Ocular Abnormality- Corneal Disorders 2

Front 1

What is Microcornea?

Back 1

•Bilateral, familial, AD inheritance

• <10mm horizontal

Front 2

What is Microcornea associated with?

Back 2

Associated with shallow anterior chamber and narrow angle

Front 3

What is Megalocornea?

Back 3

• Large cornea

• Bilateral; Non-progressive

• >13mm (12mm in neonates) horizontal Ø

Front 4

What are corneal degeneration?

Back 4

• A degeneration is an acquired abnormality in response to inflammation, trauma or ageing

• They are not inherited and may be unilateral or bilateral

Front 5

When do (corneal) degenerations develop?

Back 5

They develop in later life

Front 6

What is effected by corneal degenerations?

Back 6

Often affect the peripheral cornea

Front 7

Are corneal degenerations common?

Back 7

They are common compared to dystropies

Front 8

Name the inflammation related corneal degenerations.

Back 8

• Band keratopathy

• Saltzmann’s nodular degeneration

• Lipid keratopathy

Front 9

Name trauma related corneal degenerations

Back 9

Climatic droplet keratopathy

Front 10

Name age related corneal degenerations

Back 10

• Arcus senilis

• Cornea guttata

Front 11

What is Band keratopathy?

Back 11

• Opacity, corneal irregularity lead to discomfort and visual acuity loss

• Bilateral, asymmetrical

• Uncommon (prevalence <1/1000)

Front 12

Who is Band keratopathy more common in?

Back 12

Older px- greater than 80 yrs

Front 13

How does Band keratopathy occur?

Back 13

• Follows-on from chronic uveitis in conditions such as juvenile idiopathic arthritis

• May occur in patients with raised blood calcium levels, e.g. in renal failure

Front 14

What are the history and symptoms of Band keratopathy?

Back 14

• Chronic uveitis

• HLA B27 associated systemic disease

• Blurred vision

• Glare

• Discomfort

Front 15

What are the signs for Band keratopathy?

Back 15

• Diffuse horizontally oriented grey opacity, starting in the peripheral cornea at the level of the anterior stroma

• Develops towards central cornea through time

• Discrete calcium crystals may be visible in band

• Reduced VA, dependent upon central corneal involvement

Front 16

What is this?

Back 16

Band keratopathy

Front 17

How do you manage Band keratopathy?

Back 17

• Ocular lubricants for pain relief

• Bandage contact lenses

• Chelation or PTK to remove deposits

• Recurrence is common

Front 18

What are the associated conditions with Band keratopathy?

Back 18

• Chronic uveitis

• HLA B27 associated systemic disease

• Hyperparathyroidism

• Renal failure

Front 19

What is Climatic droplet keratopathy (CDK)?

Back 19

• Mechanical trauma from dust and sand

• Bilateral, symmetrical

• Rare – requires chronic UV light exposure

Front 20

Where does Climatic droplet keratopathy (CDK) develop?

Back 20

In Bowman's layer

Front 21

What are the history and symptoms of Climatic droplet keratopathy (CDK)?

Back 21

• Appropriate ocular exposure

• FH+

• Burning sensation

• Sensitivity to wind

• Blurred vision if advanced

Front 22

What are the signs of Climatic droplet keratopathy (CDK)?

Back 22

• Small, golden globules in anterior cornea

• Similar distribution and progress to band keratopathy, but less likely to affect central cornea

• Epithelial irregularity and opacity in later stages

• Reduced VA in later stages

Front 23

What is this?

Back 23

Climatic droplet keratopathy (CDK)

Front 24

How do you manage Climatic droplet keratopathy (CDK)?

Back 24

• Protection from UV and dust, i.e. wrap around sunglasses or avoidance of environment

• Ocular lubricants

• Superficial keratectomy

• If serious, a penetrating keratoplasty

Front 25

What are the associated conditions with Climatic droplet keratopathy (CDK)?

Back 25

• Pterygium

• Pingueculae

Front 26

What is Arcus Senilis?

Back 26

• Peripheral corneal disease

• Bilateral, symmetrical

• Extremely common

• Inceases with age

Front 27

Who is Arcus Senilis seen in?

Back 27

Typically not seen before age 50

Front 28

What does Arcus Senilis affect?

Back 28

Affects Descemet’s layer first, then anterior stroma

Front 29

What are the signs for Arcus Senilis?

Back 29

• Narrow white band, initial deep in cornea, but later both deep and superficial, appears as an arc

• Initially near lower limbus, then upper, then grows round to form a ring

• Clear corneal zone nearly always visible between ring and limbus

Front 30

What is this?

Back 30

Arcus Senilis

Front 31

What is the management for Arcus Senilis?

Back 31

• Explanation and reassurance only if in elderly

• Blood tests for lipid metabolic disorders if in young or middle aged individuals (Corneal Arcus)

Front 32

What are the associated conditions with Arcus Senilis?

Back 32

• Hypercholesterolaemia younger Px’s < 40 yrs

• Coronary heart disease; Atherosclerosis; Stroke

Front 33

What is Bacterial keratitis?

Back 33

• A breach in the corneal surface allows penetration of bacteria

• Much more serious than bacterial conjunctivitis. Sight threatening

• 65% associated with contact lens use. Relative risk 10x-40x. Contact lenses give bacteria food, warmth, and something easy to stick to.

• causing thinning, eventual scarring, and possible perforation

Front 34

What can Bacterial keratitis cause?

Back 34

May cause loss of stromal tissue or corneal perforation

Front 35

What is the history and symptoms of Bacterial keratitis?

Back 35

• Contact lens wear

• Dry eye

• Recent ocular trauma

• RCEE

• Photophobia

• Pain

• Watery discharge (mucopurulent if conjunctiva gets infected too)

Front 36

What are the signs for Bacterial keratitis?

Back 36

• Red eye

• Blepharitis

• Greyish white infiltrate in cornea with overlying epithelial staining

• Corneal stromal oedema

• Anterior uveitis

Front 37

How do you manage Bacterial keratitis?

Back 37

• Culture of corneal swabs and CL/CL case swabs if appropriate

• Broad spectrum topical antibiotic therapy started immediately

• Topical steroids should be used after the infection is resolving to minimise the resultant corneal scarring and thinning

Front 38

What are the associated conditions with Bacterial keratitis?

Back 38

• Bacterial conjunctivitis

• Dry eye

• Herpes Zoster/Simplex

• Corneal trauma

• Recurrent corneal epithelia erosion (RCEE)

Front 39

Name the different types/causes of Viral Keratitis?

Back 39

• Adenoviral Bilateral

• Herpes Simplex (HSK)

• Herpes Zoster (HZO)

Front 40

What is Adenoviral Bilateral Viral Keratitis?

Back 40

• Common, annual incidence 1%

• Incubation 4-10 days, resolves 10-14 days

Front 41

What is Herpes Simplex (HSK) Viral Keratitis?

Back 41

• HSV-1

• Unilateral

• Common, 90% have HSV1, annual incidence 8/100,000, more common in children

• Secondary to primary infection and dormant period in V

Front 42

What is Herpes Zoster (HZO) Viral Keratitis?

Back 42

• VZV

• Unilateral

• Common virus, 90% have VZV, annual incidence 20-40/100,000, incidence doubles each decade from 50

• Secondary to primary infection

Front 43

What are the history and symptoms of Adenoviral Bilateral Viral Keratitis?

Back 43

• Mild burning

• Watery discharge

• Photophobia

• Blurred vision

• URTI

Front 44

What are the history and symptoms of HSK/HZO?

Back 44

• Viral prodrome

• Variable pain

• Watery discharge

• Photophobia

• Variable vision

• Ipsilateral skin lesions

• Post herpetic neuralgia (HZO)

Front 45

What are the sign for Adenovirus?

Back 45

• Watery discharge

• Follicular conjunctivitis

• Scattered subepithelial areolar (snow balls)

• corneal opacities

• Palpable pre-auricular lymph nodes

Front 46

What are the signs of Herpes Simplex (HSK)?

Back 46

• Cold-sore skin lesions on both lids

• Watery discharge

• Conjunctivitis

• Corneal oedema

• AC inflammation

• Dendritic corneal epithelial ulcer, staining with fl and RB

• Later amoeboid ulcer

Front 47

What is this?

Back 47

Adenovirus

Front 48

What is this?

Back 48

Herpes Simplex (HSK)

Front 49

What is this?

Back 49

Herpes Simplex (HSK)

Front 50

What are the signs for Herpes Zoster Opthalmicus HZO?

Back 50

• Characteristic skin lesions following course of V1(Ophthalmic division/nasociliary branch)

• Hutchinson’s sign

• Conjunctivitis

• Palpable pre-auricular lymph nodes

• Multiple corneal microdendites peripheral and central

• Disciform keratitis (as in HSK)

• Scleritis/episcleritis

Front 51

What is this?

Back 51

HZO

hutchinson's sign

Front 52

How do you manage HSK/HZO?

Back 52

• Avoid trigger factors such as trauma and UV exposure

• Avoid contagion (HZO)

• Topical antivirals

• Topical steroids to control inflammation and prevent scarring

• Oral acyclovir

• Cycloplegics if uveitis

Front 53

What are the associated conditions with HSK?

Back 53

• Cold sores

• Uveitis

Front 54

What are the associated conditions with HZO?

Back 54

• Chickenpox

• Every ocular, intraocular and adnexal inflammation

Front 55

What is Fungal Keratitis?

Back 55

• Rare in UK, Unilateral

• Pre-existing ocular surface disease/trauma

• Inoculation with organic materials

• Most destructive and difficult to treat (50%->CF)

Front 56

What are the symptoms of Fungal Keratitis?

Back 56

Slow development of marked pain, watering and photophobia

Front 57

What are the signs of Fungal Keratitis?

Back 57

• Dense, round sub-epithelial corneal infiltrate with surrounding satellite lesions

• Concomitant intraocular inflammation

Front 58

How do you treat Fungal Keratitis?

Back 58

• Steroids promote fungal growth, anti-fungals are toxic to the cornea and several are needed to be effective against all fungi

• PK is often needed before fungus spreads

Front 59

What is Amoebic Keratitis?

Back 59

• Principle infective organism is acanthamoeba

• Principle means of infection is through soft contact lenses

• Protozoa with hard to kill cystic form (trophozite)

Front 60

What can early Amoebic Keratitis resemble?

Back 60

Early infection resembles HSK and slow developing until stroma is invaded

Front 61

What are the history and symptoms of Amoebic Keratitis?

Back 61

• Contact lens usage (esp with tap water)

• Lake or pool swimming

• Hot tub usage

• 50% discomfort, 50% more pain than signs indicate

• Photophobia

• Blurred vision

Front 62

What are the signs of Amoebic Keratitis?

Back 62

• Central punctate epitheliitis and limbitis

• Pseudo-dendrites

• Stromal infiltration along course of corneal nerves

• Stromal ring infiltrate

Front 63

What is the management for Amoebic Keratitis?

Back 63

• Stop CL wear

• Emergency referral to eye casualty

• Topical anti-amoebic and trophozoicidal drugs

• Concomitant treatment with antibiotics and steroids (remove food supply and reduce inflammation)

• PK may be necessary if stromal invasion occurred

Front 64

What is Radiation (UV Keratitis)?

Back 64

• Bilateral, acute, common

• ~25% of workplace ocular injuries in industrial cities

• ~10% of all ocular injuries

• Most damage from l=260-290nm (man made light sources)

Front 65

What are the history and symptoms of Radiation (UV Keratitis)?

Back 65

• Welding/Electrical flash

• Sunbed use

• Exposure to high altitude/highly reflective sunny environments

• Exposure 8-12 hrs prior to onset of Sx

• Intense FB sensation with lacrymation, photophobia and blurred vision

Front 66

What are the signs of Radiation (UV Keratitis)?

Back 66

• Epiphora

• Blepharitis

• Sunburn

• Corneal and conjunctival superficial punctate staining with fluorescein

• Normal tarsal conj and superior cornea

Front 67

What is the management of Radiation (UV Keratitis)?

Back 67

• Reassurance: self limiting condition, usually better within 48hrs

• Advice for hazard avoidance

• Tear lubricants, cold compresses and sunglasses for symptomatic relief

Front 68

What are dystophies and when do they usually start?

Back 68

•usually start early in life,

•affect both eyes symmetrically

•are inherited

•are quite rare

•many will affect central vision and cause pain due to RCEE associated with the growth abnormality.

Front 69

What is the most common dystrophy?

Back 69

EMB dystrophy, is the least damaging and requires the mildest forms of management

Front 70

What are degenerations and when do they start?

Back 70

•usually start late in life

• may be symmetrical or asymmetric

• do not have easily identified inheritance patterns and are common

•They typically affect the peripheral cornea

•do not affect vision.