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NBEO STEP 1 > 3.7 cornea > Flashcards

3.7 cornea Flashcards

1
Q

Causes of Dellen?

A

poor fitting GP lens
pterygia
bleb
tumor

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2
Q

cause of exposure keratopathy?

A

CN VII issue or lid issue causing incomplete lid closure

CN 7 - bells palsy, CVA, aneurysm, MS, HSV, HSZ

orbicular issue - surgery leading to ectropion, TED, lagnopthalmos, FES

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3
Q

what are symptoms that patient experiences with exposure keratopathy?

A

symptoms worse in the morning

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4
Q

what are signs of exposure keratopathy?

A

SPK -> ulcer

decreased sensitivity

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5
Q

causes of filamentary keratitis? What is the.most common?

A

chronic irritation -> dry eye
** most common cause KCS
FES, SLK, CLS, PKP, erosions, neurotrophic keratopathy

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6
Q

what are the filaments made from in filamentary keratitis?

A

degenerated epithelial cells and mucous
*** stain with NAFL

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7
Q

What is thygeson’s ? how long does it take to resolve. Who?

A

bilateral intraepithelial central crumb-like lesions that are raised that occur due to an unknown cause in 20-30 yo

exacerbations - can last 1-2 months if not treated

remissions

can take 10-20 years to resolve

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8
Q

what causes neurotrophic keratopathy?

A
  • damage to V1, VII
    surgery - cut V1- lasik, maxillary repair, etc

chronic corneal injury - cls, corneal
dystrophies

systemic disease - HSV,HSZ, DM

meds: timolol, betaxolol, diclofenac sodium

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9
Q

How does V1 affect the cornea?

A

regeneration, healing, nociceptors for pain

decreased sensitivity
reflex blinking

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10
Q

How can damage to CN 7 cause neurotropic keratitis

A

decreased reflex tearing

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11
Q

what things can affect CN 7?

A

bells
tumor
surgery - acoustic neuroma removal
MA
CVA
MS
HSV/HSZ

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12
Q

signs of neurotrophic keratitis

A

decreased sensitivity
SPK -> ulcer - > can lead to perforation b/c non-healing
no inflammation

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13
Q

what is the pathophys of RCE?

A

poor hemidesmosome attachment
to basement membrane

secondary to trauma, corneal dystrophies, thickening of BM with age

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14
Q

causes of UV/ thermal keratopathy?

A

sun exposure
welding
skiing
using a sun-lamp

high UVc - open K+ channels -> loss of intracellular K+ -> cell death

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15
Q

what layers absorb what wavelength of light in the cornea?

A
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16
Q

tear meniscus height normal

A

0.2 mm or greater

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17
Q

aqueous deficient testing

A

schirmer 1 - no anesthetic (basal, reflex, emotional )
- normal > 10 mm in 5 mins , < 5 mm = abnormal

schirmir 2 - only basal
normal > 5 mm in 5 mins

phenol red
> 10 mm in 15 seconds normal

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18
Q

evaporative testing

A

TBUT < 10 seconds abnormal

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19
Q

rose bengal vs lissamine green

A

dead and devitalized conjunctival and corneal cells, as well as cells that have lost their mucous covering

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20
Q

Tear hyperosmolarity

A

abnormal > 308, or difference > 8 most/L

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21
Q

types of aqueous deficient dry eye

A
  1. Sjögren’s Syndrome Dry Eye
    - primary
    - secondary
  2. Non-Sjögren’s Syndrome Dry Eye
    - gland attacked
    - block ducts
    - cut nerves
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22
Q

Sjögren’s Syndrome Dry Eye categories

A

primary - dry eye, dry mouth

secondary - dry eye, dry mouth + CT disorder (RA>SLE, polyartertis, granulomatosis w/ polyangititis

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23
Q

most common rheumatic disorder?

A

RA

second - Sjögren’s

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24
Q

attacked gland dry eye cause

A

sarcoid
lymphoma
aids
graft vs host disease

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25
blocked gland dry eye causes
OBSTUCTION Of lacrimal gland ducts - trachoma - pemphigoid - Erythema multiform - burns
26
cut nerves dry eye
cls DM bells drugs NK infection - HSV/HSZ surgery
27
extrinsic causes of dry eye
vitamin a deficiency topical anesthetics cls wear
28
intrinsic causes
lid pathology or dynamics low blink rate (parking sons, concentration) lid position disorders (TED, lagopthalmos) MGD, bleh
29
why does vitamin A cause dry eye?
- essential for goblet cell and glycocalyx development. - result in aqueous tear-deficient dry eye as a result of lacrimal gland acinar damage - Bitot’s spots on the conjunctiva
30
What are corneal ecstasies?
keratoconus pellucid keratoglobus
31
what do all the corneal ecstasies lead to?
hydros -> break in descemets
32
keratoconus cause
- 13% AD inheritance - most sporadic - starts in puberty - MMPs -> damage Bowmans causing collagen 1 fibril displacement -> loss of adhesion b/w fibrils -> thinning and profusion
33
keratoconus associated conditions
1. ocular allergic: ocularallegic: VKC, AKS, FES ocular K-dystrophies: Fuch's, PPMD, granular, lattice "finger grinding leads to protrusion" ocular hereditary: RP, lebers, ROP, Anaridia, cone dystrophy systemic: T-DOME (turners, down, osteogenesis imperfect, marfans , Ehler danlos + atopic dermatitis , mitral valve prolapse
34
early and later signs of KCN
early: scissoring reflex, irregular keratometry miers Fleischer's ring, inferior topo steepening late: Vogt's striae (stromal vertical lines, go away with pressure), munson's sign, Rizuti's sign ( conical refection on nasal cornea when shine light temporally), hydrops
35
Pellucid cause What does it lead to
collagen abnormality leads to protrusion above area of thinning! and ATR astigmatism
36
severity of KCN based on K values
mild < 48D mod 48-54 severe > 54
37
who gets pellucid
20-40s
38
pellucid vs KCN
- ≠ KCN: (-) cone, Fleischer’s ring, Vogt’s striae
39
keratoglobus who gets it? Associated conditions?
- birth AR inheritance or get it from advanced keratopathy (KCN), trauma, exophthalmos associated with Ehler's-danlos and Leber;s
40
what is keratoglobus
diffuse thinning in the periphery occurs at birth AR inheritance
41
What do all corneal dystrophies have in common?
AD bilateral (-) neo if anterior/stromal -> RCE if stromal/ posterior -> KCN
42
Cogan's microcytic dystrophy names
EBMD ABMD Map dot finger print
43
Cogan's microcytic dystrophy who. gets it?
AD, females > males ** most common anterior corneal dystrophy
44
what causes EBMD? complications
excessive BM production -> mature corneal cells trapped under BM -RCE (Usually asymptomatic until get this) - 10% of ABMD - RCE - 50% RCE = ABMD
45
Meesmans
" multiple cysts" AD condition that affects epithelium in 1st year of life - 100s of bilateral intraepithelial cysts across entire cornea can lead to RCE
46
Reis- Buckler who? What?
AD occurs early in life - 4/5tears old - Bowmans layer is replaced with Collagen -> PAIN (RCE) -> decrease with time , but opacities worse with age grey reticular opacities in central cornea look like " Reeces pieces"
47
stromal corneal dystrophies
1. macular 2. granular 3. Avellino 4. Lattice 5. Schnyder's " Marilyn Monroe got hers in LA" all lead to RCE
48
macular dystrophy
think "Mac daddy"- AR!!!!! (least common, most severe ie affect vision early by 30 years old) diffuse strömal haze (3-9 years old) leads to stromal opacification , stromal thinning, and multiple grey/white opacities in all layers of the cornea everywhere RCE***
49
what are the macular dystrophies opacities?
mucopolysaccarhide deposits
50
granular dystrophy
start getting by age 10, vision loss at 60 snowflake granules (hyaline deposits in central stroma) spread to epi and deep stroma - become confluent and decrease VA - rarely get RCE
51
Avellino dystrophy
variant of granular dystrophy has both granular like and lattice - like deposits in the central cornea
52
lattice dystrophy
AD stromal dystrophy amyloid deposits Anterior stromal haze with branching, refractile lattice lines. Decreased va by 30s because of stromal haze and scarring RCE
53
What stromal dystrophies have a mutation in the TGFB1 gene?
granular lattice avellino
54
Posterior corneal dystrophies
Fuchs Posterior polymorphous dystrophy
55
Fuchs Who? Symptoms? Causes? Complications? What can worsen it?
30% hereditary Post menopausal
56
Posterior polymorphous dystrophy Who Symptoms Signs Complications
20-50 or see hazy cornea at birth Symptoms: decreased vision secondary to edema , most asymptomatic , bilateral Complications: Bullae, corneal edema
57
Endothelial cell count normal/abnormal
58
Congenital anterior segment anomalies
Megalocornea Microcornea Cornea plana Anaridia Haab striae Axonfield reiger syndrome Peters Anomaly Limbal dermoid Forceps injury
59
Megalocornea Who
X linked - males Bilateral corneal diameter > or equal to 13 mm High myopes with steep cornea - have good VA with correction Can be associated with lens subluxation and angle abnormalities -> glaucoma because of stretching of the tissue - associated with CT disorders - think TDOME
60
Microcornea
61
Cornea plana
Corneal curvature = scleral curvature - flat corneas < 38 D , hyperopia, shallow AC, increased risk of angle closure glaucoma Associations : sclerocornea/ Microcornea
62
Sclerocornea
63
Haab striae vs forceps injury
64
Axenfield reiger syndrome
Angle Anomolies = prominent iris processes to level of PE - can obscure SS

NBEO STEP 1 (14 decks)

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