AED - Corneal Ectasia - Week 11 Flashcards
Is bowmans membrane a basement membrane like descemets membrane? Explain its structure in this regard.
It is not
It is an acellular layer composed of randomly arranged collagen fibres
How thicc is the corneal stroma typically?
500μm
What is corneal ectasia characterised by? List three things that contribute to this.
Corneal conditions that are characterised by progressive thinning of the corneal stroma
-biochemical weakening
-increased corneal curvature
-irregular astigmatism
List three classifications of corneal ectasia and give an example each.
Degenerative
-keratoconus
-pellucid marginal degeneration
Congenital anatomy
-keratoglobus
Mechanical trauma such as post-surgery
-iatrogenic ectasia
Is keratoconus progressive? Is it symmetrical or asymmetrical? Is it inflammatory?
Progressive, typically asymmetrical, and non-inflammatory
What is keratoconus characterised by? Is it uni- or bilateral?
Progressive thinning of the axial corneal stroma
It is bilateral
What condition is the most common primary corneal ectasia?
Keratoconus
In what regions is the prevalence of keratoconus higher?
Regions where cosanguinity occurs
What is the onset of keratoconus? When does it stabilise? Does its clinical course vary significantly or not?
Typical onset at puberty
Stabilises ~35-40yoa
Clinical course varies significantly
List 6 associations with keratoconus. Are associations common or is it an isolated ocular finding?
Most commonly an isolated ocular finding
Possible associations include:
-atopy (vernal, athsma, eczema)
-leber’s congenital amaurosis
-retinitis pigmentosa
-down’s syndrome
-connective tissue disorders
-mitral valve prolapse
What is the aetiology and pathogenesis of keratoconus?
Uncertain
What is the mode of inheritance for keratoconus? Does it have complete or variable penetrance?
Autosomal dominant with variable penetrance
What does the link between keratoconus and connective tissue disorders suggest?
A possible genetic abnormality in connective tissues
What do family members of a keratoconic individual typically have?
30-50% have subtle topographic abnormalities
Explain two biochemical abnormalities of proteinases in keratoconus.
Increased proteinase activity
Decreased activity of proteinase inhibitors
How does interleukin-1 affect keratocytes (3)?
It is a key modulator of keratocyte proliferation, differentiation, and death
What is interleukin-1 produced by in the eye (2)?
Epithelium and endothelium
How do interleukin-1 receptor levels compare in keratoconic eyes vs normal eyes?
Four-fold more IL-1 receptors in keratoconic eyes
What does epithelial trauma result in the release of and what consequence does this have (2)?
Increased release of IL-1, which results in increased keratocyte loss and stromal thinning
What band of UV light does the cornea absorb most? What does this result in?
Most of the UVB light
Results in the creation of oxygen free radicals, resulting in oxidation damage
List three general biochemical abnormalities in keratoconus.
Proteinases
IL-1
Oxidative damage
List two environmental influences of keratoconus. What consideration may be given for this?
High levels of atopy including hayfever
Vigorous eye rubbing
Consider topical antihistamine or mast cell stabiliser therapy
In what percentage of patients is hayfever an environmental influence for keratoconus?
Approximately half of patients
What is the histopathology of the cornea in keratoconus (biochemical resistance?
50% decrease in biochemical resistance
What is the d cross linking like in keratoconic eyes?
A decrease in d cross links between and within collagen fibres in the anterior stroma
List four primary corneal changes in a keratoconic eye.
Epithelial anomalies
Breaks in bowmans layer
Stromal thinning
Descemets membrane breaks
What happens to the basal epithelial cells in keratoconic corneas (2)? What does this result in (2)?
Basal epithelial cells degenerate
Down-growth of epithelial basal cells into bowmans membrane
Results in a thickened basement membrane-like layer and breaks in bowmans layer occurs
What fills breaks in bowmans layer in a keratoconic eye?
Filled by eruptions of underlying stromal collagen
What are fleischers ring in keratoconic eyes and where can it be found?
Iron deposits in basal cells at the base of the cone
Is lamellae organisation affected in keratoconus? Explain.
Yes, the gross organisation changes
It is more compact and there is loss of arrangement
What happens to fibre bundle thickness and corneal nerve density in keratoconus?
Reduced density of corneal nerves and thicker fibre bundles
Is decemet’s membrane affected early on or late into the disease with keratoconus?
Late into the disease
What results due to breaks in descemets membrane (3)?
Acute corneal hydrops
Aqueaous enters the corneal stroma
Dramatic corneal oedema occurs
Are the symptoms of keratoconus stable or highly variable?
Highly variable
List 7 possible symptoms of keratoconus.
Blurred vision
Increased light sensitivity
Flaring of lights
Difficulty with night vision
Eye strain
Dry/itch/irritated eyes
History of eye rubbing
List 7 signs of keratoconus.
Reduced best corrected visual acuity
Frequent changes in refraction
Scissor reflex with retinoscopy
Charleux oil droplet with ophthalmoscopy
Doubled/distorted mires with keratometry
Corneal topography
Reduced central corneal thickness with pachymetry
What three things can be found with a slit lamp assessment of a keratoconic eye?
Vogt’s striae (corneal folds)
Fleischer’s ring
Corneal stromal thinning
What is corneal nerve visibility like in a keratoconic eye with slit lamp examination?
Increased visibility
Define musnon’s sign for keratoconus.
A V-shaped indentation observed in the lower eyelid when patient gaze is directed downwards