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OD2 (S1&2) > AED - Corneal Degenerations and Deposits - Week 10 > Flashcards

AED - Corneal Degenerations and Deposits - Week 10 Flashcards

1
Q

Are corneal degenerations typically familial or non-familial? Are they early or late-onset?

A

Non-familial
Usually late onset

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2
Q

Are corneal degenerations symmetrical or asymmetrical? Are they uni- or bilateral? Do they occur centrally or peripherally?

A

Asymmetric, unilateral, and can be central or peripheral

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3
Q

Define corneal degeneration and note what it is characterised by (3).

A

Changes to the corneal tissue due to inflammation, age, or systemic disease
Characterised by a deposition of material, thinning of the tissue, or vascularisation

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4
Q

What is band keratopathy, what is it composed of, how does it appear, what colour and in what region (3)?

A

A band of grey/white deposits in the sub-epithelial region, bowmans layer, and/or the anterior stroma

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5
Q

List three general causes of band keratopathy and note hich one is rare.

A

Idiopathic
Age-related
Hereditary

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6
Q

List three ocular conditions that can result in band keratopathy. Are they common?

A

Chronic ocular inflammation
Silicone oil in the eye after ocular surgery
Longstanding glaucoma
Common

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7
Q

List three metabolic conditions that can cause band keratopathy. Are they common?

A

Hypercalcaemia
Gout
Chronic renal failure
Uncommon

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8
Q

List 3 symptoms of band keratopathy.

A

May develop surface irritation
Blurred vision
Glare

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9
Q

List a sign of band keratopathy.

A

Grey/white opacities in the anterior cornea

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10
Q

Do symptoms of band keratopathy arise immediately?

A

Is asymptomatic initially

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11
Q

Where on the cornea is band keratopathy opacities generally confined to? Are there any clear areas?

A

Interpalpebral area - clear zone at the limbus

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12
Q

What may opacities of band keratopathy contain and what may these possibly be? Explain these structures.

A

May contain holes, possibly nerve endings
They become elevated and nodular.

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13
Q

Is it easy or difficult to mistake band keratopathy?

A

Difficult

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14
Q

What is the treatment for mild band keratopathy (2)?

A

Artificial tears or bandage contact lenses for comfort it necessary and vision is unaffected
Identify the underlying cause and treat if able or refer

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15
Q

What is the treatment for band keratopathy with poor comfort and affected vision (4)?

A

Referral needed
-chelating agent after removing epithelium to manually remove calcium
-superficial (manual) or phototherapeutic keratectomy

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16
Q

What counsel may need to be given to band keratopathy patients?

A

Counselled that it is likely to recur if the underlying cause remains

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17
Q

Describe phototherapeutic keratectomy for treating band keratopathy. Explain its advantage over manual superficial keratectomy.

A

Laser thechnique to remove the corneal epithelium
Designed to minimise tissue removal and reduce surgical trauma

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18
Q

Is salzmanns nodular degeneration common or rare? Is it inflammatory? Does it progress quickly?

A

Rare, non-inflammatory, and slow progression

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19
Q

Is salzmanns nodular degeneration typically uni- or bilateral?

A

Usually bilateral, but can be unilateral

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20
Q

In what age and gender is salzmanns nodular degeneration most common?

A

Middle-aged women

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21
Q

Describe what salzmanns nodular degeneration looks like, including texture, colour (2), flatness, and composition. What is it sometimes described as?

A

Smooth, blue/white, elevated nodules sometimes described as avascular pannus
Made of fibrocellular material

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22
Q

Describe in detail the composition of salzmanns nodular degeneration, and between what two layers it occurs.

A

Irregularly arranged collagen fibrils with hyalinisation between the epithelium and bowmans layer

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23
Q

List three conditions associated with salzmanns nodular degeneration. What do these three have in common?

A

Associated with chronic keratopathy
-vernal keratoconjunctivitis
-trachoma
-interstitial keratitis

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24
Q

List 5 symptoms of salzmanns nodular degeneration.

A

Surface discomfort
FB sensation
Increased lacrimation
Photophobia
Blurred vision

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25
Q

Is salzmanns nodular degneration always symptomatic?

A

No, can be asymptomatic

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26
Q

What happens to the epithelium overlying a nodule in in salzmanns nodular degeneration?

A

Atrophies

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27
Q

What colour are the nodules in salzmanns nodular degeneration? Are they single or multiple lesions? Are they raised or flat? Where on the cornea can they be found?

A

Single or multiple grey-white elevated lesions found anywhere on the cornea

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28
Q

What can sometimes be found at the base of nodules in salzmanns nodular degeneration?

A

Possible iron deposits

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29
Q

List three differential diagnoses for salzmanns nodular degneration.

A

Phyctenule
Band keratopathy
Spheroidal degeneration

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30
Q

List two treatment options for salzmanns nodular degeneration.

A

Usually tear supplements for comfort
Ocassional manual removal, or PTK, or at worst a lamellar or penetrating graft

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31
Q

Can salzmanns nodular degeneration recur with removal of the nodules?

A

May recur

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32
Q

Is terriens marginal degneration common or rare?

A

Rare

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33
Q

Is terriens marginal degneration uni- or bilateral? Does it cause pain? Does it progress fast or slow?

A

Bilateral (can be unilateral), painless, and slowly progressive

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34
Q

What is terriens marginal degneration? What is its aetiology? What age and gender does it most commonly affect?

A

Progressive thinning of the peripheral corneal stroma
Unknown aetiology
Most commonly affects older males

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35
Q

List three symptoms of terriens marginal degneration. Explain what happens initially (3).

A

No pain
No redness
No photophobia
Initially asymptomatic with periodic irritation, then decreasing vision

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36
Q

What occurs as a result of corneal thinning in terriens marginal degneration?

A

Irregular astigmatism

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37
Q

What can generally be seen with terriens marginal degneration (colour, composition, and transparency) and where does it usually begin? What eventually happens?

A

Fine white punctate stromal lipid opacities, usually beginning superiorly
Coalesces and progresses to mild superficial vascularisation (pseudopterygium)

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38
Q

How does the thinning pattern of terriens marginal degneration progress?

A

In a circumferential pattern

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39
Q

Is the overlying epithelium intact in terriens marginal degneration?

A

Yesd

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40
Q

Is there a clear zone in terriens marginal degneration (aside from the central cornea)? What can often be found on the leading edge?

A

Separated from the limbus by a clear zone
Leading edge often has yellow lipid deposits

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41
Q

What does terriens marginal degneration ultimately result in?

A

A peripheral corneal gutter, with the cliff end facing the central cornea

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42
Q

What is there a higher risk of with terriens marginal degneration?

A

Perofration potential

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43
Q

What magnitude of astigmatic changes can terriens marginal degneration cause?

A

> 10D

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44
Q

List three differential diagnoses for terriens marginal degneration.

A

Pellucid marginal degeneration
Pannus/pterygium
Other peripheral ulcerations

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45
Q

List 4 treatment options for terriens marginal degneration.

A

Corneal topography
Pachymetry
Astigmatic correction
Keratoplasty for poor vision

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46
Q

Is spheroidal degeneration common or rare?

A

Rare

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47
Q

Is spheroidal degeneration uni- or bilateral?

A

Can be either

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48
Q

What kind of people does spheroidal degeneration generally affect?

A

People who work outdoors (high UV, extreme temperature, dry environment etc)

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49
Q

Which gender does spheroidal degeneration affect more?

A

M>F

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50
Q

What is the primary form of spheroidal degeneration? Are there any other forms?

A

Primary form affects the cornea (corneal form)
Can also affect the conjunctiva

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51
Q

What associated structure may be present with spheroidal degeneration?

A

Pterygium

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52
Q

List three symptoms of spheroidal degeneration.

A

Surface irritation
Burning
FB sensation

53
Q

How does spheroidal degeneration appear, including location, size, shape, colour, composition, and layer found in.

A

Interpalpebral, small, globular, yellow-brown, proteinaceous droplets in bowmans layer and superficial stroma

54
Q

What is the surrounding corneal stroma of spheroidal degeneration lesions like?

A

Often opaque

55
Q

Does spheroidal degeneration begin centrally then peripherally or vice versa, or everywhere at once?

A

Begins peripherally and progresses centrally

56
Q

What can advanced lesions of spheroidal degeneration look like (2)?

A

Become nodular and elevated

57
Q

List 4 treatment options for spheroidal degeneration.

A

Advice on UV protection
Initially, ocular lubricants for comfort
Referral for epithelial debridement - superficial keratectomy
Occasionally penetrating keratoplasty

58
Q

Is polymorphic amyloid degeneration common or rare?

A

Relatively uncommon

59
Q

Is polymorphic amyloid degeneration uni- or bilateral?

A

Bilateral

60
Q

Is polymorphic amyloid degeneration harmful?

A

Innocuous

61
Q

When does polymorphic amyloid degeneration typically occur?

A

After the age of 50

62
Q

How does polymorphic amyloid degeneration appear, including appearance, shape, composition, and layer found in.

A

Varying sizes of refractile, punctate, comma-shaped and filamentous amyloid deposits throughout the stroma

63
Q

What slit lamp technique is best to see polymorphic amyloid degeneration?

A

Retroillumination

64
Q

Does polymorphic amyloid degeneration have any systemic associations?

A

No

65
Q

What is the treatment for polymorphic amyloid degeneration?

A

None required

66
Q

What layer of the cornea are polymorphic amyloid degeneration lesions typically found

A

Mid to deep stroma

67
Q

What are corneal deposits due to? What are two key features of them?

A

Abnormal accumulation of material in the cornea
Key features are depth and pigmentation

68
Q

Is corneal arcus common or rare?

A

Very common

69
Q

Is corneal arcus uni- or bilateral?

A

Usually bilateral

70
Q

What is corneal arcus (composition), where does it come from, and in what two layers is it most prominent?

A

Lipid deposits in the cornea from the vasculature
Most prominent near bowmans layer and descemets membrane

71
Q

Define corneal senilis. What is it rarely associated with?

A

Universal in those over 80 years old
Rarely associated with abnormal blood lipids

72
Q

Define corneal juvenilis. What may it be due to? If unilateral, what should be checked for and on which side?

A

May be due to hyperlipidaemia in those under 40 years of age
If unilateral, need to check for carotid disease on the uninvolved side

73
Q

What can corneal juvenilis occur in?

A

Schnyders crystalline dystrophy

74
Q

What is a symptom of corneal arcus?

A

Asymptomatic

75
Q

Where do corneal arcus lesions begin (2) and which direction do they later extend?

A

Lipid deposits begin inferiorly and superiorly and later extend laterally

76
Q

Is there a clear zone with corneal arcus?

A

Yes, at the limbus, thinner in old people

77
Q

What is the treatment for corneal arcus (2)?

A

No treatment required unless a referral is needed to check blood lipids

78
Q

Is lipid keratopathy common or rare?

A

Relatively uncommon

79
Q

Is lipid keratopathy uni- or bilateral? What region of the eye can it affect (3)?

A

Unilateral, may be central, peripheral, or diffuse

80
Q

What form of lipid keratopathy is less common, and what features does it have? Is it uni- or bilateral?

A

Primary form
Has features of corneal dystrophy

81
Q

Describe the secondary form of lipid keratopathy, including colour, composition, edge appearance, blood supply, clear zone, and layer found in.

A

White/yellow corneal stromal lipid deposits
Have feathery edges and are separated by a clear narrow zone from corneal stromal neovascularisation

82
Q

What two conditions may the secondary form of lipid keratopathy be associated with?

A

Previous HSV or HSK

83
Q

In what case can vision be affected in lipid keratopathy?

A

If located centrally

84
Q

What is the treatment for lipid keratopathy and why?

A

Topical steroids to reduce neovascularisation

85
Q

Is vogts limbal girdle common or rare? Which age group?

A

Very common in patients >45 years of age

86
Q

Is vogts limbal girdle uni- or bilateral?

A

Bilateral

87
Q

What does vogts limbal girdle look like? What colour, region of the eye (2), and shape?

A

Chalky white deposits along the nasal and temporal limbus, in the inter-palpebral fissure, crescent-shaped

88
Q

What does histology suggest of the deposits found in vogts limbal girdle (2) and from this what may it be related to?

A

Either elastoid or calcified deposits
-possible relation to band keratopathy

89
Q

What is a symptom of vogts limbal girdle?

A

Asymptomatic

90
Q

Which layer are the deposits of vogts limbal girdle found in?

A

They are sub-epithelial

91
Q

Are deposits found in vogts limbal girdle connected to the limbus (2)?

A

They may or may not be separated from the limbus

92
Q

What is the treatment for vogts limbal girdle?

A

No treatment necessary and totally benign

93
Q

Is vortex keratopathy uni- or bilateral? Is it symmetrical?

A

Bilateral and symmetrical

94
Q

What colour do deposits in vortex keratopathy have? How are they arranged and in what layer? How does it extend?

A

Golden-brown deposits in the corneal epithelium arranged in a curvi-linear fashion and extends outward in a swirl (whorl-shaped)

95
Q

Is the limbus spared in vortex keratopathy?

A

Yesd

96
Q

Where do vortex keratopathy deposits begin and as what?

A

Below the pupil as punctate deposits

97
Q

What a natural cause of vortex keratopathy? What is the mode of inheritance and what kind of disease is it? What else can cause it? Give the most common as an example.

A

Fabrys disease, an x-linked lipid metabolism disorder
Can be drug-induced
-amiodarone

98
Q

Can female carriers of vortex keratopathy still show signs?

A

Yesd

99
Q

List 6 ocular signs of fabrys disease.

A

Optic atrophy
Conjunctival aneurysms
Lens opacities
Papilloedema
Macular oedema
Retinal oedema

100
Q

List 6 systemic signs of fabrys disease.

A

Hand and foot pain
Skin blemishes
Heart attack
Stroke
Kidney disease

101
Q

What is a symptom of vortex keratopathy?

A

Largely asymptomatic

102
Q

What is required when assessing vortex keratopathy? What is the treatment (3)?

A

Determine the cause
Referral for opinion regarding dose if dose-induced
If fabrys is suspected, referral for diagnosis

103
Q

Describe a rust ring (corneal iron deposit). What two layers will it typically be found in? What may it require?

A

Epithelial or stromal rust from corneal foreign body
May require further debridement with appropriate trauma management

104
Q

What is the cause of hudson-stahli line? Describe it, the layer its found in, and location. What does it occur with? What treatment is required?

A

Idiopathic
Epithelial iron deposit just below the mid-point of the interpalpebral fissure
Occurs with advancing age
No management required

105
Q

Where can fleischers ring be found and in what condition? What formation does it have? What can it assist with? What treatment is required?

A

Found at the base of the cone in keratoconus with a circulat formation
May assist in diagnosing keratoconus, but doesnt alter management if present

106
Q

Where can stockers line be found and in what condition? What layer? What may it indicate?

A

Epithelial iron deposit at the leading edge of a pterygium
May indicate slowed growth of the pterygium

107
Q

Where can ferrys line be found and in what condition? What layer? Are they common or rare? Are they significant?

A

Epithelial iron deposit at the front edge of a filtering bleb
Rare with no significance

108
Q

Where can siderosis be found (what layer) and following what? What does location affect? What may be necessary and why?

A

Stromal iron deposits from an intraocular foreign body
Location affects management of the foreign body
Graft may be necessary to restore visiond

109
Q

Where can haemosiderosis be found (what layer) and following what?

A

Stroml iron deposits as a result of intraocular blood (hyphaema)

110
Q

Are kayser-fleischer rings common or rare? Are they uni- or bilateral?

A

Rare and bilateral

111
Q

What is the composition of kayser-fleischer rings? What layer are they found in? What colour?

A

Copper deposits found in descemets membrane
Green-brown deposits

112
Q

List 4 possible causes of kayser-fleischer rings.

A

Wilsons disease
Liver cirrhosis
Motor disorders
Non-wilsonian liver diease

113
Q

What is wilsons disease? What mode of inheritance?

A

Autosomal recessive disease caused by ceruloplasmin enzyme deficiency

114
Q

In what meridian do kayser-fleischer rings begin? Where does it extend to eventually? What technique may be necessary to see the rings in early cases?

A

Begins in the vertical meridian
Extends to involve corneal circumference
Early cases may need gonioscopy to see deposits

115
Q

What may be associated with kayser-fleischer rings? What can this result in?

A

May have associated sub-capsular lenticular deposits, resulting in a sunflower cataract

116
Q

What is the treatment for kayser-fleischer rings (2)?

A

Referral for diagnosis/management of systemic disease
-copper celating agents

117
Q

Is crocodile shagreen common or rare? Is it uni- or bilateral? Is it symptomatic? In what patients is it often evident?

A

Uncommon
Asymptomatic
Bilateral
Often edivent in older patients

118
Q

How does crocodile shagreen appear (including shape)? What layer? What is it separated by? Is it a clear corneal dystrophy?

A

Greyish-whitte polygonal stromal opacity separated by relatively clear areas
Is not a clear corneal dystrophy

119
Q

What part of the eye is crocodile shagreen most common? Explain.

A

Most common anterior but can be posterior

120
Q

What is the treatment for crocodile shagreen?

A

No management required

121
Q

Is corneal farinata common or rare? Is it uni- or bilateral? Is it symptomatic?

A

Relatively common
Asymptomatic
Bilateral

122
Q

How does corneal farinata appear? What layer? What region of the eye is it most prominent?

A

Minute flour dust-like white deposits that are in the deep stroma
Most prominent centrally

123
Q

What is the mechanism behind corneal farinata (accumulation of what compound in what cells)? What causes this?

A

Cause unknown but thought to be lipofuscin accumulation in stromal keratocytes

124
Q

What slit lamp technique best allows you to see corneal farinata?

A

Retroillumination of the iris

125
Q

What is the treatment for corneal farinata?

A

None required

126
Q

Accumulation of what compound at what layer of the eye causes corneal guttata? This is caused by what cell abnormality? What appearance does this give the endothelium?

A

Due to focal accumulations of abnormal collagen on the posterior surface of descemets membrane
Caused by endothelial cell abnormalities
Gives the endothelium a beaten metal appearance

127
Q

What disease are corneal guttata most commonly associated with?

A

Fuchs endothelial dystrophy

128
Q

Are peripheral guttatae related to Fuchs endothelial dystrophy? Explain.

A

Are visible in normal adult corneas, and unrelated to fuchs endothelial dystrophy

OD2 (S1&2) (174 decks)

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