BCSC 8. External Disease and Cornea Flashcards
Cornea receives glucose from
Aqueous humor
Increased matrix metalloproteinase-9
DES
Initial treatment for neurotrophic ulcer
bandage contact lens
Shown to reduce postherpetic neuralgia (PHN)
Prior VZ vaccine reduces PHN by 66%
Broad activity against yeast and filamentous funghi
Topical amphotericin B 0.15%
Better for filamentous molds
Natamycin 5%
Treatment for repeated recurrence of HZ keratitis
maintenance dose of valacyclovir
Most common fungal corneal pathogen
Candida (yeast)
Radial perineuritis
Acanthamoebea keratitis
27 yo F s/p LASIK 6 wks ago noted to have infiltrate at interface with no improvement after 3 days of q1hr fluoroquinolone eyedrops. Next step
Lift flap; cx on blood, chocolate agar, Sabourad’s agar. Start Fortified vancoycin and gentamicin q1hr.
MC cause of late interface infections (after 2 weeks)
Slow-growing organisms - Candida or atypical mycobacteria. Require definitive identification of causative agent
Condition a/w keratinized epithelial cells (metaplastic epithelial change)
MUCOUS MEMBRANE PEMPHIGOID - associated conditions. SJS, TEN, GVHD (severe ocular surface dx)
Treatment for large corneal ulcer in nursing home patient
corneal scraping for culture and sensitivity testing, f/b fortified topical vancomycin and gentamicin
Tx for vision rehabilitation for severe ocular surface dx with SJS and TEN
OSTEO-ODONTO-KERATOPROSTHESIS and boston type II keratoprosthesis
Eosinophils in conjunctiva are less numerous and more often degranulated in ___ compared to ___.
Atopic keratoconjunctivitis c/t VKC
Percentage of patients with necrotizing scleritis that have detectable systemic disorder
66%
Percentage of patients with diffuse or nodular scleritis that have detectable systemic disorder
33%
central opacity of cornea with underlying ENDOTHELIAL DEFECT and IRIS ADHESIONS
Peters anomoly
Vertical ruptures in descemet membrane that can lead to corneal edema, permanent vertical striae in posterior cornea resulting in high astigmatism
Birth trauma injury
Horizontal curvilinear breaks in the Descemet membrane associated with congenital glaucoma
Haab striae
Opacities are accumulations of unesterified and esterified cholesterol and phospholipids
Schnyder corneal dystrophy
X-linked recessive disorder of cornea
Hunter and Fabry
Drug a/w cornea verticillata
Amiodarone
Produces lysosomal deposits in basal corneal epithelium creating whorl-like pattern
Amiodarone (similar pattern found in Fabry’s disease)
Inheritance of marfan syndrome
AD
AD disorder a/w defect in fibrillin gene, lens subluxation, scleral thinning (blue) and CORNEAL FLATTENING
Marfan syndrome
Corneal finding in Marfan
Corneal flattening
Thinning of peripheral cornea that is quiet, noninflammatory, slowly progressive.
Terrien marginal degeneration
Line of lipid deposits appears at leading edge of pannus
Terrien marginal degeneration
Lucid interval occurs between limbus and peripheral edge of keratopathy
Calcific band keratopathy
Fine, dustlike, basophilic deposits in bowman membrane
Band keratopathy
Always treat traumatic hyphema with these medicines
TOPICAL CORTICOSTEROIDS and CYCLOPLEGIC drugs - reduce inflammation and put pupil at rest to reduce incidence of rebleeding. +/- oral corticosteroids if severe inflammation. Topical anti-hypertensives mainstay (beta-bloackers and alpha agonists)
Clinical finding that best supports diagnosis of limbal stem cell failure
Absence of limbal palisades of Vogt, abnormal epithelium on cornea, vascularization
Corneal epithelium is highly differentiated cell type that is entirely regenerated approximately
every 7 days
Remove interrupted sutures s/p PK at this time interval
4 weeks
Tx for Fuchs CED
Endothelial keratoplasty (DSEK or DMEK)
POW3 s/p PKP p/w persistent epithelial defect
presume herpetic disease, trial of oral acyclovir 400 mg po QID. Giving topical corticosteroids is CONTRAINDICATED!!
DDx enlarged Corneal Nerves
MARKING "L" Cornea M: MEN II B (med Ca thyroid, pheo, neuroma) A: Acanthamoeba R: Refsum's disease (phytanic acid/Riley Day) K: Keratoconus I: Icthyosis N: Neurofibromatosis G: Grafts (failed) Glaucoma (infantile) L: Leprosy
D/Dx Ring infiltrate
the PATH to ring infiltrate P: Pseudomonas A: Acanthamoeba T: Topical anesthetic abuse H: Herpes simplex virus
MPS does NOT heavily involve cornea
Sam the Hunter must see to shoot
S: Sanfilippo
H: Hunter
MPS most heavily involves cornea
Hurler and Scheie’s
Cloudy Corneas
STUMPED S: Sclerocornea T: Tears in descemet's (infantile glaucoma, birth trauma) U: Ulcers (HSV, bacterial, neutotrophic) M: Metabolic (mucopolysaccaridosis) P: Peter's anomaly E: Endothelial dystrophies (CHED, PPMD, CHSD D: Dermoid
Direct penetration of intact epithelium
"N & N Can Lyse Hole Skin" Neisseria gonorrhea N. meningidides Corynebacterium diptheriae Listeria Hemophilis Shigella
Derived from neuroectoderm
ROVINZ R: RPE/Pig CB epi O: Optic nerve/axons V: Vit (all) I: Iris sphincter/dilator N: Neurosensory ret/nonpig CB epithelium Z: Zonules
Derived from surface ectoderm
CCLLSZ C: Cilia C: Conj/Cornea epithelium L: Lids/Lacrimal gland and drainage L: Lens S: Skin Z: Zonules
Derived from mesoderm
MEETS M: Mesoderm E: EOM E - Endotherlial blood vessels T: Temporal sclera S: Schlem's canal