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344 Cards in this Set

  • Front
  • Back
The ______ is the most common site of anterior segment pathology.
eyelid
Acute ulcerative/staphylococcal blepharitis
Presents with
a. brittle, crusty, yellowish scales along the lid margins (collerettes)
b. Lid margins are tender and red
c. A secondary keratoconjunctivitis with superficial punctate keratitis and infiltrates is commonly present at the 2-, 4-, 8-, and 10-o’clock positions.
Acute ulcerative/staphylococcal blepharitis treatment
d. Treatment consists of general lid hygiene, including warm compresses and lid scrubs; antibiotic ointments are applied at least twice per day; if SPK and infiltrates are present, an antibiotic/steroid combination may be utilized; follow-up is in 2 weeks.
Seborrheic/Squamous Blepharitis
Presents with
greasy, oily, dandruff-like scales along the lid margins
2. Patients may be asymptomatic or may complain of burning because of acidic tears and fast break-up time of the tear film
3. Seborrheic dermatitis may be present
Seborrheic/Squamous Blepharitis
Treatment
Treatment consists of generalized lid hygiene and control of any seborrhea with shampoos, e.g., Sebutone, Sebulex, Fostex, selenium sulfide, or zinc pyrithione. Tear film may be affected and require treatment. Antibiotic ointments or antibiotic/steroid are indicated if the patient manifests active inflammation
5. Dermatology consult if the other skin condition warrants
6. Follow-up in 2/4 weeks
Mixed blepharitis is
1. A chronic seborrheic blepharitis with superimposed acute bacterial involvement
2. Treatment consists of short-term treatment of the acute process and long-term treatment of the chronic process using shampoos and lid hygiene
___________ is a mite that lives in the hair follicles and sebaceous glands of almost everyone over the age of 50
It Presents as an acute blepharitis with intense itching in _________
Treat with ____________
Demodex Follicularum

the morning

lid hygiene and ointment, 1% Mercuric Oxide, at bedtime to entangle the mites
this is presence of lice in the lashes
It Presents clinically with _________ at the base of the lashes and intense itching and irritation
Treat with
Pediculosis Palpebrum

brownish black nodules

Kwell or Rid shampoos and yellow oxide of mercury ointment on the lid margins
Treat other family members
_________ is the loss of eyelashes or eyebrows.
Madarosis
Thickening of the eyelids due to long term ulcerative blepharitis is known as
Tylosis
Meibomianitis treatment
Treatment with hot compresses QID, gland expression, and antibiotic ointment to the lid margins
This is a sterile granulomatous inflammation of a meibomian gland or a duct of a meibomian gland
It Presents as a nonpainful, palpable localized lump
Treatment includes:
chalazion

vigorous hot compresses and steroid ointment or intralesional injection of steroid, e.g., triamcinolone if the chalazion is small; if the lesion is larger than 10mm, excision. Most resolve without surgical excision
External Hordeolum is
An acute abscess infection of a lash follicle or a gland associated with a lash follicle
B. Unilateral pain, redness, and swelling along the lid margin pointing toward the skin of the lid
T/F An external hordeolum will cause patient to be in pain
T
____________ is An acute abscess infection presenting as a focal area of pain, redness, and swelling of the meibomian gland
There may be preauricular node involvement
C. Observe for cellulitis
D. Treatment consists of
Internal Hordeolum

hot compresses QID and antibiotics, Polysporin, Tobramycin Q3H, Ciloxan, Ocuflox
E. Follow-up in 3-5 days and observe for cellulitis
An acute diffuse spread of inflammatory cells and debris through the loose tissue of the lid
Preceptal Cellulitis
Orbital Cellulitis is a
very serious, potentially life-threatening inflammation that proceeds behind the _________
Patient will have marked ________
C. Impaired ocular _____
D. Marked pain and fever
Treatment includes: T
orbital septum

proptosis

motility

he patient should be hospitalized and treated with IV antibiosis
___________ is ayellow-gray, crusty, often weeping lesion of the skin
Impetigo
Acyclovir Zovirax
dosage
HZ: 800mg 5 X D X 7D
HS: 400mg 5 X D X 7D
Valacyclovir Valtrex dosage
HZ: two 500mg tabs tid X 7D
HS: 500mg tabs tid X 7D
Famciclovir Famvir dosage
HZ: 500mg tid X 7D
HS: 500mg bid X 7D
Molluscum contagiosum is a:

It may shed active ____ into the cul-de-sac, causing a follicular conjunctivitis
3. Short-term treatment consists of
1. A white, round, waxy, noninflamed, umbilicated lesion

2.virus

3.curement; permanent treatment consists of surgical removal
___________ is a chronic, idiopathic skin disorder resulting in a facial flush and sebaceous gland hypertrophy
2. 30% of the cases present with blepharokerato-conjunctivitis
3. Treat with systemic
Acne rosacea

tetracycline 250 mg QID
Catarrhal
is characterized by a
white, stringy discharge
b. May be caused by allergic conjunctivitis
Papillae are
a. Nodular elevations with central vascular tufts
This disease:
1. Occurs over 2-3 days
2. Eyes took meaty red with a mucopurulent discharge
3. Lashes matted in the morning
4. Papillae may be present
5. Rule out chlamydia infection
6. Treat with lid hygiene, irrigation, warm compresses, and antibiosis
7. Follow-up in 5 days
Bacterial conjunctivitis
This type of conjunctivitis occurs in minutes to hours in type 1 ypersensitivty reactions and in hours to days in type 4 hypersensitivty reactions. Its hallmark is ITCHINESS
Allergic conjunctivitis. Papillae are usually present. Treat with an NSAID/ antihistamine, mast cell stabalizar
________ is a new growth or malignant tumor that occurs in the epithelial tissue. May infitrate adjacent tissues or give rise to metastasis
carinoma
A lesion that is flat is known as a
macule
A lesion that has superfiical elevation is known as a
papule
______ means having a broad base, directly attached to the skine
sessile
Penduculated means
having a stalk
A hardened cyst is called
indurated
An abrasion involving the epidermis is called
excoriated
Eccorinc hidrocytoma is a cystic tumor of a
sweat gland
A cystic tumor of a gland whose secretiosn are made up of component cells of the gland is know nas ___ hidrocytoma
aprocrine
T/F Syringomas are harmless sweat duct tumors
T. They are often found in clusters on eyelids but can be elsewhere on body.
A moveable, papable, smooth round mass that appears in the superior temporal aspect of the lid is known as a
dermoid

must be surgically removed
T/F Papilloma are almost always lobulated in appearance
T

it is a growth consisting of epithelial cells covering fibrovascular tissue
A slow growing papilloma transmited by a virus is known as
Verruca
Xanthelasma is a flat yellow lipid laden lesion occuring periobitally whos treament is
optical surgical removal and a serium lipid evaluation
T/F Hemangiomas never disappear
FALSE, tend to disappear in 4-7 yeras. Are benign tumor composed of new blood vessels
This is considered to be a precurosor to swuamous cell carinoma
Acitinic keratosis. A red, scaly lesion on the eyelids, brow, ears or neck
_________ Presents as a raised lesion with nodular pearly borders, an induarted base, a crusty eroded center, and telangiectasia around its edges
Basal cell carincoma
This type of carincoma tends to be missed in diagnoisis and can be life threatening as a result
Sebaceous gland carcinoma. Resembles meibomian gland inflammation
_________ is a large, ill-defined brown spot appearing on the lids and brow during pregnancy
Chloasma
Vitiligo is a whitening of the skin resulting from
the loss of melanin

May be idiopathic: Family history is 50%, may occur as a sequela of systemic lupus erythematosus; may occur in Vogt-Koyanagi-Harada syndrome (bilateral deafness, bilateral uveitis, alopecia, poliosis, vitiligo, and optic neuritis)
3. Rule out Thyroid, anemias, pituitary
Nevus of Ota is a unilateral, blue-gray hyperpigmentation of the
periorbital tissue with increased pigmentation of all the contiguous ocular structures
the most common type of malignant melanoma to affect the eyelids
nodular malignant melanoma
A whitening of the lashes is known as
Poliosis

2. May be idiopathic; may be a sequela of chronic blepharitis or may be a part of the Vogt-Koyanage syndrome
A yellow nodule of hyaline-elastic tissue is known as
Pinguecula
Conjunctival concretions (lithiasis)
1. Calcareous cysts characterized by yellowish particles in the cul-de-sac
2. May be removed; the patient feels irritated
Telangiectasia
Dilation of conjunctival vessels
T/F the following represent benign tumors:
- Bowman’s dsease
- Squamous cell carcinoma
- Kaposi sarcoma
FALSE

Malignant
Discrete black deposits located in the cul-de-sacs is due to prolonged use of
epinephrine
A redundancy of lid skin and herniation of orbital fat through the orbital septum owing to aging or familial factors
Dermatochalasis
T/F Ectropion
is the rolling of the lid margin, usually the lower lid,> so that the lashes irritate the cornea
FALSE
Entropion
A semilunar fold of skin from the upper lid that crossed the inner canthus is known as this kind of fold
Epicanthal Folds
Blepharoptosis
is an abnormal drooping of the
upper lid

70% are unilateral and congenital; if bilateral, the ptosis is usually hereditary
Acquired ptosis may be myopathic, e.g., owing to some pathology of the levator muscle or Horner’s muscle; neuropathic, e.g., the result of a third nerve palsy or an interruption of sympathetic innervation to the eye; or mechanical, e.g., chalazion or dermatochalasis
Trichiasis
1. An inward turning of the lashes
2. Treat by epilation or destroying the lash follicle
The inability to make tears is known as
Alacrima
• Bilateral
• All findings of DES, ulcer, etc.
Canaliculas are at the lid margin
__ mm Vertical
__mm Horizontal
Upper and lower meet at __ degrees
2
8
25
Lacrimal Sac in Bony Lacrimal Fossa
___ mm in Length
15
Nasolacrimal Duct
is 12 mm long and terminates in
Inferior Meatus
Acute Bacterial Dacryoadenitis
is most commonly due to
Staphylococcus most common
Dacryoadenitis is the inflammation of
lacrimal glands
Simple Episcleritis
1. Hyperemia may be diffuse or localized sectorally between
the limbus and the insertion of the recti muscles
2. Is recurrent and transient
3. Is generally self-limiting in approximately 3 weeks
4. Treat with FML, HMS, or Pred Mild; taper dosage over 3 weeks, e.g., QID x 5 days, TID x 5 days, BID x 5 days, QD x 5 days
T/F Sclera has a high metabolic activity and is not very sensitive to pain
FALSE
Has a low metabolic activity but derives its nutrition from the underlying choroid and overlying episclera

SENSITIVE to pain
_______ can be distended until age 3; after age 3 only the lamina cribosa can be stretched
Sclera
The most important local cause of scleral inflmmation is
herpes zoster
Nodular scleritis is treated systemitically with
Indocin, 100 mg/day, in a tapering regimen
Treat with Pred Forte for symptomatic relief




1. Sclera tissue is heaped up in a non-moveable, painful nodule
2. Overlying episclera is tightly adherent
3. Is very tender to touch
4. Inflammation does not extend beyond nodule
5. Necrosis possible if persistent
This may be brawny in which the entire anterior scleral segment starts to develop a slowly progressive gelatinous swelling
Often leads to scleral necrosis
Diffuse scleraitis
The most severe form of scleritis is
Necrotizing scleritis with inflammation

2. Occurs with gradual onset of pain and redness that spreads
3. Avascular patches form in the deep episcleral vascular plexus owing to vascular occlusion and obliteration
4. The sclera becomes transparent, allowing the underlying choroid to show through
5. The anterior uvea becomes inflamed and the cornea starts to melt
6. Treatment should begin before tissue loss has occurred
7. Treat with large doses of systemic steroid and Indocin
8. 25% of patients are dead within 5 years from the underlying systemic disease
Contusions are
A bruise, Ecchymosis, e.g., a collection of blood in local tissue as a result of blunt trauma; the skin is not ruptured
T/F No scarring occurs in 2nd degree burns
TRUE

scar occurs only in 3rd
An extravasation of blood beneath the conjunctiva
Subconjunctival Hemorrhage


Usually found in an older patient after an episode of sneezing, coughing, or straining
3. May result in trauma
4. Is more prevalent in hypertensives
A break in the conjunctiva following injury
Conjunctival Laceration

2. Rule out Globe laceration
3. Treat with antibiosis
The cornea consists of five layers
Epithelium - surface ectoderm
Anterior Limiting Lamina - mesoderm
Stroma - mesoderm
Posterior Limiting Lamina - mesoderm
Endothelium - mesenchymal cells
T/F Cornea is more sensitive centrally than peripherally
T
The Cornea is Avascular and
Oxygen – primarily comes from _________

Glucose comes primarily from ____
tear fluid / air, and aqueous and limbal circulation


aqueous
STUMPED Classification
S = Sclerocornea
T = Tears in Descemet’s membrane
U = Ulcer
M = Metabolic (very rare at birth)
P = Posterior Corneal Defect
E = Endothelial Dystrophy
D = Dermoid
S = Sclerocornea
Diffuse whitening or scleralization of the cornea
Can be partial or complete opacity
Central cornea is flat
Surgical prognosis is poor
Always suspect this disease in infants with unilateral or bilateral corneal clouding
Congenital cataracts
________ anomaly:
Central opacity, defects in stroma, Descemet’s and endothelium
Peripheral cornea is usually clear
Synechiae from iris collarette to cornea
Usually bilateral
May be associated with systemic syndromes
Peter’s
This disease is:
Autosomal recessive or dominant
Primary dysfunction and degeneration of the endothelium
Diffuse corneal edema
Ground glass appearance to total opacity
Avascular; NO inflammation
Pachs : 2 to 3 times normal thickness
Surgical treatment likely
Congenital hereditary endothelial dystrophy (CHED)
What is a dermoid?
Solid, benign congenital tumors
Commonly at inferotemporal corneoscleral junction
Can contain hair follicles, sebaceous and sweat glands
Microphthalmos
Eye is small and malformed
Microcornea
Corneal diameter < 10mm in a normal sized eye
If entire eye is small =
nanophthalmos
Megalocornea
Corneal diameter 13mm or more
X-linked recessive; Corneas steep; myopia
Cornea Plana
Cornea is flat (25 – 35 D), hyperopia
What are infiltrates?
Collection of inflammatory cells in the corneal stroma; Overlying INTACT epithelium
How do you treat sterile infiltrates
Topical steroids
PredForte 1% q2h;
Taper over 2-3 weeks
Check IOP
Follow-up 2-3 days after first visit, then start tapering steroids
Can use “soft” steroids such as Lotemax / Alrex
If you are NOT SURE if its sterile
Tobramycin plus steroids (Tobradex


If Contact Lens wearer:
STOP lens wear immediately
Discard lenses, cases, solutions
Consider changing lens type / solutions if necessary
No lens wear until cornea is clear and eye is quiet
How do you treat corneal steroids
ANTIBIOTICS !
Broad-spectrum gtts (e.g., Viagmox)
Fortified antibiotics
Hospitalization

STEROID use indicated in sterile ulcers
Antibiotic cover
Immunosuppression in certain diseases
Stromal Swelling Pressure is a force required to
compress the stroma and remove fluid. (More hydrated the stroma, the lower the swelling pressure & vice versa)
T/F corneal hydration does not require oxygen and energy for pumps
FALSE
Require oxygen and energy for these pumps
T/F Chronic or acute high IOP can cause edema
T
Managing epithelial and stromal edema
Hypertonic agents
5 % sodium chloride drops
Improves BK, microcysts
Stings upon instillation
Glycerin drops
Bandage contact lenses
Very comfortable
High oxygen lenses only
Regular follow-up
Cover of antibiotic gtts
How do you treat corneal edema?
Anterior stromal cautery
Conjunctival flap
Amniotic membrane
Phototherapeutic keratectomy (excimer)
Penetrating keratoplasty
Deep lamellar endothelial keratoplasty
When you see corneal deposits you must consider its
color and depth!!

Depth
Superficial = Epithelium, Bowman’s, Antr Stroma
Stromal = Bulk of stroma
Deep Stromal = Postr Stroma, Descemet’s, and endothelium
Color
Pigmented
Non-pigmented
Refractile / crystalline
Pigmented corneal depoists
Pigmented
Cornea Verticillata (whorl like) is seen due to
Fabry’s disease, amiodarone, choloroquine, naproxen, etc
Pigmented corneal depoists
Pigmented
Epithelial iron lines are due
Keratoconus (Fleischer), Hudson-Stahli
Pigmented corneal depoists
Pigmented Adrenochrome deposits lines are due to
Epinephrine eye drops for glaucoma, appear Brown-black
Non-Pigmented Corneal Deposits are due to
Band keratopathy
Hypercalcemia; Chronic ocular inflammation (kids)
Calcium in epth basement memb, Bowman’s and antr stroma
Chalky white deposits in interpalpebral zone
This type of antibiotic can cause chalky white deposits
Fluoroquinolones (e.g., ciprofloxacin eye drops)
Meesman’s dystrophy causes
Refractile superficial corneal deposits

Autosomal dominant
Bilateral intraepithelial cysts throughout cornea
Gray on direct illumination
Transparent on retro illumination
All epithelial
Clear cornea between cysts
Pigmented Stromal deposits are due to
Corneal blood staining
Hyphema and elevated IOP

Siderosis
Siderosis
Iron deposition within intraocular structures
Metallic foreign body
Iris, lens, ciliary body, RPE can all be involved
Iris heterochromia
Posterior corneal stroma involved
Arcus Senilis is lipid deposits found in the
stroma
Yellow brown or green ring at the level of Descemet’s membrane in the peripheral cornea
Copper deposition in Wilson’s disease
Autosomal recessive disease

deep stromal deposits
Cornea Farinata
Looks like “flour” in the cornea
Bilateral


Its a nonpigmented stromal deposit
These are
Inherited, bilateral, non-inflammatory, primary alteration or opacity of the cornea that occurs at birth and is not associated with prior systemic disease
corneal Dystrophies
What is the only exclusively epithelial dystrophy?
Meesmann’s Juvenile Epithelial Dystrophy

Autosomal dominant
Mutation in corneal keratin
First few years of life
Intraepithelial microcysts or vesicles
Microcysts contain degenerate epithelial cell products
Vision is unaffected or mildly affected
Can manage with rewetting agents
Not associated with recurrent corneal erosions
What is the most common anterior corneal dystrophy
Epithelial Basement Membrane Dystrophy

Epithelial microcysts, map-like lines around microcysts, fingerprint lines in the epithelium
Primary symptoms from recurrent corneal erosions, blurred vision, pain on awakening
Primary symptoms from recurrent corneal erosions (RCE), blurred vision, pain on awakening
Patients who get RCE without history of trauma should be investigated for EBMD
What is the most common Endothelial dystrophy?
Fuch's Dystrophy

Women are affected three times more commonly than men
Presents usually in the sixth decade of life, yet clinical changes occur much earlier
Inheritance pattern not defined (occasionally found autosomal dominant)
Bilateral & asymmetric

Three clinical stages seen with Fuchs’
Corneal Guttata (guttae)
Stromal & Epithelial Edema
Corneal Scarring
(Subepithelial scarring forms as the corneal edema progresses & becomes chronic

Subepithelial fibrosis often is accompanied with vascularization
Three clinical stages seen with Fuchs’
Corneal Guttata (guttae)
Stromal & Epithelial Edema
Corneal Scarring- (Subepithelial scarring forms as the corneal edema progresses & becomes chronic Subepithelial fibrosis often is accompanied with vascularization)
Corneal Guttata are
excrescences of Descemet’s membrane produced by abnormal endothelial cells (abnormal collagenous tissue)
Appearance of discrete refractile spots
Guttae can occur without manifest Fuchs’
Treatment of Fuch's
Hypertonic saline drops during the day & hypertonic ointment at night
Dehydration using a blow-dryer
Bandage soft contact lens (high water) - to relieve the pain associated with ruptured epithelial bullae
Penetrating Keratoplasty indicated in advanced stages
High chance of successful surgery (PK)
Slit lamp findings of Keratoconus
Full Fleischer’s ring encircling cone at Bowman’s, thinning of cornea, corneal ruptures with scarring
Vogt’s striae
Stretch” lines at Descemet’s membrane
Parallel; may run in different planes
Reduce Visual acuity
Diagnostic for KC
Fleischer’s ring
Hemosiderin iron ring at level of Bowman’s
Delineates base of cone
Diagnostic for KC
Iridiocorneal Endothelial Syndromes include
Essential Iris Atrophy

Iris nevus syndrome

Chandler’s syndrome
Corneal edema (normal or slightly high IOP)
Minimal iris atrophy
No heterochromia
Glaucoma
Definition of degeneration:
Changes in tissues that cause deterioration & can impair function
Also can be related to specific disease processes
No genetic predisposition
Salzmann’s nodular degeneration
Chronic inflammation
Phlyctenular keratitis, VKC, Trachoma
Females > males
Nodules do not contain inflammatory cells
Dellens are
Saucer-like depressions in the corneal surface
Bacterial keratitis – Most common pathogens
P. aeruginosa
S. aureus
S. pyogenes
S. pneumoniae (pneumococcus)
How to treat bacterial corneal ulcer
Oral antibiotics
Subconjunctival antibiotic injections
Change antibiotics if culture shows resistant organism
But don’t change if getting better!
Use Cycloplegics!!
Atropine bid or Cyclopentolate tid
Topical steroids….CAUTION!!! Best avoided
Must exclude viral / fungal / protozoan
Can reduce inflammation, increase comfort
Can preserve corneal graft
________ infection can elicit a severe inflammatory response that can cause stromal necrosis and melting
Fungal
Fungal Keratitis treatment
A broad spectrum antibiotic must be used
Subconjunctival fluconazole may be used in severe cases with hypopyon
Systemic anti-fungals may be required for severe keratitis or endophthalmitis
Surgical options
What is the major cause of unilateral corneal scarring worldwide and the most common infectious cause of corneal blindness in developed countries
Herpetic eye disease
With Severe Herpes Simplex Keratitis inappropriate topical steroid use predisposes the patient to risk of
geographic ulceration
Categories of Herpes Simplex Virus Keratitis
Infectious epithelial keratitis
Neurotrophic keratopathy
Stromal keratitis
Endothelilitis
Most common clinical manifestations of infectious epithelial keratitis are the _____________ ulcers
dendritic and geographic
A true ulcer extends through the ________ and will stain positively with fluorescein
basement membrane
A dendritic ulcer signs
HSV Epithelial keratitis
Ulcerated; extends to basement membrane
Stains positive with fluorescein
A psuedo-dendritic ulcer signs
Recently healed epth defects, Zoster lesions, Toxic drug reactions
They are raised; not ulcerated
Do NOT stain with fluorescein
T/F A Herpes Simplex Virus keratitis symptom includes corneal sensation reduction
T
With Herpes Zoster Ophthalmicus
this phase precedes the appearance of the rash
Prodromal
The healing process repair system should promote regeneration rather than _____- in order to restore normal corneal function
scarring/fibrosis
The corneal ________- is rich with cytokines
epithelium
_______ and ______ cause upregualtion and expression of cell adhesion moclules in vascular endothelial cells
TNF a
and interferon
The inflammatory mediate to be present within the first few hours is
neutrophils
The source of neutrophils are
limbal blood vessels
tear film
conjunctiva
T/F neutrophils usually disappear within 24-48 hours after inflammatory stimulus
T
_______ causes conjunctival and limbal mast cells to release inflammatory mdiates, enhace chemotaxis and phagocytosis, enhace expression of endothelial cell adhesion molculees as well.
Substance P
Antigen presenting cells progessin antigens and migrate via_____ to the spleen
limbal lood vseels.
They activate T cells in spleen to form specific CD4 T helper cells, which tave back to the cornea and rlease cytokines.
Th2 cells produces _____- and allergic reactions.

Th1 cells produce _____
IgE


IL-2
In the cornea, the epithelium heals by _______ and the stroma heals by __________
regeneration

fibrosis
T/F Cytokines are synthesized and released by cells at the site of inflammation while neutrophils must be transported in
T
_____ are the principal source of Interluekin L-1
macrophages
are also produced by corneal keratinocytes
Production and release of IL-1by corneal cells may play a central role in mediating collagenase expression that is important in corneal_- and ______--
thinning and perforation
What is Sustance P
a neurotransmitter than functiosn as a mediator of neuorgenic inflammation and a neutrophic factor
The most important growth factors in maintaing cell homeostasis and modulating the healing response in the cornea:
Epidermal growth factor
Hepatocyte growth factor and
Keratinocyte growth factor.

HGF and KGF regulate corneal epithelia clel proliferation, motility and differentiation.
These regulate corneal epithelial cell proliferation, motility and differentiation.
Hepatocyte growth factor and
Keratinocyte growth factor.

HGF and KGF
What allows mediatiors to come into contact with uninjured epithelia lcells and stromal keratocytes?
epithelial damage of tight junctison and barriers
The primary function of collage type 1 in the cornea
provide strucutral support
Type IV collagen, laminin and fibronectin are found in
epithelial basement membrane of cornea.
When damaged, fibronectin is snythesized and posits, serving as a temporary matrix for epithelial cell adhesion and migration
What degrades components of the xtracellular matrix of the corneal epithelium?
Matrix metalloprteinases

collagenases, stromelysins, and gelatinases
Matrix metalloprteinases are synthesized in the cell and secreted to
extraceullar space.
T/f Matrix metalloprteinases are produced continuously
FALSE only when needed.
Expression and be induced or supporsed
The primary goal of corneal healing treatment is
to repaire corneal epithelial damage as rapidly as possible to prevent development of microbial or nonmicrobial ulceration.
Myofibroblasts are resonible for________- and contribute to _____ associated with photorefractive keratotmoy
would contraction in incisinoal procedures.

haze
What causes anchoring fibrils to melt in Recurrent corneal erosion? CE? What drug
is known to decrease its activity?
MMP-9, a gelatinase

Doxacylcine and and steriods
_______neovascularization overlies Descement's membrane and occurs with iterstitial keratitis
Deep
The most common cause of interstitial keratitis is
Herpes simplex

syphilis is second
Angiostatin is used to suppress
tumor growth
This inhibits cell migration and proliferation and enhancesvasicular endothelial cell apoptosis
Endostatin
Treatment of choice for keratoconus
RGP, except in the earliest cases
T/F Corneal transplant/penetrating keratoplasty is often used as the treatment of choice for keratocnus
FALSE

surgery is the last resort!!!
The First Definite Apical Clearance lens was the first
BC that doesn't produce bearing
The hallmark sign of infectious keratitis is
INFILTRATES, diffuse or accumulation of inflammatory material.
An ulcer isn't an ulcer unless there is an _______ defect
epithelial defect.
Patient presens with a red eye, decrased acuity, pain, photophobia, swelling lids stuck together in the AM and discharge. They probably have
infiltrative keratitis.

DISCHARGE is key in diagnosising
The only FDA approved drug for treating mild to moderate corneal ulcers is
CILOXAN --> 2 ggts every 15 minutes for first 6 hours and then 2 gtts every 30 minutes for next 12 hours, followed by 2 gtts QID for 14 days.
Corneal ulcer treatment
cefazolin, troramycin, cilozan
cycloplege,
bandage CL
Steroids --> controversial
NSAIDS
possible debrdiement
Reduced corneal sensivitiys is an important aspect of
recurrent ocular HSV
T/F Herpes Simplex Virus usually presents bilaterally
FALSE

usually unilateral.
When would you treat Herpes Simplex Virus keratitis WITH a steriod?
When its a stromal lesion!!
Phototherpeutic Keratectomy
removes and smooths over irregular surface and releives patieton of erosion on apermeanent basis. No scarring.
The worst cause of chemical burns
alkali agents
A ___ fcyst is moveable, palpable, smooth, round mass that frequenty appearrs on the suerior temportal or nasal aspect of the lid
dermoid.
Treat by surgical removal.
A generic name for solid growths
papilloma.

May present as a single finger like projection or a cluster.
An aging spot is known as a
Chlosoma, a large ill defined brown spot
A whitening of the skins resulting from the loss of melanin is known as _________ and may occur as aprt of lupus or Vogt-Koyanagi-Harada syndrome (bilateral deafness, uveitis, alopecia, optic neuritis)
Vitiligo
Dilation of conjunctival vessels
Telangiesctasia
Parakeratosis is the retention of ________- in the keratinizing layer --> incomplete keratinazation.
Nuclei
Happens when cells reach the top layer in quicker fashion than normal and do not have time to lose their nuclei, sign that skin is irritated
Hyerkeratosis definition
excessive thickness of keratin layer.
An increase in squamous layer thickness is knwo nas
Acanthosis
Dyskeratosis is the keratizination in the _______ layer
aquamous layer... skin loses polarity.
T/F The skin of the eyelid is thicker than the skin of the rest of the body
FALSE
thinner

Eyelids continue to get even thinnerwith age.
Cure rate of an excisional biopsy
95%
This technique involve sectioning up the whole lesion into indvidual squares, cutting them out and lael each section
Moh's technique/ Moh's micrograhpic surgery.

99.5% cure rate, bt it is expensive and time consuming
The most popular method of lesion excision
modified frozen section control. 99.5% cure rate
T/F Benign lesions grow quicker than malignant lesions
T
Most common carincoma
And its appearance
Basal cell.
occurs mainly on neck and head. Also found on lower eelid and inner canthus

Appears siny, pearly nodule. See telangietatic vessels.
The key histological cell type of basal cell carincoma
Peripheral palisading cells --> surround the outside of the tumor, are twice as large as basal cells.

Also see: basaloid cells, pleomprhism and atypia
The least common carincoma
sebaceous cell carincoma
If patient presents with blepharoconjunctivitis lasting more than 4 months you must send patient for a biopsy because it might be
sebaceous cell carincoma.

See loss of lashes --> implies malignant
Another term for a solar, senile keratosis
Actinic keratosis.
See round, flat, scaly lesion with erythematous base. Benign
3 Types of nevi
Junctional
Intradermal
Comound
Anything pigmented and lesioned should be
removed!
If growss depper than 1mm into the dermis, it can be FATAL
Molluscum contagiosum is a _______ infection of epidermis
viral.
Treat or will spread.

See a waxy nodule, central umbilication
Most common childood vascular tumor
Capillary hemangioma. Prolfieration of ENODTHELIAL cells, see irregular surface,purple0red, elevated cherry hemangioma. May appear as blue nevous or strawbery nevous
This hemangioma appears blue in color and is associated with Sture0Weber syndrome
Cavernous hemangioma.
T/F Tropicamide gets rid of more residual accomodation than cyclopenolate
FALSE
cyclopentolate lasts long but gets rid of residual accomodation better
T/F Monofision causes difficult binocular fusion and poor stereopsis
FALSE
reality that binocular vision is preserved and stero is preserved but there is some loss in CONTRAST sensitiity
Monvision typically fails due to
BLUR
One of the most important tets to decide if a patient is a good candidate for corneal refractive surgery is
pachymetry
______ microcmeters need to be ablated to correct one diopter refractive error
12
____________ microns is the base minimtum that should remain in the corneal bed. The flap has approximate ______ microns
250-300

120-160
Prospective evaluation of radial keratometry after 1 year, 25-35% of RK patients and 10-23% of PRK patients needed an
optical aid
This doctor invented radial keratotomy
Dr. Sato in Japan 1920s

Radial incisions made in anterior and posterior cornea to create a flattenin effect
Photorefractive Keratoctomy
precise no heat generated cold laser. Works well by avlation. Used widely in Europe
When is PRK better than LASIK?
when you have narrow palpebral apertures
deep set globes
flat corneas
epthelial basement membrane dystrophy
thinner corneas
What percentage of Lasik pateitns are 20/40 or better?
93%
IOP reading may __________ after laser vision correctio ndue to new thinness of cornea
decrease 2-3 mm g
_________ is a lid notc that usually occurs on the superior medial aspect of the lid. You treat this with lubrication bandage les if there is a corneal prolem
Coloboma
A semilunar fold of skin from the upper lid that covers the inner canthus
epicanthal folds
the leading of the bilateral ptosis
Myasthenia gravis
Additional row lashes
Distichiasis
Infantile dacryocystitis is ________ and is treated with __________which performed by
infantile duct obstruction, see chronic epiphoria and mucopurlent discharge.
You do not want to do surgery until 1 year of age for safety reasons and the fact that theblockage usualyl clears within the first year.

Treat with hydrostatitic massages , block puncta and massage ith gentle rapid downward motion 6-8 times, 3 times a day with a warm compress.
_______- is an infection of the lacrimal SAC and almost always bacterial
Dacryocystitis
T/F Dacryoadenitis is an infection of the lacrimal sac and is mostly bacterial
FALSE!!!

it is an infection of lacrimal GLANDS and is mostly viral!!
T/F For Acute Bacterial Dacryoadenitis you treat with SYSTEMIC antibiotics rather than tpoical
T
______ acts as a SYNOVIAL membrane for smooth eye movements
Episclera
synovial membrane=lubricating body.
T/F The episclera is a vascular layer
T, provides nutrition for underlying sclera.
Episceraltisis is almost always
UNILATERAL and SECTORIAL and is OFTEN recurrent
T/F VA's are not effected wit episceratisis
T
Simple/Diffuse episcleritis is treated with
Alrex or Pred Mild and supportive therapy with artificial tears
Inflammation of the sclera may involve the deep epsicerlal vascualr plexus producing a _____________________ with necrosis. Due to loss of circulation- results in loss of structure and function
bendy aneurysm
T/F When you have scleratitis you will also have flare and cells (uveitis) and may have iritis
T
The most important LOCAL cause of scleraitis
Herpes Zoster
The most common systemic cause of scleritis is
Rheumatoid arthritis.
T/F Give patient topical steriods if necrotizing scleritis with inflammation is present
FALSE

give systemic steriods, Indocin
A thickening of the sclera which causes folds in the retina and around the optic nerve head/retinal wrinkling is known as
posterior scleritis
Reflex tearing is due to which cranial nerve
opthalmic division of CN V
Most common cause of dry eye
aqueous deficiency! (can be due to rematoid arthritis, lupus, sjogrens, menopause, etc)
A hyperplasia of conjunctival tissue leads to
pteryguim
Hallmark sign of atopic (allergic) keratoconjunctivitis

and treatment
Superficial punctate staining

Also is a BILATERAL condition

Treat with cold compress and steriods, lubricant.
IF chronic, use mast cell stabilizers like Alomide and systemic antihistamines
T/F Superior Limbic KEratoconjunctivitis patients will experience photpohbia, foreign body sensation, itching and discharge
FALSE

no itching or discharge!!

Will see inflammation of superior tarsal conjunctivitis with papillary hypertropy
T/F Superior Limbic KEratoconjunctivitis patients will experience photpohbia, foreign body sensation, itching and discharge
FALSE

no itching or discharge!!

Will see inflammation of superior tarsal conjunctivitis with papillary hypertropy
T/F Superior Limbic KEratoconjunctivitis patients will experience photpohbia, foreign body sensation, itching and discharge
FALSE

no itching or discharge!!

Will see inflammation of superior tarsal conjunctivitis with papillary hypertropy
T/F Superior Limbic KEratoconjunctivitis patients will experience photpohbia, foreign body sensation, itching and discharge
FALSE

no itching or discharge!!

Will see inflammation of superior tarsal conjunctivitis with papillary hypertropy
T/F Superior Limbic KEratoconjunctivitis patients will experience photpohbia, foreign body sensation, itching and discharge
FALSE

no itching or discharge!!

Will see inflammation of superior tarsal conjunctivitis with papillary hypertropy
T/F Superior Limbic KEratoconjunctivitis patients will experience photpohbia, foreign body sensation, itching and discharge
FALSE

no itching or discharge!!

Will see inflammation of superior tarsal conjunctivitis with papillary hypertropy
T/F Superior Limbic KEratoconjunctivitis patients will experience photpohbia, foreign body sensation, itching and discharge
FALSE

no itching or discharge!!

Will see inflammation of superior tarsal conjunctivitis with papillary hypertropy
Treatment of Superior Limbic Keratoconjunctivitis
lubrication, discontinue CL, mast cell stabilizer. topical steriods, possible debridgement
Treatment of Superior Limbic Keratoconjunctivitis
lubrication, discontinue CL, mast cell stabilizer. topical steriods, possible debridgement
Treatment of Superior Limbic Keratoconjunctivitis
lubrication, discontinue CL, mast cell stabilizer. topical steriods, possible debridgement
Normal tear osmolarity
311 msOsm/L
Treatment of Superior Limbic Keratoconjunctivitis
lubrication, discontinue CL, mast cell stabilizer. topical steriods, possible debridgement
Normal tear osmolarity
311 msOsm/L
Normal tear osmolarity
311 msOsm/L
Normal tear osmolarity
311 msOsm/L
This noncaseating granulomatous inflammatory infiltrate mainly effects lungs but may be chronic infllamtion of meibomian glands or Zeis sebaceous glands due to its enlargemnt of lacrima and salivatory glands
Sarcoidosis
Treatment of Superior Limbic Keratoconjunctivitis
lubrication, discontinue CL, mast cell stabilizer. topical steriods, possible debridgement
This noncaseating granulomatous inflammatory infiltrate mainly effects lungs but may be chronic infllamtion of meibomian glands or Zeis sebaceous glands due to its enlargemnt of lacrima and salivatory glands
Sarcoidosis
Treatment of Superior Limbic Keratoconjunctivitis
lubrication, discontinue CL, mast cell stabilizer. topical steriods, possible debridgement
Treatment of Superior Limbic Keratoconjunctivitis
lubrication, discontinue CL, mast cell stabilizer. topical steriods, possible debridgement
T/F Herpes Zoster Opthalmicus is a unilateral, vesicular lesion distributed along CN V
TRUE
This noncaseating granulomatous inflammatory infiltrate mainly effects lungs but may be chronic infllamtion of meibomian glands or Zeis sebaceous glands due to its enlargemnt of lacrima and salivatory glands
Sarcoidosis
Normal tear osmolarity
311 msOsm/L
T/F Herpes Zoster Opthalmicus is a unilateral, vesicular lesion distributed along CN V
TRUE
This noncaseating granulomatous inflammatory infiltrate mainly effects lungs but may be chronic infllamtion of meibomian glands or Zeis sebaceous glands due to its enlargemnt of lacrima and salivatory glands
Sarcoidosis
Normal tear osmolarity
311 msOsm/L
Normal tear osmolarity
311 msOsm/L
T/F Herpes Zoster Opthalmicus is a unilateral, vesicular lesion distributed along CN V
TRUE
Treatment for Herpes Zoster Opthalmicus
Acyclovir
This noncaseating granulomatous inflammatory infiltrate mainly effects lungs but may be chronic infllamtion of meibomian glands or Zeis sebaceous glands due to its enlargemnt of lacrima and salivatory glands
Sarcoidosis
This noncaseating granulomatous inflammatory infiltrate mainly effects lungs but may be chronic infllamtion of meibomian glands or Zeis sebaceous glands due to its enlargemnt of lacrima and salivatory glands
Sarcoidosis
T/F Herpes Zoster Opthalmicus is a unilateral, vesicular lesion distributed along CN V
TRUE
This noncaseating granulomatous inflammatory infiltrate mainly effects lungs but may be chronic infllamtion of meibomian glands or Zeis sebaceous glands due to its enlargemnt of lacrima and salivatory glands
Sarcoidosis
Treatment for Herpes Zoster Opthalmicus
Acyclovir
Treatment for Herpes Zoster Opthalmicus
Acyclovir
The decreased amount of _______ destabilizes the tear film, which is reflected by shorter tear break-up times (TBUT) in dry eye patients
mucins
T/F Herpes Zoster Opthalmicus is a unilateral, vesicular lesion distributed along CN V
TRUE
The decreased amount of _______ destabilizes the tear film, which is reflected by shorter tear break-up times (TBUT) in dry eye patients
mucins
The decreased amount of _______ destabilizes the tear film, which is reflected by shorter tear break-up times (TBUT) in dry eye patients
mucins
T/F Herpes Zoster Opthalmicus is a unilateral, vesicular lesion distributed along CN V
TRUE
T/F Herpes Zoster Opthalmicus is a unilateral, vesicular lesion distributed along CN V
TRUE
Treatment for Herpes Zoster Opthalmicus
Acyclovir
Treatment for Herpes Zoster Opthalmicus
Acyclovir
The decreased amount of _______ destabilizes the tear film, which is reflected by shorter tear break-up times (TBUT) in dry eye patients
mucins
osmolality ____________ (greater OR lesser) than 312 mOsm/Kg is considered diagnostic of dry eye
GREATER
Treatment for Herpes Zoster Opthalmicus
Acyclovir
Treatment for Herpes Zoster Opthalmicus
Acyclovir
osmolality ____________ (greater OR lesser) than 312 mOsm/Kg is considered diagnostic of dry eye
GREATER
osmolality ____________ (greater OR lesser) than 312 mOsm/Kg is considered diagnostic of dry eye
GREATER
The decreased amount of _______ destabilizes the tear film, which is reflected by shorter tear break-up times (TBUT) in dry eye patients
mucins
osmolality ____________ (greater OR lesser) than 312 mOsm/Kg is considered diagnostic of dry eye
GREATER
Aqueous Deficiency Sign: low ___ Test(tear volume/flow) score
Schirmer
The decreased amount of _______ destabilizes the tear film, which is reflected by shorter tear break-up times (TBUT) in dry eye patients
mucins
The decreased amount of _______ destabilizes the tear film, which is reflected by shorter tear break-up times (TBUT) in dry eye patients
mucins
Aqueous Deficiency Sign: low ___ Test(tear volume/flow) score
Schirmer
Aqueous Deficiency Sign: low ___ Test(tear volume/flow) score
Schirmer
Aqueous Deficiency Sign: low ___ Test(tear volume/flow) score
Schirmer
osmolality ____________ (greater OR lesser) than 312 mOsm/Kg is considered diagnostic of dry eye
GREATER
osmolality ____________ (greater OR lesser) than 312 mOsm/Kg is considered diagnostic of dry eye
GREATER
osmolality ____________ (greater OR lesser) than 312 mOsm/Kg is considered diagnostic of dry eye
GREATER
Mucin Deficiency Sign: rapid ___________time
tear film break-up
Mucin Deficiency Sign: rapid ___________time
tear film break-up
Mucin Deficiency Sign: rapid ___________time
tear film break-up
Lipid Deficiency
Signs:
irregular meibomian gland expression, fast TFBUT
Mucin Deficiency Sign: rapid ___________time
tear film break-up
Aqueous Deficiency Sign: low ___ Test(tear volume/flow) score
Schirmer
Lipid Deficiency
Signs:
irregular meibomian gland expression, fast TFBUT
Aqueous Deficiency Sign: low ___ Test(tear volume/flow) score
Schirmer
Aqueous Deficiency Sign: low ___ Test(tear volume/flow) score
Schirmer
Schirmer 1 test without anesthesia normal result is usually at least _____mm in 5 minutes
WITH anesthesia normal result is usually _____ mm
15
10 mm
Schirmer 1 test without anesthesia normal result is usually at least _____mm in 5 minutes
WITH anesthesia normal result is usually _____ mm
15
10 mm
Mucin Deficiency Sign: rapid ___________time
tear film break-up
Lipid Deficiency
Signs:
irregular meibomian gland expression, fast TFBUT
Lipid Deficiency
Signs:
irregular meibomian gland expression, fast TFBUT
Mucin Deficiency Sign: rapid ___________time
tear film break-up
Mucin Deficiency Sign: rapid ___________time
tear film break-up
Lactoferrin Concentration _______-in a dry eye Diagnostic test for KCS < ____mg/dl - LG deficiency
decreases

90
Lipid Deficiency
Signs:
irregular meibomian gland expression, fast TFBUT
Schirmer 1 test without anesthesia normal result is usually at least _____mm in 5 minutes
WITH anesthesia normal result is usually _____ mm
15
10 mm
Lipid Deficiency
Signs:
irregular meibomian gland expression, fast TFBUT
Lactoferrin Concentration _______-in a dry eye Diagnostic test for KCS < ____mg/dl - LG deficiency
decreases

90
Schirmer 1 test without anesthesia normal result is usually at least _____mm in 5 minutes
WITH anesthesia normal result is usually _____ mm
15
10 mm
Schirmer 1 test without anesthesia normal result is usually at least _____mm in 5 minutes
WITH anesthesia normal result is usually _____ mm
15
10 mm
Schirmer 1 test without anesthesia normal result is usually at least _____mm in 5 minutes
WITH anesthesia normal result is usually _____ mm
15
10 mm
Lactoferrin Concentration _______-in a dry eye Diagnostic test for KCS < ____mg/dl - LG deficiency
decreases

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Lactoferrin Concentration _______-in a dry eye Diagnostic test for KCS < ____mg/dl - LG deficiency
decreases

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_________ stimulate the lacrimal gland _________e.g., pilocarpine, eledoisin
CHOLINERGICS
Lactoferrin Concentration _______-in a dry eye Diagnostic test for KCS < ____mg/dl - LG deficiency
decreases

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Lipid Deficiency
Signs:
irregular meibomian gland expression, fast TFBUT
_________ stimulate the lacrimal gland _________e.g., pilocarpine, eledoisin
CHOLINERGICS
Lactoferrin Concentration _______-in a dry eye Diagnostic test for KCS < ____mg/dl - LG deficiency
decreases

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_________ stimulate the lacrimal gland _________e.g., pilocarpine, eledoisin
CHOLINERGICS
A mucin secretogogues
INS365 – Still in clinical trials
_________ stimulate the lacrimal gland _________e.g., pilocarpine, eledoisin
CHOLINERGICS
_________ stimulate the lacrimal gland _________e.g., pilocarpine, eledoisin
CHOLINERGICS
A mucin secretogogues
INS365 – Still in clinical trials
Schirmer 1 test without anesthesia normal result is usually at least _____mm in 5 minutes
WITH anesthesia normal result is usually _____ mm
15
10 mm
_________ stimulate the lacrimal gland _________e.g., pilocarpine, eledoisin
CHOLINERGICS
A mucin secretogogues
INS365 – Still in clinical trials
Lactoferrin Concentration _______-in a dry eye Diagnostic test for KCS < ____mg/dl - LG deficiency
decreases

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A mucin secretogogues
INS365 – Still in clinical trials
A mucin secretogogues
INS365 – Still in clinical trials
A mucin secretogogues
INS365 – Still in clinical trials
_________ stimulate the lacrimal gland _________e.g., pilocarpine, eledoisin
CHOLINERGICS
A mucin secretogogues
INS365 – Still in clinical trials