Ch 19. Peripheral Corneal Disease.

Question 1

What is the main treatment for Wilson’s disease?

Answer 1

D-Penicillamine

Which prevents disease progression and reduces the amount of copper already deposited in tissues. Ocular examinations help to document reduction of copper in the tissues of the body.

Question 2

Is there a corneal distrophy that affects the peripheral cornea exclusively?

Answer 2

NO

Lattice corneal dystrophy type II, is associated with systemic amyloid deposition, and affects mainly the peripheral corneal, but not exclusively.

Question 3

What proporotion of normal people may have a posterior embriotoxon?

Answer 3

up to 15%

Question 4

What is the systemic vasculitis that most frequently involves the ocular surface?

Answer 4

Of the systemic vasculitides, rheumatoid arthritis is themost common. Rheumatoid arthritis is a multisystem diseasewhich primarily involves the peripheral joints. Nonarticularvasculitis affects 25% of patients and is associated withcardiac disease, pulmonary disease, splenomegaly, and ocular disease.

Question 5

Name this finding

Answer 5

This is a peripheral ulcerative keratitis.

Other than the history of rheumatoid arthritis in this patient, it can be distinguished from other perpheral ulcers by the deep ulceration concentric with the limbus and the steep, undermined central border of the ulcer

Question 6

Name this finding, occuring in an patient affected by rheumatoid Arthritis.

Answer 6

Corneal Furrow

Question 7

What proportion of patients with poliarteritis nodosa wil have ocular disease?

Answer 7

20%

_{in the form of bilateral peripheral ulcerative keratitis.}

Question 8

Granulomatosis with polyangitis (former Wegener’s disease) has two forms of ocular disease, a limited and a severe form. What is the 1 tear mortality of patients with the severe form?

Answer 8

82% at 1 year mortality.

Question 9

(T/F)

The staphylococcal disease is the main cause for flictenular and marginal keratitis, and therefor it should always be treated with topical steroids.

Answer 9

staphylococcal disease is the main source of disease in the developed world. But Tuberculosis associated disease has been described as a strong cause also.

Therefore tuberculosis must be suspected, to avoid steroids in certain scenarios, until after a negative diagnosis.

Question 10

Name the following lesion

Answer 10

Corneal phlyctenule

Question 11

How is the pain described in Mooren’s Ulcer?

Answer 11

Very intense.

Question 12

Is a Corneal Arcus always a normal manifestation of aging?

Answer 12

Not always, it can be a sign of hiperlipoproteinemia, and therefore, lipid profile should be obtained in any patient under 50 who exhibits a corneal arcus

Question 13

Describe terrien’s marginal degeneration.

Answer 13

Peripheral degeneration, typically arrising in the superior cornea, that starts as a peripheral sterile infiltrate that shows progresive vascularization and thinning and leads to progressive astigmatism.

It is ussually not painful, even in the active phase.

Question 14

How can terrien’s marginal degeneration be differentiated from mooren’s ulcer?

Answer 14

Because the former is not painful, while the later is very painful.

The central, leading edge is undermined in mooren’s, and smoth in teriens.

Question 15

What type of astigmatism is produced by Pellucid Marginal Degeneration?

Answer 15

ATR astigmatism