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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
when do you biopsy PAM?
>1 cm in diameter
26
whats the w/u for conj malignant melanoma?
full body scan and LFTs
27
whats the surgical management of sebaceous cell ca
full-thickness lid biopsy--send fresh for oil red o staining | don't forget its pagetoid spread (spreads from deep to superficial)
28
what causes episcleritis and how do you treat it?
its just irritation, lubricate
29
whats the symptoms of scleritis?
deep pain
30
whats the workup for scleritis?
infectious, collagen vascular dz | rf, ana, anca,lyme, syphilis, tb
31
how do you treat scleritis?
NSAIDS
32
Whats posterior embryotoxon?
anteriorly displaced prominent schwalbes line
33
whats the abnormality in peters?
no K endo or decemets
34
Whats the abnormal finding in chandlers syndrome
clinically iris looks normal but there is "reversal" on the specular microscopy- cells look black w white borders
35
whats zirgan?
ganciclovir ointment
36
how do you treat acanthomeba?
biguanide (PHMB) or chlorhexadine
37
what was the variable in HEDS1?
Everyone on viroptic but...did steroid help treat stroma keratitis?
38
2 findings of heds1
1) use steroid for stromal keratitis | 2) use oral acyclovir 400tid for iridocyclitits
39
finding of heds2
acyclovir 400bid x 1 yr reduced recurrence by 41%
40
whats the ring you see in herpes?
Wesley immune ring
41
post-lasik pt with stroma keratitis..cause?
atypical mycobacteria- had an outbreak bc of reusable blades. Treat with amikacin
42
which mucopolysaccaride does not involve the cornea?
sanfillipo and hunters | "sam the hunter must see to shoot"
43
whats the finding in thygessons
bilateral in boys white eyes, white deposits, negative staining
44
cogan syndrome
interstitial keratitis with defness
45
whats the treatment of fungal keratitis?
topical natamycin 5%
46
ddx of enlarged K nerve MARKING L cornea
``` MEN2B Acanthomeba Riley day/refsums dz Keratoconus Icthyosis NF1 Grafts (failed) Leprosy ```
47
4 drugs that cause K verticilata
1) amiodorone 2) indomethacin 3) chloroquine 4) hydroxychloroquine
48
corneal graft rejection sign
khohodust line (inflammatory cells on K endo)
49
how could prostate cancer cause blepharitis?
anti-androgen treatment causes decr meibomian gland fxn
50
how does early acanthomeba present
PERINEURITIS in the cornea with pain- culture on non-nutrient agar w e coli overlay
51
which herpes are associated with cin?
HHV 16 AND 18 (HHV 6 and 11 is conj papilloma)
52
how do you manage terriens marginal degeneration
rx for glasses to account for any astigmatism and counsel the pt that the astig may get worse with time
53
what are salzmanns nodules (looks like clear lump on surface)?
post-inflammatory thing when bowmans get replaced by fibrillar material. Treat with superficial keratectomy
54
what is type 2 lattice dystrophy?
meretoja syndrome- get recur erosions from lattice and systemic amyloid deposition, can have cn7 palsy
55
terriens marginal degen 1) bilat v unilat 2) red eye or white eye? 3) location of thinning? 4) young or old? 5) treatment?
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
56
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?
``` unilateral red eye older pts +epi defect steroids!!!! bc its an immunologic resp possibly to hepatitis ```
57
PUK 1) unilater or bilat? 2) cause? 3) w/u? 4) rx?
unilateral infectious or autoimmune cbc, ana, anca, syphilis, ace, ppd doxy or conj recession to move inflammatory mediators away from cornea
58
whats the difference between moorens and PUK?
look the same but in PUK theres a known autoimmune or inflammatory cause
59
what causes phlectunule? where in cornea occur? how to treat?
type-4 t cell mediated inflammation post-allergy fleshy nodule at limbus rx with steroids
60
what serotypes of chlamydia causes trachoma
serotypes A-C
61
Whats the treatment of trachoma?
1) topical erythro | 2) oral erythro x2 weeks for concomitant pneumonitis
62
what causes SLK?
mechanical rubbing of lid on conj eg in thyroid. can rx by trimming conj
63
atopic conjunctivitis 1) kids or older pple? 2) whats the usual pmhx include? 3) finding 4) rx?
older pple eczema/atopy GPC steroids
64
Vernal conjunctivitis 1) kids or older pple? 2) name 2 findings 3) rx
kids, seasonal horner trantas dots/GPC/eosinophilia steroids
65
whats the histologic finding in band K?
calcium hydroxyapetite in bowmans
66
where is keyser Fleischer ring located?
decemets
67
``` IRON LINES Hudson stahli line stocker fleicher ferry warring ```
``` Hudson stahli line- bleb stocker- PTG fleicher-KCN ferry- bleb warring- RK ```
68
what hereditary dz is associated with K verticilatta?
Fabrys disease (alpha galactosidase deficiency)
69
what does salzmanns look like?
clear bump
70
1) whats the cause of salzmanns | 2) how to treat salzmanns?
1) post inflammatory fibrillar material at level of bowmans | 2) lubricate or superficial keratectomy
71
whats inside the dots in meesmans dystrophy and what stains it?
"peculiar substance" PAS+
72
What the electron microscopy finding in reiss bucklers?
rod-shaped (R for Reiss buckler)
73
whats the electron microscopy finding in theil benke?
curly fibers has honey-comb appearance in central K only recurrent erosions due to path at level of bowmans
74
which is the only AR corneal dystrophy?
macular
75
whats the typical CCT in Fuchs?
>650
76
what CCT foreshadows bad outcome in CE?
>625
77
What type of abnormal collagen is found in fuchs?
fetal banded type 8 collagen
78
is PPMD visually signif? | whats the clinical finding?
NO | Snail tracks
79
which dystrophy recurs the most in PK?
Reiss bucklers
80
whats "irregular astigmatism?
no bowtie pattern!
81
who gets keratoglobus? | how steep is the k?
1) ehlers-danlos or collagen disorders | 2) >50 also thin all over
82
what ideal cell count in a donor cornea
>2500
83
whats the wavelength of the excimer laser?
193nm
84
whats an epikeratoplasty? and who gets it?
sew an extra K on top of your K. Used for aphakic pts
85
whats an abnormal TBUT?
<10secs
86
how do you do a schirmers I?
no anesthetic- measure tears with paper- <10mm is abnormal
87
how is rose Bengal and lissamine green different from fluorescein?
rose Bengal and lissamine stain dead/sick cells | fluorescein stains erosion
88
whats the optical principle behind keratometry?
"optical doubling"
89
name 3 causes of mucin deficiency
1) SJS 2) OCP 3) linear IgA deficiency
90
what are 2 drugs you can use for MGD?
1) Doxy | 2) Azasite (topical azithromycin)
91
whats the ddx for any inflammation in the eye? | or vasculitis
``` TB Sarcoid lyme Syphillis Wegeners Lupus ```
92
OCP and SJS what type of hypersens rxn?
type 2 (direct ab vs. tissue)
93
what do you do immunofluorescence for (3 things)?
SJS OCP Linear IgA deficiency
94
how do you treat OCP systemically?
dapsone- but not if have G6PD deficiency
95
what meds can cause symblepharon?
1) ecothiophate | 2) BAK
96
How does muro help EBMD?
Helps create adhesions between epithelial cells
97
staph- clusters or chains?
clusters | "the staff clusters around the water cooler"
98
who gets filamentary dry eye?
severe dry eye (mucus adheres to eroded area)
99
whats the potassium content of the lens?
HIGH! pumps K INTO lens
100
whats the metabolism pathway in the lens?
anaerobic unless high glucose then shifts to HMP shunt
101
whats the direction of subluxation in homocystinurea?
down and in
102
atopic dermatitis- what type of cataract?
anterior subcapsulr
103
3 risk factors for psc cataracts?
1) smoking 2) dm2 3) steroid use
104
when do you get "oil droplet cataract" that you see on retroillumination
galactosemia
105
what's the minimum ecc for a k donor graft
2000
106
how long after CE does CME tend to appear?
6-10 weeks
107
what type of hpv casues - sessile squam papilloma - peduculated squam papilloma
sessile- hpv 16, 18 (sex-ile- teenage yrs 16, 18) | peduculated hpv 6, 16
108
what do you see in bietti corneal dystrophy?
AR (dirty dozen type thing) crystals in k periphery nyctalopia from retinal degenration
109
what does the schimflug (pentacam) measure?
anterior and posterior K curvature, CCT and ACD
110
Besides hep c, what else can moorans be associated with?
flukes
111
whats the mutation in meesmans
KRT12
112
name ecc at birth young adult 65 yo
4000 3000 2500
113
recurrence in grafts of dystrophies | Really? Lets graft more
reis bucklers lattice granular macular
114
age of presentation of stromal dystrophies | "might like to grow"
macular lattice granular
115
what are shield ulcers ass with?
vernal conjuctivitis
116
whats GPC associated with?
cl wear vernal conjunct atopic conjunct
117
how does doxy effect the cornea?
inhibits martix metalloproteinase
118
does scleromalacia perforans have inflammation?
NO
119
What alpha hemolytic strep?
strep viridens
120
at what CCT does epi edema typically appear
>700
121
what are cowdry bodies associated with?
hsv and vzv
122
how does the K get neurtrophils and lysozyme?
tears (NOT limbal blood vessels)
123
snow blindness and welding injury can damage what layer of the K?
Epithelium
124
PUK involves the sclera but ....... does not
moorens (K only)
125
what bugs can invade intact epitelium? CHANLS
``` corneybacterium haemophilus aegyptus Neisseria listeria shigella ```
126
what type of crystallins are the most in the lens | which are largest
Beta is the most common | alpha are the largest w highest molecular weight
127
what contributes to anterior capsular phimosis?
any dz with loose zonules--> the capsule can contract more
128
which type of icthyosis has K changes?
X LINKED
129
What bug causes chronic angular blepharoconjunctivitis?
Moraxella lacunata
130
which map measures central corneal power?
axial map
131
which map measures peripheral corneal power?
instantaneous map
132
what kind of K changes do you see with aniridia?
progressive opacification
133
what causes thygessons? how do you treat?
dry eye and mgd, occurs in boys usually bilateral | lubricate +/- lotemax or fml
134
whats lisch epithelial dystrophy?
x-linked epi dystrophy similar to meesmans has clear intervening spaces between the cysts
135
what finding on exam indicates that post-op K edema may resolve
clear cornea periphery
136
what contributes the refractive power of the K. The air/tear interface or the tear/cornea interface?
air/tear!!!!!
137
in which case would you consider doing a running suture in a pk?
KCN kids, thin K, vasc K- do interupteds
138
what part of the K is effected wit "fleck" dystrophy?
stroma
139
what are filaments made of and how do you treat?
epi with mucus core | 10% N-acetylcystine
140
at what ECC will you start getting K edema?
500 cells
141
which mucopolysaccaridoses actually causes clouded corneas?
hunters hurlers schies sanfillipos
142
what can you look for on an ELISA in macular K dystrophy
sulfated keratin sulate
143
how do you treat hydrops?
observe | or possible muro +bcl
144
UBIAD1 gene causes which dystrophy?
schnyders
145
besides apple green birefringence, lattice can stain with what?
crystal violet metachromasia
146
you see a "wavelike" K epi irregularity, what dz are you thinking?
limbal stem cell deficieny staining pattern is 2/2 conjunctivization of the K
147
which drop is ineffective for ice?
pilo | drugs of choice are aq suppressants like b-block and cai
148
In the hav recurrence trial, what was found to cause recurrences?
None! | Stress, sunlight, menatruation and cl wear were not proven to be triggers for outbreaks
149
Which type of adenovirus causes ekc?
Type 8
150
what level of the K does crocodile shagreen effect?
deep stroma
151
is crocodile shagreen visually significant?
no
152
whats the biggest difference between crocodile shagreen and central cloudy dystrophy of francois?
crocodile- 2/2 old age | francois- AD inherited disorder
153
TGFB1 - LARGE dystrophies- what locus is fucked up
5q31
154
whats the thinnest part of the cornea?
temporal to center
155
at what level of the K, is K verticilatta?
epi

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