Ocular Disease Mt 2 - Cornea

Front 1

How long does the epithelium take to heal if the basement membrane is damaged? If the BM is not damaged?

Back 1

Damaged = 6-8 days
Not damaged = 2-3 days

Front 2

Corneal scarring occurs if...

Back 2

Interrupt bowman's membrane and below

Front 3

You see a narrow, crescent-shaped white line in the interpalpebral zone of the peripheral cornea, made of small, chalk-like flecks below the epithelium...

Back 3

Limbal girdle of Vogt

Front 4

You see bilateral small grayish-white flecks in the deep corneal stroma, in the interpalpebral limbal region. Endothelium is normal...

Back 4

Corneal farinata

Front 5

You see vertically linear striations in Descemet's membrane...

Back 5

Descemet's striae

Front 6

Your 10 year-old pt has small, circular dark areas projected into the endothelium from Descemet's...

Back 6

Hassal-Henle Bodies (Descemet's Warts)

Front 7

You see a polygon pattern of gray-white opacities separated by clear spaces at the level of Bowman's layer and the Basal epithelium; VAs are normal.

Back 7

Anterior Mosaic Shagreen (crocodile shagreen)

Front 8

You see a faint brownish-green deposition in the lower 1/3 of the cornea in the interpalpebral region...

Back 8

Deposits of iron - Hudson-Stahli line

Front 9

You see a yellow-white ring in the peripheral cornea, localized in the stroma; there is a clear area between the ring and the limbus...

Back 9

Corneal arcus (cholesterol deposition)

Front 10

You see dessication and corneal thinning at the base of a pterygium. Fluorescein pools in the affected area but does not stain...

Back 10

Dellen

Front 11

You see thinning of the superior cornea; the epithelium is intact, and NaFl pools but does not stain the area...

Back 11

Terrien's marginal degeneration

Front 12

You notice a hazy "swiss cheese" appearance across the interpalpebral zone of the cornea; the patient complains of decreased vision and FB sensation. You localize the lesion at the superficial cornea, at Bowman's layer...

Back 12

Calcific Band Keratopathy

Front 13

How do you Tx calcific band keratopathy?

Back 13

EDTA - removes calcium, then scrape gently. CAP eye if epithelium involved. If mild, use artificial tears. Can also use PTK.

Front 14

T/F - Salzmann's nodular degeneration is inflammatory.

Back 14

False - noninflammatory deposition of hyaline plaques between epithelium and Bowman's

Front 15

You see bluish-white spots around the pupillary area, which was preceded by phlyctenules...

Back 15

Salzmann's nodular degeneration

Front 16

You see a slowly progressive marginal ulcer; the eye is red, painful, and the ulcer appears to be spreading from a point in the periphery...

Back 16

Mooren's degeneration

Front 17

Mooren's degeneration in older people is (severe/benign), (unilateral/bilateral), and (hard/easier) to manage vs Mooren's in younger folks.

Back 17

Benign, unilateral, easier

Front 18

You see a small corneal opacity indicating the presence of a previous foreign body; the opacity contains calcium deposition...

Back 18

Coat's white ring - can also have iron deposit

Front 19

T/F - Dystrophies are assoc w/ an acquired loss of function assoc w/ aging, inflammation, infection, or systemic disease.

Back 19

False - Degenerations

Front 20

T/F - Sx in Map-Dot-Fingerprint dystrophies tend to decrease as the pt ages.

Back 20

False - Sx tend to get worse as the pt ages.

Front 21

Map-Dot-Fingerprint is due to areas of (thinning/thickening) of (epithelial/endothelial) basement membrane.

Back 21

thickening, epithelial

Front 22

Recurrent erosions due to poor hemidesmosomal or desmosomal attachments?

Back 22

Hemidesmosomal

Front 23

T/F - Recurrent erosions often associated w/ MDF dystrophy.

Back 23

True; also assoc w/ metaherpetic lesions, bullous keratopathy, exposure keratitis, trichiasis.

Front 24

Recurrent erosions are worst in the AM/PM?

Back 24

AM

Front 25

What is the first step in treating recurrent erosions? What's next after that? How long do you treat?

Back 25

Topical cycloplegic, then topical antibiotic, then pressure patch.

Once healing complete, use hyperosmotic drops for 6-8 wks

Can also use stromal puncture or PTK

Front 26

Your pt has a fragmented bowman's and basement membrane in the central cornea; the patient has reduced VAs, pain, FB sensation, redness, lacrimation...

Back 26

Reis-Buckler (Bowman's Layer dystrophy)

Front 27

Name the types of stromal dystrophies and their causes.

Back 27

1. Macular (Groenow Type II) - MPS deposits
2. Granular (Groenow Type I) - Hyaline deposition
3. Lattice (Biber-Haab-Dimmer) - Amyloid deposition

Front 28

How do you Tx stromal dystrophies?

Back 28

CLs (create regular optical surface), penetrating keratoplasty, excimer laser

Front 29

What is involved with the Central Crystalline Dystrophy of Schneider?

Back 29

Corneal arcus, diffuse central corneal opacification, central crystalline deposits (needle-like), stroma is clear; occasionally assoc w/ hyperlipidemia (hence arcus)

Front 30

What is Bullous Keratopathy?

Back 30

Cornea swells and opacifies, which causes epith to have gaps then vesicles form (w/ fluid inside)

Front 31

What is characterized by abnormal production of descemet's collagen by the endothelium, which causes areas of thickening in the central cornea?

Back 31

Corneal guttata

Front 32

T/F - Gutatta is usually asymptomatic.

Back 32

True

Front 33

How do you Tx guttata?

Back 33

No Tx indicated, watch for signs of Fuch's dystrophy

Front 34

How does Fuch's endothelial-epithelial dystrophy develop?

Back 34

- Central gutatta spreads towards periphery
- Increase in K edema, see folds in Descemet's
- Bullae form (Bullous keratopathy), which can rupture
- Subepithelial layers can become vascularized and scarred

Front 35

Decrease in VAs seen in (Guttata/Fuch's/Both)?

Back 35

Fuch's only

Front 36

T/F - No pain involved w/ Fuch's dystrophy.

Back 36

False - pain is involved when bullae rupture and loss of epith

Front 37

How do you Tx Fuch's dystrophy?

Back 37

NaCl, bandage CL, hair dryer, penetrating keratoplasty, DSEK, antiglaucoma meds to decrease IOP.

Front 38

Fragmentation of Bowman's membrane, resulting in thinning cornea is characteristic of...

Back 38

Anterior keratoconus

Front 39

T/F - Vertical striae or ruptures in Bowman's membrane occur in anterior keratoconus.

Back 39

False - vertical striae or ruptures in DESCEMET's

Front 40

Fleischer's ring occurs (early/late) in _____. It is a deposition of ___.

Back 40

Late, keratoconus, iron in basal epithelium around base of cone.

Front 41

Corneal thinning occurs (late/early) in keratoconus.

Back 41

Late

Front 42

Acute hydrops is associated with...

Back 42

Keratoconus - ruptured Descemet's membrane, resulting in corneal edema

Front 43

What is Munson's Sign?

Back 43

Bulging of eye thru lid when look down in Keratoconus.

Front 44

What is characterized by an anteriorly placed Schwalbe's ring, and the eye is otherwise normal?

Back 44

Posterior embrytoxin (an AC dysgenesis)

Front 45

What is characterized by iris strands (anterior synechiae) extending across the AC angle inserting onto a prominent Schwalbe's ring?

Back 45

Axenfeld's anomaly (an AC dysgenesis)

Front 46

You see a prominent Schwalbe's ring, anterior synechiae, hypoplasia of the iris stroma, and glaucoma...

Back 46

Reiger's anomaly (an AC dysgenesis)

Front 47

You see a corneal leukoma with an anterior synechiae, and the lens is displaced anteriorly, which results in a narrow AC. The patient also has a cleft lip...

Back 47

Peter's anomaly (an AC dysgenesis)

Front 48

Melanin deposits on the endothelium arranged vertically...

Back 48

Kruckenberg spindle

Front 49

Iron deposits at lower 1/3 of cornea...

Back 49

Hudson-stahli line

Front 50

___ deposits at the leading edge of a pterygium is characteristic of ____.

Back 50

Iron, Stocker's Line

Front 51

Your patient has Wilson's Disease, and has ____ deposits at the level of Descemet's; this is characteristic of...

Back 51

Copper; Kayser-Fleischer ring

Front 52

What medications cause whorl-like deposits on the cornea?

Back 52

Amiodarone, Phenothiazine, Chloroquine, Indomethacin

Front 53

T/F - Staph aureus keratitis can result in diffuse SPK.

Back 53

True - but can also cause a band of SPK across the inferior cornea

Front 54

T/F - Staph aureus keratitis can result in SEIs.

Back 54

True, occasionally

Front 55

What med is NOT indicated for Strep keratitis?

Back 55

Aminoglycosides

Front 56

Your patient presents with diffuse SPK, pseudomembrane, conjunctival hemorrhaging, and mucopurulent exudate. What is the causative agent?

Back 56

Strep

Front 57

What is the most common pathogen in CL related bacterial ulcers?

Back 57

Pseudomonas aerunginosa

Front 58

T/F - Diabetes can predispose a pt to corneal ulcers.

Back 58

True

Front 59

T/F - Using steroids can predispose a person to develop corneal ulcers.

Back 59

True

Front 60

You see a gray-white, infiltrated, central ulcer with a distinct border. What is the causative agent?

Back 60

Staph aureus

Front 61

You see a gray ulcer originating from where the patient scratched his eye; it appears to grow towards the center and it has indistinct borders. What is the causative agent?

Back 61

Strep pneumoniae

Front 62

Your patient complains of a grayish mark in the line of his vision which grew since he scratched his eye about 20 hours ago. Under slit lamp you see a ground glass texture, and a severe AC rxn. What is the causative agent? What is the next step?

Back 62

Pseudomonas aeuringinosa; hit hard w/ Fluoroquinolones.

Front 63

Your patient's bacterial ulcer has resolved, but there is still considerable inflammation. Is it appropriate to use steroids?

Back 63

Controversial, but okay as long as after 96 hrs.

Front 64

An ulcer developing over time with a distinct border is a good or bad sign?

Back 64

Good sign (indistinct border = worsening)

Front 65

Are oral antibiotics used in the first line of Tx for corneal ulcers?

Back 65

Must use topical ABs initially, but can use Monocycline or Doxycycline PO - has anti-inflammatory properties.

Front 66

What med is indicated for gram negative cocci causing an ulcer?

Back 66

Ceftriaxone

Front 67

What med is indicated for gram negative rod causing an ulcer?

Back 67

Tobramycin or Gentamycin

Front 68

What is Cefazolin used for?

Back 68

Tx Gram (+) cocci causing ulcer (staph, strep)