye descemetocele small scar large leukoma shrunken/degenerative eye ant/post synechiae cataract glaucoma |
|
|
describe appearance of ulcer caused by staph Aureus
|
gray-white infiltrate
round-oval central distinct borders |
|
|
describe appearance of ulcer caused by strept pneumoniae
|
dirty gray ulcer
spreads in a snake-like fashion overhangs margins hypopyon |
|
|
describe the appearance of an ulcer caused by pseudomonas aeruginosa
|
epithelial ulcer
dense infiltrates necrosis green mucopurulent forms ring abscess rapid evolution into perfortion & eye loss (48hrs) |
|
|
what type of bacterial ulcer is characterized by rapid revolution - leading to perforation and loss of eye possible within 48 hours?
|
pseudomonas aeruginosa
|
|
|
etiology of psuedomonas aeruginosa bacterial ulcer
|
endotoxin produced by the org - it's a protease that's proteolytic against corneal collagen
|
|
|
what type of bacterial is staph aureus and where is it found normally?
|
gram + cocci
skin, nose, conj |
|
|
what type of bacteria is strept pneum. and where is it found normally?
|
gram + diplococci
resp tract |
|
|
what type of bacteria is pseudomonas aeruginosa and where is it found?
|
gram - rod
found in fluorescein, CL cases, eye makeup, or resulting from corneal trauma |
|
|
bacterial ulcers caused by ____________ account for the most common cause of CL related ulcerations
|
pseudomonas aeruginosa
|
|
|
bacterial ulcers in alcoholics, diabetics, and debilitated pts are most likely caused by...
|
moraxella liquefaciens
|
|
|
pt has a corneal abrasion/ulcer... under what conditions would you suspect that it was caused by a fungal origin?
|
when cornea has been abraded by:
any type of vegie matter (tree, branch, shrub) post steroid trx poor response to antibiotics |
|
|
etiology of fungal caused corneal ulcers
|
tropical climates
candida fusarium cephalosporium asperiguillus |
|
|
trc of fungal caused corneal ulcers
|
antifungals (natamycin)
(steroids make it worse!!!) |
|
|
what type of smear/clx/agar do we use to test for fungal presence?
|
Sabouraud's agar
|
|
|
pt presents with a white ring shaped infiltrate & is complaining of a lot of eye pain. you find dendriform lesions. what might you suspect?
|
acanthamoeba keratitis
(it mimics stromal disciform herpes) |
|
|
what type of infectious keratitis mimics stromal disciform herpes?
|
acanthamoeba keratitis
|
|
|
etiology of acanthamoeba keratitis
|
common freshwater parasite
found in hot tubs, dirty pools, saliva, tap water, nonpreserved saline solns (homemade) |
|
|
trx of acanthamoeba keratitis
|
no very efficacious agents
pt ed on CL hygiene neosporin corneal transplant |
|
|
acanthamoeba grows readily on what type of agar?
|
bld agar
|
