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172 Cards in this Set
- Front
- Back
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Dystrophies = primary or secondary disorders?*
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Primary (not caused by another reason)
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Degenerations = primary or secondary disorders?*
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Secondary (from a specific insult e.g. trauma, infection, exposure)
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Dystrophies = bilat or unilat?*
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bilat
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Degenerations = bilat or unilat?*
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unilat
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Dystrophies = symmetrical or asymm?*
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symmetrical
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Dystrophies = affect one or many layers of the cornea?*
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one
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Central location = Dystrophy or Degeneration?
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Dystrophy
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T/F - Dystrophies are inherited.
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True
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T/F - Degenerations involve inflammation.
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True
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What are other terms for EBMD?
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Map-Dot-Fingerprint dystrophy
Cogan's Microcystic dystrophy |
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T/F - EBMD can be acquired.
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True - after age 40 or from trauma
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EBMD seen mostly in (males/females) and (hispanics/blacks/caucasians)?
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Caucasian females
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What is the most common change in EBMD?
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geographic maps
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What happens to the basement membrane in EBMD? Why does this happen?
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Thickening of BM due to abnormal turnover, maturation, and synthesis of BM
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The thickened BM in EBMD causes what effects on the epithelium?
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Blocks normal migration of epithelial cells to surface; epith cells around abnormal BM do not form hemidesmosomes which results in weak adhesion of epith to BM
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"Maps" in EBMD is due to?*
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Thickening of BM
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"Fingerprints" in EBMD is due to?*
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Thickened and reduplicated BM
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"Dots" in EBMD is due to?
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Microcysts (trapped cellular debris)
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T/F - EBMD is typically asymptomatic.
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True
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If EBMD Sx arises, what are the typical complaints?
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FB sensation, photophobia, pain, tearing, transient bluring due to irreg epith surface
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What percentage of EBMD develop recurrent corneal erosions?
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10%
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Tx EBMD?
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Asympt = reassure & observe
No erosion = RGPs and SCLs to mask irregularities Erosion = Bandage SCL for comfort and improved vision |
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Tx Recurrent Corneal Erosion?
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- Cycloplegic for pain (2% homatropine)
- AB coverage (FQ) - Epith scraping - When healing complete: hyperosmotics, lubricants - Stromal puncture - PTK |
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T/F - Mild steroids are ok for Tx recurrent corneal erosions
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True (e.g Lotemax, Alrex)
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How long should you Tx recurrent corneal erosions?*
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6-8 wks
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T/F - Bland ointment is contraindicated for recurrent corneal erosions.
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True - will seep into corneal layers and cause more swelling
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T/F - Oral ABs are indicated for recurrent corneal erosions.
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True - can use Tetra or Doxy PO 50-100mg BID 2 mos
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What is the Tx regimen of oral Tetra or Doxy for recurrent corneal erosions? Why use these?
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50-100 mg BID x 2mos
- Anti collagenase properties - Inhibits metalloproteinases that cleave anchoring of Bowman's layer |
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What corneal disease occurs during the 1st 5 yrs of life and pts are asymptomatic until middle age?
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Meesmans' Juvenile Epithelial Dystrophy
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You are observing Christian Bale's cornea and notice a focal thickening of the BM and microcysts all over the cornea (mostly in the visual axis and mid-periphery). He doesn't complain of any Sx hence it didn't stop him from playing his role in "The Dark Knight". What is this?
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Meesmans' Juvenile Epithelial Dystrophy
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How is Meesmans' Juvenile Epithelial Dystrophy best viewed in the slit lamp?*
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Direct focal and retroillumination
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If Meesmans' Juvenile Epithelial Dystrophy is symptomatic, what kinds of Sx would you note and what causes these Sx?
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- Blur - irreg astig due to vesicles
- Irritation, photophobia - when vesicles break - Also can involve glare, photophobia, FB sensation |
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How do you Tx Meesmans' Juvenile Epithelial Dystrophy?
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- Most are non-Sx therefore no Tx
- Bandage SCLs if vesicles break - Erosion if occurs, treat like EBMD (epith scrape, stromal puncture, PTK) |
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Reis-Buckler's Dystrophy involves what layer of the cornea?*
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Bowman's Layer
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T/F - Reis-Buckler's typically occurs in the 1st decade of life, poor vision by age 30.
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False - poor vision by age 20
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You see a fishnet pattern of ring-like subepithelial opacities in Bowman's layer. What is this condition and what are these opacities composed of?
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Reis-Buckler's. Made up of collagen fibrils and thickened epithelium
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T/F - Reis-Buckler's can be associated with recurrent corneal erosions.
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True
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T/F - Reis-Buckler's can be in the peripheral cornea.
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True, but starts from central cornea and progresses to periphery.
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Your patient complains of spontaneous RCEs which has gotten worse over time, loss of corneal sensation, and decreased vision. In the slit lamp, you see opacities forming a honeycomb pattern. What do you suspect?
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Reis-Buckler's
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Tx Reis-Buckler's ?
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- Bandage SCLs for RCEs
- Superficial keratectomy - PTK - PK (Penetrating Keratoplasty - high incidence of recurrence in donor graft) |
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What type of substance causes the opacities in Lattice Dystrophy?
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Amyloid
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Lattice Dystrophy occurs in what layer of the cornea?
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Stroma
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Lattice Dystrophy Type I involves (central/peripheral) opacities early on.
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central
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Lattice Dystrophy involves (thin/thick) lines that (thicken/thin) with age.
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thin, thicken
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RCEs in Lattice Dystrophy Type I are (rare/common)?*
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common
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How is Lattice Dystrophy Type I best seen in the slit lamp (illum and mag)?
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Retroillumination, mod (16x) mag
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T/F - Lattice Dystrophy Type I involves corneal areas between opacities that are clear.
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True
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T/F - Lattice Dystrophy Type I involves deeper stroma with age.
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True
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T/F - Lattice Dystrophy Type II involves many thick refractile lines in the central cornea.*
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False - few refractile lines that extend to the limbus
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T/F - Recurrent erosions in Lattice Dystrophy Type II are rare.
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True
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Lattice Dystrophy Type II is associated with what systemic conditions?
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Systemic amyloidosis, Alzheimer's Disease
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What is systemic amyloidosis?
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Assoc w/ Lattice Dystrophy Type II. Deposition of amyloid in tissues of body, cranial & peripheral neuropathy, skin changes, OAG, pseudoexfoliation
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Lattice Dystrophy Type II involves (vertical/horz/radial) lines in the (central/periph) cornea.*
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radial, periph
(spares the central cornea therefore vision spared) |
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T/F - Both Lattice Dystrophy Types I and II are Autosomal Recessive.*
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False - Autosomal Dominant
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T/F - Both Lattice Dystrophy Types I and II involve erosions.
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True - but common in Type I, rare in Type II
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T/F - There is no systemic involvement in Lattice Dystrophy Type I.
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True
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Tx Lattice Dystrophy?
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- Bandage Cls for RCE
- PTK - PK |
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What is the most common stromal dystrophy?*
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Granular Dystrophy
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What are the deposits in granular dystropy made of?*
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Eosinophilic Hyaline deposits
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Where are the deposits in Granular Dystrophy typically seen early on?*
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Anterior stroma
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T/F - Stroma between opacities in early Granular Dystrophy is hazy.
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False - clear, but later becomes hazy
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T/F - Granular Dystrophy starts centrally and migrates to periphery
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True
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T/F - Late Granular Dystrophy involves coalesced opacities in the anterior stroma.
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False - posterior stroma
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RCEs in Granular Dystrophy is (common/rare)?*
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rare
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What are the Sx of Granular Dystrophy?
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Glare, FB sensation, decr VAs after 5th decade of life (good VAs in early years)
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Tx Granular Dystrophy?
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- Superficial keratectomy/debridement (for early)
- PTK - Bandage SCLs in RCE - Lamellar Keratoplasty - Penetrating Keratoplasty (high recurrence rate, occurs in periphery and migrates centrally) |
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Granular Dystrophy involves opacities that start from the (center/periphery) and move (centrally/peripherally).
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center, peripherally
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T/F - Granular Dystrophy has a high recurrence rate after PK.
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True
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T/F - Lattice Dystrophy has a low recurrence rate after PK.
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True
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A combined granular and lattice dystrophy is involved in...*
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Avellino Dystrophy
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What deposits are involved in Avellino Dystrophy?
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hyaline and amyloid
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T/F - In Avellino Dystrophy, granular changes occur first, then lattice changes occur later.
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True ("Lattice Later")
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What gene is involved with Avellino, Granular, and Lattice Degeneration?*
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BIGH3
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T/F - Macular Dystrophy is Autosomal Recessive.*
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True
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Macular Dystrophy is (more/less) severe than AD dystrophies.
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more (both genes carry the mutation)
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When is the onset for Macular Dystrophy?
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1st decade of life
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When is the onset for Granular Dystrophy?
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1st decade of life
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Your 30 y/o patient has a diffuse stromal haze with milky white opacities affecting all layers of the cornea with poor VAs. You suspect...
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Macular Dystrophy
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Macular Dystrophy involves what type of deposits?*
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Glucosaminoglycans (MPS)
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Macular Dystrophy affects what layer of the cornea?
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All layers (milky white opacities of MPS)
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RCEs in Macular Dystrophy is (rare/common)
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common
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Tx Macular Dystrophy?
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- Bandage SCLs for RCE
- Tinted or cosmetic SCLs to reduce photophobia - PTK - PK (surgical modality of choice; need PK sooner b/c affects VAs earlier) |
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Recurrence after graft is (rare/common) in Macular Dystrophy.
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Rare
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What is the surgical modality of choice in Macular Dystrophy?*
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PK
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T/F - Onset of deposits in Granular, Macular, and Lattice Dystrophy starts in the 1st decade.
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True
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When are the onset of symptoms in the following dystrophies:
- Granular - Macular - Lattice |
Decades:
- Granular = 3rd or no Sx - Macular = 1st - Lattice = 2nd |
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Endothelial dystrophy is characterized by what stages?
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- Guttata
- Stromal or epithelial edema - Corneal fibrosis or scarring |
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What is Guttata?
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Excessive production of BM material which accumulates into these guttata, which projects into the anterior chamber; results in thinning or missing endoth cells over areas of guttata.
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Fuch's Dystrophy = guttata (with/without) corneal edema.
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with (Fuch's is a later stage of endoth dystrophy)
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Endothelial Dystrophy = guttata (with/without) corneal edema.
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without
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Fuch's Dystrophy more common in (males/females).
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Females
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Fuch's Dystrophy more typical in (younger/older) people?
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Older
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T/F - Fuch's Dystrophy is associated with ocular HTN and closed angle glaucoma.
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False - OPEN angle glaucoma
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Fuch's Dystrophy is best seen with what kind of illumination?
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Retro-illumination
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Edema is greatest in what time of the day for Fuch's?
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AM (reports "hazy" vision that improves later in the day)
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T/F - Fuch's Dystrophy has an "orange peel" or "beaten metal" appearance.
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True
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Fuch's Dystrophy can involve (this corneal problem) in later stages.
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Bullous keratopathy
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Bullous Keratopathy (during Fuch's) occurs due to...
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epithelial edema
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Decreased VAs in Fuch's occurs due to...
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cornea surface changes, subepithelial fibrotic scarring
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T/F - Fuch's Dystrophy involves FB sensation but no pain.
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False - does involve pain and discomfort
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Tx Fuch's Dystrophy?
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- Monitor early cases
- Hyperosmotics for edema - Bandage SCLs (for RCE cause by bullae, and for discomfort) - OK to use hyperosmotics over high water content disposable SCL - PK (common indication, can combine w/ cataract extraction in older pts) - Monitor pts w/ glaucoma or ocular HTN |
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Your patient comes in with blurry vision in AM that improves later in the day. You note multiple divots in retroillumination. What is the condition and how do you Tx?
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Fuch's Dystrophy - monitor since it's just an early case
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Posterior Polymorphous Dystrophy = AD or AR?
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Both AD and AR
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Posterior Polymorphous Dystrophy onset?
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Early in life
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Posterior Polymorphous Dystrophy progression?
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non or slowly progressive
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You note the following on your patient's cornea - what do you suspect?
- Abnormal endoth cells - Areas of thickened Descemet's with gray-white circular rings/vesicles - Diffuse stromal and epith edema - Peripheral anterior synechiae |
Posterior Polymorphous Dystrophy
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Posterior Polymorphous Dystrophy is best seen in what illum?
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focal and retro-illum
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Posterior Polymorphous Dystrophy Sx?
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Slowly progressive, VAs good, usualy no Sx.
If Sx = blurry vision, edema (ranging from mild to bullous keratopathy) |
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Posterior Polymorphous Dystrophy Tx?
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- Most pts no Sx & remain stable.
- Hyperosmotics for edema - Bandage SCLs for pain mgt of bullous keratopathy - PK - Treat elevated IOPs |
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Corneal degenerations assoc w/ aging typically are (central/peripheral) and usually visually (significant/insignificant).
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peripheral, insignificant
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Acute corneal degenerations assoc w/ ocular insult are typically due to...
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bacterial keratitis
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Chronic corneal degenerations assoc w/ ocular insult are typically due to...
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recurrent uveitis
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T/F - Corneal degenerations assoc w/ ocular insult are typically (peripheral/central)?
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central (visually impacting)
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Name the four corneal degenerations related to aging changes.
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Arcus Senilis
Limbal Girdle of Vogt Crocodile Shagreen Corneal Farinata |
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What is the most common peripheral corneal opacity?
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Corneal arcus
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What is the theory behind corneal arcus?
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Lipids leak from limbal blood vessels
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Corneal arcus is seen in __% of those over 70 and __% of those over 80.
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75%, 100%
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Systemic hyperlipidemia is associated with what corneal degeneration?*
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Corneal arcus (men under 50)
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Your patient presents with arcus on the left eye, but not on the right. What does this mean? What course of action is next?*
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Possible carotid occlusive disease; side with arcus is normal. Order an MRI/ultrasound.
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If your corneal arcus pt is under 40 years old, what is the course of management?
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Refer for serum cholesterol measurement
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Over __% of Dr. T's patients questioned to admitting having elevated cholesterol levels.
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80%
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Where is the Limbal Girdle of Vogt localized? What shape, color?
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Interpalpebral zone @ 3:00 & 9:00, symmetrical. White arcuate opacity.
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What degeneration is an early form of calcific band keratopathy?
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Limbal Girdle of Vogt Type I
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Limbal Girdle of Vogt Type I is (separated from/connected to) the limbus, and Type II (is/is not) connected.
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separated from, is
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T/F - both types of Limbal Girdle of Vogt require treatment.
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False - no Tx necessary for either
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T/F - Limbal Girdle of Vogt Type II is the degeneration of elastic collagen in the epithelium.
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False - in Bowman's Layer.
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You see polygonal white patches separated by clear intervals at the level of Bowman's; looks like a mosaic/cracked ice. The patient is asymptomatic. What is this?
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Crocodile shagreen
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Corneal Farianata = fine, powder-like, punctate gray-white opacities in what layer of the cornea?
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Deep stroma, pre-Descemet's
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Where is Corneal Farianata found (location and depth)?
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Posterior stroma, exclusively in the interpalpebral region
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T/F - Corneal Farianata is a progressive condition.
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False
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Corneal arcus = dystrophy or degeneration?
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Degeneration
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Salzmann's Nodular Degeneration is caused by...
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Non-specific corneal response to chronic insult (phlyctenulosis, trachoma, keratitis, cornea inflammation)
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Salzmann's Nodular Degeneration is typically (central/peripheral).
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Peripheral (or mid-peripheral)
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Salzmann's Nodular Degeneration is more in (men/women).
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Women
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What is the pathologic process involved in Salzmann's Nodular Degeneration?
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Hyaline plaques form between epith and Bowman's, then epith thins and Bowman's is destroyed.
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T/F - Salzmann's Nodular Degeneration typically affects VAs.
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False - only unless in visual axis
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Tx Salzmann's Nodular Degeneration?
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- Superficial nodules: Superficial keratectomy & PTK
- Lesions extending to mid-stroma: PK (recurrence possible) |
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Lipid Degeneration is in what layer of the cornea?
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Stroma
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T/F - Lipid Degeneration Type I is associated with vascularization.
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False - Type II is assoc w/ vascularization
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Lipid Degeneration is typically central or peripheral?
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either
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Lipids leaking from corneal vessels as a result of corneal insult is characteristic of...
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Lipid Degeneration
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Lipid Degeneration Tx?*
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Stop the deposition of lipids, esp towards pupil - treat the primary disease. Also control inflammation w/ topical corticosteroids.
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T/F - Lipid Degeneration is associated with hyperlipidemia.
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False - lipid metabolism in these pts is normal
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What is the cause of Mooren's Ulcer?*
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Unknown etiology, possibly Type III immune hypersens rxn
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T/F - Mooren's Ulcer involves pain but no inflammation.
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False - there IS inflammation
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T/F - Mooren's Ulcer starts peripherally.
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True, then progresses centrally, circumferentially, and posteriorly
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T/F - Mooren's Ulcer affects both the epithelium and stroma.
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True (epith breakdown and stromal melt)
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T/F - Mooren's Ulcer involves vascularization.
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True
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T/F - Mooren's Ulcer does not involve corneal perforation.
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False - perf is possible since cornea is thinned
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Which type of Mooren's Ulcer is more devestating?
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Type II - not responsive to therapy of any kind
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Which type of Mooren's Ulcer is seen in the elderly?
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Type I
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Mooren's Ulcer Type II = unilat or bilat?
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bilat
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Mooren's Ulcer Type II = painful or no pain?
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Painful
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Tx Mooren's Ulcer?
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- DON'T manage on your own
- Topical ABs - Cycloplegic - Topical steroids - Systemic steroids - Immunosuppressive agents - Serious cases: conj or corneal resection, tissue adhesive - Bilat cases: systemic dz workup |
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You see bilateral gradual thinning of superior and inferior cornea, forming a "gutter." You also see lipid deposition and vascularization. What is this?
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Terrien's Marginal Degeneration
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Terrien's Marginal Degeneration is more common in men or women?
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Men (3x)
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Terrien's Marginal Degeneration involves what Sx?
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Decr VA due to induction of ATR astig; thinning causes flattening of vertical meridian.
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Terrien's Marginal Degeneration Type I = young or old?
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Young (under 20)
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T/F - Terrien's Marginal Degeneration Type I involves episcleritis or scleritis.
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True
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Tx Terrien's Marginal Degeneration?
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- Spectacle or GP Rx
- Custom shape lamellar keratoplasty ("banana" shaped lamellar donor to fit "gutter") - Conj flap resection |
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What corneal degeneration involves a painless corneal thinning just peripheral to an arcus, seen typically in elderly?
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Furrow degeneration
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Furrow degeneration involves an intact or degenerated epith?
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Intact
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Furrow degeneration = inflam or no inflam?
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No inflam
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Furrow degeneration = perf or no perf risk?
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no perf risk
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Tx Furrow degeneration?
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No Tx necessary
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Tx Dellen?
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- Tx or remove adjacent elevation if possible
- Keep dellen lubricated esp at night |
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What corneal dystrophy is assoc w/ peripheral anterior synechiae?
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Posterior Polymorphous Dystrophy (abnormal endoth can grow across trab mesh resulting in glaucoma)
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T/F - Reis Buckler's tends to have a high recurrence rate after PK.
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True
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Which corneal dystrophy involves treating elevated IOPs?
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Posterior Polymorphous Dystrophy
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Macular Dystrophy involves opacities that start from the (center/periphery) and move (centrally/peripherally).
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periphery, centrally
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Lattice Dystrophy Type I involves good vision until age __, Type II at age __.
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40's, 60's
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What typically asymptomatic degeneration involves a breakdown of Bowman's layer?
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Crocodile shagreen
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