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Cornea Flashcards

rock cornea

0
Q

K verticilata

Facts in

A 
Fabrys
Amio
Chloroquine
Tamoxifen
Subconj gent
Ibupofen
Naproxen
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1
Q

Whats Avelino dys?

A 
Gran + lattice
LGA airport (lattice granular avellino all same family)
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2
Q

Whats meretoja sx

A

Lattice and systemic amyloid

Masked facies and cranial n palsies

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3
Q

Stumped

A 
Sclerocornea
Trauma (foreceps)
Ulcer
Metabolic conditions 
Peters
Endothel dystrophy
Dermoid
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4
Q

What % of peters will be bilateral?

A

60

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5
Q

Which dystrophies are tgfb1?

A 
Large (5 letters = chrom. 5)
Lattice
Avellino
Reis bucklers
Granular
Empty
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6
Q

What does a pt w schnyders k dysrophy c/o?

A

Decr vision during day when pupil small bc cant get thru central cholest plaquea

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7
Q

Whats the eye finding in goldenhars

A

Dermoids

Preaur skin tag
Bellybutton tag

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8
Q

Name 8 causes of spontaineous hyphema

A
  1. Retinoblastoma
  2. Von willinbrand
  3. Leukemia
  4. Juv xanthogran (tuton)
  5. Nvi
  6. Hemophilia
  7. Iris melanoma
  8. Zoster uveitis
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9
Q

Refractive power of the cornea

A

43.25

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11
Q

What syndrome is keratoglobus ass w?

A

Ehlera danlos

Can have deafness

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12
Q

short stature, short stubby fingers, microspherophakia, extopia lentis

A

weill-marchessani

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13
Q

whats the surgical risk in a pt w nanophthalmos?

A

spontaneous choroidal hemorrhage

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14
Q

microphthalmos

A

small screwed up eye

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15
Q

what causes keratoglobus?

A

high IOP pushes against ectatic cornea causing thinning and K readings in the 60s

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16
Q

name 3 syndrome associated with keratoglobus

A

1) LCA
2) Ehlers-danlos
3) Rubenstein-Taybi syndrome

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17
Q

what syndrome is limbal dermoid associated with?

A

Goldenhaar

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18
Q

Name the 3 indications for corneal surgery

A

1) center of K has opacity and cant see through it
2) opacity NEAR visual axis causing astigmatism that cant be corrected with glasses
3) pain/redness failed medical treatment

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19
Q

name 2 causes of massive telangiectasias of the conj

A

1) ataxia-telangiectasia (aka Louis bar- AR)

2) osler-weber-rendu syndrome (plt disorder w renal compromise)

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20
Q

name 5 causes of follicular conjunctivitis

A 
adeno hardly happens to careful nuns
adenovirus
herpes
hemorrhagic conjunctivitis (picornavirus)
chlamydia
newcastles disease (a bird virus)
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21
Q

what causes ligneous conjunctivitis?

A

type 1 plasminogen deficiency

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22
Q

whats the finding in CIN

A

“fimbriated blood vessels” grows rapidly in immunocompromise

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23
Q

how do you treat CIN?

A

Excisional biopsy with surrounding cryo

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24
Q

where does SCC of conj usually appear?

A

by limbus and may be white bc its growing faster than the eye can lubricate it so it keratinizes itself

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25
Q

when do you biopsy PAM?

A

> 1 cm in diameter

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26
Q

whats the w/u for conj malignant melanoma?

A

full body scan and LFTs

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27
Q

whats the surgical management of sebaceous cell ca

A

full-thickness lid biopsy–send fresh for oil red o staining

don’t forget its pagetoid spread (spreads from deep to superficial)

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28
Q

what causes episcleritis and how do you treat it?

A

its just irritation, lubricate

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29
Q

whats the symptoms of scleritis?

A

deep pain

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30
Q

whats the workup for scleritis?

A

infectious, collagen vascular dz

rf, ana, anca,lyme, syphilis, tb

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31
Q

how do you treat scleritis?

A

NSAIDS

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32
Q

Whats posterior embryotoxon?

A

anteriorly displaced prominent schwalbes line

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33
Q

whats the abnormality in peters?

A

no K endo or decemets

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34
Q

Whats the abnormal finding in chandlers syndrome

A

clinically iris looks normal but there is “reversal” on the specular microscopy- cells look black w white borders

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35
Q

whats zirgan?

A

ganciclovir ointment

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36
Q

how do you treat acanthomeba?

A

biguanide (PHMB) or chlorhexadine

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37
Q

what was the variable in HEDS1?

A

Everyone on viroptic but…did steroid help treat stroma keratitis?

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38
Q

2 findings of heds1

A

1) use steroid for stromal keratitis

2) use oral acyclovir 400tid for iridocyclitits

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39
Q

finding of heds2

A

acyclovir 400bid x 1 yr reduced recurrence by 41%

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40
Q

whats the ring you see in herpes?

A

Wesley immune ring

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41
Q

post-lasik pt with stroma keratitis..cause?

A

atypical mycobacteria- had an outbreak bc of reusable blades. Treat with amikacin

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42
Q

which mucopolysaccaride does not involve the cornea?

A

sanfillipo and hunters

“sam the hunter must see to shoot”

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43
Q

whats the finding in thygessons

A

bilateral in boys white eyes, white deposits, negative staining

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44
Q

cogan syndrome

A

interstitial keratitis with defness

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45
Q

whats the treatment of fungal keratitis?

A

topical natamycin 5%

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46
Q

ddx of enlarged K nerve MARKING L cornea

A 
MEN2B
Acanthomeba
Riley day/refsums dz
Keratoconus
Icthyosis
NF1
Grafts (failed)
Leprosy
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47
Q

4 drugs that cause K verticilata

A

1) amiodorone
2) indomethacin
3) chloroquine
4) hydroxychloroquine

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48
Q

corneal graft rejection sign

A

khohodust line (inflammatory cells on K endo)

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49
Q

how could prostate cancer cause blepharitis?

A

anti-androgen treatment causes decr meibomian gland fxn

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50
Q

how does early acanthomeba present

A

PERINEURITIS in the cornea with pain- culture on non-nutrient agar w e coli overlay

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51
Q

which herpes are associated with cin?

A

HHV 16 AND 18 (HHV 6 and 11 is conj papilloma)

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52
Q

how do you manage terriens marginal degeneration

A

rx for glasses to account for any astigmatism and counsel the pt that the astig may get worse with time

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53
Q

what are salzmanns nodules (looks like clear lump on surface)?

A

post-inflammatory thing when bowmans get replaced by fibrillar material. Treat with superficial keratectomy

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54
Q

what is type 2 lattice dystrophy?

A

meretoja syndrome- get recur erosions from lattice and systemic amyloid deposition, can have cn7 palsy

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55
Q

terriens marginal degen

1) bilat v unilat
2) red eye or white eye?
3) location of thinning?
4) young or old?
5) treatment?

A

bilateral
white
limbus, esp sup-temp, with lipid bc of bridging blood vessels
young
rx for astigmatism caused by the thinning- usually steep at 180 bc thins at 90

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56
Q

moorens

1) unilat v bilt
2) red eye or white eye?
3) old or young pts?
4) epi defect or no epi defect?
5) rx?

A 
unilateral
red eye
older pts
\+epi defect
steroids!!!! bc its an immunologic resp possibly to hepatitis
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57
Q

PUK

1) unilater or bilat?
2) cause?
3) w/u?
4) rx?

A

unilateral
infectious or autoimmune
cbc, ana, anca, syphilis, ace, ppd
doxy or conj recession to move inflammatory mediators away from cornea

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58
Q

whats the difference between moorens and PUK?

A

look the same but in PUK theres a known autoimmune or inflammatory cause

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59
Q

what causes phlectunule? where in cornea occur? how to treat?

A

type-4 t cell mediated inflammation
post-allergy
fleshy nodule at limbus
rx with steroids

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60
Q

what serotypes of chlamydia causes trachoma

A

serotypes A-C

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61
Q

Whats the treatment of trachoma?

A

1) topical erythro

2) oral erythro x2 weeks for concomitant pneumonitis

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62
Q

what causes SLK?

A

mechanical rubbing of lid on conj eg in thyroid. can rx by trimming conj

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63
Q

atopic conjunctivitis

1) kids or older pple?
2) whats the usual pmhx include?
3) finding
4) rx?

A

older pple
eczema/atopy
GPC
steroids

64
Q

Vernal conjunctivitis

1) kids or older pple?
2) name 2 findings
3) rx

A

kids, seasonal
horner trantas dots/GPC/eosinophilia
steroids

65
Q

whats the histologic finding in band K?

A

calcium hydroxyapetite in bowmans

66
Q

where is keyser Fleischer ring located?

A

decemets

67
Q 
IRON LINES
Hudson stahli line
stocker
fleicher
ferry
warring
A 
Hudson stahli line- bleb
stocker- PTG
fleicher-KCN
ferry- bleb
warring- RK
68
Q

what hereditary dz is associated with K verticilatta?

A

Fabrys disease (alpha galactosidase deficiency)

69
Q

what does salzmanns look like?

A

clear bump

70
Q

1) whats the cause of salzmanns

2) how to treat salzmanns?

A

1) post inflammatory fibrillar material at level of bowmans

2) lubricate or superficial keratectomy

71
Q

whats inside the dots in meesmans dystrophy and what stains it?

A

“peculiar substance” PAS+

72
Q

What the electron microscopy finding in reiss bucklers?

A

rod-shaped (R for Reiss buckler)

73
Q

whats the electron microscopy finding in theil benke?

A

curly fibers
has honey-comb appearance in central K only
recurrent erosions due to path at level of bowmans

74
Q

which is the only AR corneal dystrophy?

A

macular

75
Q

whats the typical CCT in Fuchs?

A

> 650

76
Q

what CCT foreshadows bad outcome in CE?

A

> 625

77
Q

What type of abnormal collagen is found in fuchs?

A

fetal banded type 8 collagen

78
Q

is PPMD visually signif?

whats the clinical finding?

A

NO

Snail tracks

79
Q

which dystrophy recurs the most in PK?

A

Reiss bucklers

80
Q

whats “irregular astigmatism?

A

no bowtie pattern!

81
Q

who gets keratoglobus?

how steep is the k?

A

1) ehlers-danlos or collagen disorders

2) >50 also thin all over

82
Q

what ideal cell count in a donor cornea

A

> 2500

83
Q

whats the wavelength of the excimer laser?

A

193nm

84
Q

whats an epikeratoplasty? and who gets it?

A

sew an extra K on top of your K. Used for aphakic pts

85
Q

whats an abnormal TBUT?

A

<10secs

86
Q

how do you do a schirmers I?

A

no anesthetic- measure tears with paper- <10mm is abnormal

87
Q

how is rose Bengal and lissamine green different from fluorescein?

A

rose Bengal and lissamine stain dead/sick cells

fluorescein stains erosion

88
Q

whats the optical principle behind keratometry?

A

“optical doubling”

89
Q

name 3 causes of mucin deficiency

A

1) SJS
2) OCP
3) linear IgA deficiency

90
Q

what are 2 drugs you can use for MGD?

A

1) Doxy

2) Azasite (topical azithromycin)

91
Q

whats the ddx for any inflammation in the eye?

or vasculitis

A 
TB
Sarcoid
lyme
Syphillis
Wegeners
Lupus
92
Q

OCP and SJS what type of hypersens rxn?

A

type 2 (direct ab vs. tissue)

93
Q

what do you do immunofluorescence for (3 things)?

A

SJS
OCP
Linear IgA deficiency

94
Q

how do you treat OCP systemically?

A

dapsone- but not if have G6PD deficiency

95
Q

what meds can cause symblepharon?

A

1) ecothiophate

2) BAK

96
Q

How does muro help EBMD?

A

Helps create adhesions between epithelial cells

97
Q

staph- clusters or chains?

A

clusters

“the staff clusters around the water cooler”

98
Q

who gets filamentary dry eye?

A

severe dry eye (mucus adheres to eroded area)

99
Q

whats the potassium content of the lens?

A

HIGH! pumps K INTO lens

100
Q

whats the metabolism pathway in the lens?

A

anaerobic unless high glucose then shifts to HMP shunt

101
Q

whats the direction of subluxation in homocystinurea?

A

down and in

102
Q

atopic dermatitis- what type of cataract?

A

anterior subcapsulr

103
Q

3 risk factors for psc cataracts?

A

1) smoking
2) dm2
3) steroid use

104
Q

when do you get “oil droplet cataract” that you see on retroillumination

A

galactosemia

105
Q

what’s the minimum ecc for a k donor graft

A

2000

106
Q

how long after CE does CME tend to appear?

A

6-10 weeks

107
Q

what type of hpv casues

  • sessile squam papilloma
  • peduculated squam papilloma
A

sessile- hpv 16, 18 (sex-ile- teenage yrs 16, 18)

peduculated hpv 6, 16

108
Q

what do you see in bietti corneal dystrophy?

A

AR (dirty dozen type thing)
crystals in k periphery
nyctalopia from retinal degenration

109
Q

what does the schimflug (pentacam) measure?

A

anterior and posterior K curvature, CCT and ACD

110
Q

Besides hep c, what else can moorans be associated with?

A

flukes

111
Q

whats the mutation in meesmans

A

KRT12

112
Q

name ecc
at birth
young adult
65 yo

A

4000
3000
2500

113
Q

recurrence in grafts of dystrophies

Really? Lets graft more

A

reis bucklers
lattice
granular
macular

114
Q

age of presentation of stromal dystrophies

“might like to grow”

A

macular
lattice
granular

115
Q

what are shield ulcers ass with?

A

vernal conjuctivitis

116
Q

whats GPC associated with?

A

cl wear
vernal conjunct
atopic conjunct

117
Q

how does doxy effect the cornea?

A

inhibits martix metalloproteinase

118
Q

does scleromalacia perforans have inflammation?

A

NO

119
Q

What alpha hemolytic strep?

A

strep viridens

120
Q

at what CCT does epi edema typically appear

A

> 700

121
Q

what are cowdry bodies associated with?

A

hsv and vzv

122
Q

how does the K get neurtrophils and lysozyme?

A

tears (NOT limbal blood vessels)

123
Q

snow blindness and welding injury can damage what layer of the K?

A

Epithelium

124
Q

PUK involves the sclera but ……. does not

A

moorens (K only)

125
Q

what bugs can invade intact epitelium? CHANLS

A 
corneybacterium
haemophilus
aegyptus
Neisseria
listeria
shigella
126
Q

what type of crystallins are the most in the lens

which are largest

A

Beta is the most common

alpha are the largest w highest molecular weight

127
Q

what contributes to anterior capsular phimosis?

A

any dz with loose zonules–> the capsule can contract more

128
Q

which type of icthyosis has K changes?

A

X LINKED

129
Q

What bug causes chronic angular blepharoconjunctivitis?

A

Moraxella lacunata

130
Q

which map measures central corneal power?

A

axial map

131
Q

which map measures peripheral corneal power?

A

instantaneous map

132
Q

what kind of K changes do you see with aniridia?

A

progressive opacification

133
Q

what causes thygessons? how do you treat?

A

dry eye and mgd, occurs in boys usually bilateral

lubricate +/- lotemax or fml

134
Q

whats lisch epithelial dystrophy?

A

x-linked epi dystrophy
similar to meesmans
has clear intervening spaces between the cysts

135
Q

what finding on exam indicates that post-op K edema may resolve

A

clear cornea periphery

136
Q

what contributes the refractive power of the K. The air/tear interface or the tear/cornea interface?

A

air/tear!!!!!

137
Q

in which case would you consider doing a running suture in a pk?

A

KCN

kids, thin K, vasc K- do interupteds

138
Q

what part of the K is effected wit “fleck” dystrophy?

A

stroma

139
Q

what are filaments made of and how do you treat?

A

epi with mucus core

10% N-acetylcystine

140
Q

at what ECC will you start getting K edema?

A

500 cells

141
Q

which mucopolysaccaridoses actually causes clouded corneas?

A

hunters
hurlers
schies
sanfillipos

142
Q

what can you look for on an ELISA in macular K dystrophy

A

sulfated keratin sulate

143
Q

how do you treat hydrops?

A

observe

or possible muro +bcl

144
Q

UBIAD1 gene causes which dystrophy?

A

schnyders

145
Q

besides apple green birefringence, lattice can stain with what?

A

crystal violet metachromasia

146
Q

you see a “wavelike” K epi irregularity, what dz are you thinking?

A

limbal stem cell deficieny staining pattern is 2/2 conjunctivization of the K

147
Q

which drop is ineffective for ice?

A

pilo

drugs of choice are aq suppressants like b-block and cai

148
Q

In the hav recurrence trial, what was found to cause recurrences?

A

None!

Stress, sunlight, menatruation and cl wear were not proven to be triggers for outbreaks

149
Q

Which type of adenovirus causes ekc?

A

Type 8

150
Q

what level of the K does crocodile shagreen effect?

A

deep stroma

151
Q

is crocodile shagreen visually significant?

A

no

152
Q

whats the biggest difference between crocodile shagreen and central cloudy dystrophy of francois?

A

crocodile- 2/2 old age

francois- AD inherited disorder

153
Q

TGFB1 - LARGE dystrophies- what locus is fucked up

A

5q31

154
Q

whats the thinnest part of the cornea?

A

temporal to center

155
Q

at what level of the K, is K verticilatta?

A

epi

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