CORNEA Flashcards
A 65 years old man come to opd with pain, lacrimation,photophobia and red eyes .You examine his eyes and noticed white raised border of an ulcer near the limbus. It was spreading circumferentially undermining the corneal epithelium. What is your dx? How would you proceed with this case.
- Mooren ulcer
Treatment
Atropine for pain relief.
Topical steroids are not effective.
Systemic immunosuppressants e g cyclosporins and steroids are used .
Conjunctival resection and keratoplasty may be done.
1.Interstitial keratitis is the inflammation of ______.
- What is Neurotrophic keratopathy?
- Corneal sensations and lacrimation are ____in Neurotrophic keratopathy?
4.treatment of Neurotrophic keratopathy!
5.what occurs in exposure keratopathy?
- What is the treatment of exposure keratopathy?
- Inflammation of corneal stroma due to underlying systemic diseases e.g syphilis,TB and Herpes etc.
- Impaired corneal sensation due to damage to CN 5 which may be caused by trauma,tumor,DM,Herpes zoster,LASIK surgery.
There is painless red eye .cornea is dull, epithelial defects and ulceration occurs. - Reduced
- Artificial tears
Anti collagenase agents e.g acetyl cysteine or systemic tetracycline.
Topical nerve growth factor drops. Protect ocular surface by tapping of eyelids, botulinum toxin to I duce proptosis,contact lenses, tarsorrhaphy.
5.Exposure keratopathy is caused by incomplete lod closure resulting in dry eyes. Causes are
CN 7 palsy,Proptosis, ectropion and blepharoplasty.
6.Lubrication by artificial tears.
Tarsorrhaphy
Treat ectropion if present.
- A 21 years old boy came to opd complaining of reduced vision for last 2 months. On examination his conjunctiva showed cobblestone appearance . There is photophobia and positive Munson’s sign(bulging of lower eyelids when patient looks down). Slit lamp examination showed forward bulging of both corneas and Vogts lines(stromal stress lines).
What is your dx?
What are other signs of this condition?
Treatment?
-
Keratoconus
Thinning of corneal stroma leads to forward bulging of central or paracentral cornea.
Corneal topography and keratometry are done.
_There issudden visual loss due to hydrops ,progressive myopia Astigmatism on keratometry._
Oil droplet reflex on distant direct ophthalmoscopy.
Retinoscopy shows scissors reflex.
Corneal scarring may occur.
Treatment
🎟️Spectacles to correct refractive error.
🎟️Intacs….intra corneal ring segment🎟️Collagen Cross Linking
🎟️Deep anterior lamellar keratoplasty
🎟️acute hydrops is treated by hypertonic saline and patching.
- A 30 years old man came to opd with complaints of dry eyes ,itching, discomfort and foreign body sensation for last 5 days . Staining with rose Bengal revealed corneal filaments. What is this condition and how would you manage ?
- Filamentary keratitis
Corneal filaments are strands of degenerative epithelial cells and mucus that move with blinking.
Treatment
Mechanical removal of filaments and patching.
Hypertonic saline to encourage adhesion and mucolytic agents.
Contact lenses
Treat the underlying cause e.g dry eyes.
- What is arcus senilis?
2.Lipid keratopathy occurs in____?
3.What is band keratopathy?
- Which type of degenerative corneal disease occurs in people exposed to UV light in which amber coloured granules are deposited in superficial stroma?
- What are grey white nodular opacities called which occur in trachoma?
- Peripheral corneal opacity due to lipid infiltration. Occurs in old age.
2.Herpes simplex and herpes zoster keratitis.
- Deposition of Ca salts in Bowman’s layer,stroma and epithelial basement membrane.
Treat by chelation with EDTA, Lamellar keratoplasty,excimer keratectomy. - Spheroidal degenerations.
5.Salzman nodular degeneration
- Name the anterior dystrophies of cornea!
2.Name the stromal dystrophies!
- Posterior dystrophy!
- Microcystic
Reis bucklers dystrophy
Meesman’s dystrophy
Recurrent corneal erosion syndrome.
2.Granular dystrophy
Lattice dystrophy
Macular dystrophy (has hazy cornea in bw opacities)
- Fuchs endothelial dystrophy!
5% sodium chloride ointment
Soft contact lenses may be useful
Endothelial replacement surgery
Keratoplasty.
Types
Which one is done when
1. 90% of corneal thickness is involved.
2.opacities involve anterior one third of cornea.
3. Post chemical burns or Steven jhonson syndrome
4. Fuchs endothelial dystrophy
Removal of patients diseased cornea and replacing it by donors healthy cornea.
Penetrating keratoplasty
It is full thickness excision of the cornea.
Indications
Corneal opacity
Corneal dystrophy
Advanced keratoconus
Replace inflamed unresponsive cornea
Descemetocele
Lamellar keratoplasty
Include superficial and deep lamellar keratoplasty
Superficial lamellar keratoplasty is partial thickness excision of corneal epithelium and stroma. Deep stroma and endothelium are left behind.
Deep lamellar keratoplasty
Removes cornea upto Descemet’s membrane .
- Deep lamellar keratoplasty
2.superficial lamellar keratoplasty - Limbal stem cell grafting
- Endothelial keratoplasty
- What are the layers of cornea
ABCDE!
Define the following corneal scarring!
3.Nebula
4.Macula
5.Leucoma
1.Epithelium
Bowman’s layer
Stroma
Descemet’s membrane
Endothelium
- Nebula is very thin scar due to scarring of Bowman’s layer and superficial lamellar
4.Macula is scarring due to involvement of ant half of corneal stroma.
5.Leucoma is dense white corneal opacity with iris adherent on its back.
A 40 years old woman came to opd with complaints of itching, photophobia, blurred vision and lacrimation. On examination you noticed red eyes ,hypopyon and hazy cornea.
On Instilling 2% fluorescein dye , an ulceration is seen on cornea. C/S revealed staphylococcal infection.
1.What is your dx?
2.How would you manage this patient?
3. What are complications of corneal ulcer?
1.Bacterial corneal ulcer.
2.treatment
Control of infection
Topical antibiotics
Antibiotic ointments
Systemic antibiotics are not used because cornea is avascular. Used only when ulcer is near limbus.
Relief of pain
Atropine
Analgesics
Anti glaucoma drugs
Treatment of descemetocele
Anti glaucoma drugs
Avoid straining
Conjunctival flap and amniotic membrane is used.
Therapeutic corneal grafts
Treatment of perforated corneal ulcer
Topical antibiotics
Anticollagenases tetracyclines
Conjunctival flap or amniotic membrane transplant
Keratoplasty.
How to treat non healing corneal ulcer
Conjunctival flap or amniotic membrane transplant
Tarsorrhaphy
Keratoplasty
Avoid bandage and steroids in pyogenic ulcer as it promotes growth of bacteria
3.Complications of corneal ulcer
Anterior uveitis
Secondary glaucoma
Descemetocele
Perforation
Cataract formation
Endopthalmitis,panopthalmitis
Corneal scarring ,fistula
1.Which corneal ulcer causes greyish white feathery edges and satellite lesions? How would you diagnose this organism?
2.Which organism causes ring abscess, pseudodendrites, perineural infiltrates(radial keratoneuritis) and enlargement of corneal nerves? How would you dx it?
3.which ulcer causes dendritic/geographical/amoeboid /acute epithelial keratitis? How would you diagnose it?
- What is disciform keratitis? How would you treat it?
- What organism causes eyelid edema with maculopapular rash at the tip of the nose (Hutchinson sign) and micro dendritic ulcer?
- Fungal keratitis . The organism is identified by KOH potassium hydroxide/sabourauds dextrose agar.
2.acanthamoeba keratitis. PAS stain or calcofluor white stain.
- Herpes simplex causes dendritic and geographical ulcer. Corneal sensitivity is markedly diminished.
TTT…topical acyclovir
Debridement is effective for dendritic ulcer but not for geographical ulcer.
4.It is viral endothelitis causing corneal edema and stromal thickening.
TTT…steroids, antivirals, antibiotics and cycloplegics.
5.herpes zoster.
TTT is same as other viral keratitis.
