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Ophthalmology > Cornea > Flashcards

Cornea Flashcards

0
Q

What’s a fleischer ring

A

Base of cone in KC

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1
Q

Bacteria that penetrate the corneal epithelium

A 
Cornyeabacterium
Aegyptius (hemophilia)
Nisseria
Acanthamoeba
Listeria
Shigella
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3
Q

What’s a stocker line

A

Head of ptyregium (sTock = pTyregium)

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4
Q

What’s a Ferry’s line

A

Adjacent to filtering bleb (Ferry = Filtering)

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5
Q

What’s a Hudson - Stahli line

A

Horizontal line at lower 1/3 of cornea. Normal aging (stAhli = Age)

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6
Q

DDx of prominent corneal nerves

A

GRAFIK PENDANT

  • congenital Glaucoma
  • Refsum
  • Acanthamoeba, amyloid
  • Fuch’s
  • Ichthyosis
  • KC
  • failed PK
  • mEn 2b
  • neurofibromatosis
  • Dry eyes, Drugs
  • Aging
  • Leprosy (not sure why this is N)
  • Trauma
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7
Q

Membranes

A

(SnM = sjs, neisseria give membranes)

SJS
Neisseria

Strep pyogenes
Diphtheria

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8
Q

Pseudomembranes

A 
EKC, HSV
OCP, GVHD
Chalmydia
Ligneous
Kawasaki
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9
Q

Conj vessel anneurysms

A 
Fabry's dz
Sentinel vessels to underlying melanoma
Ataxia telangiectasia
SWS
Sickle cell
DM
Gangliosidosis
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10
Q

Angular blepharitis

A

Moraxella, staph

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11
Q

Phlyctenules

A

TB
Staph

Candida, rosacea, HSV

Type IV hypersensitivity

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12
Q

Types of chalmydia

A

A-C Trachoma

D–K STD

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13
Q

Signs of trachoma

A

“Hey FATSO” (ironic because most people with trachoma are malnournished :(

Herbert pits
Follicles sup>inf
Arlt's line (cicatrizing conjunctiva)
Trichiasis
Superior pannus, superior papillae
Opacification of cornea
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14
Q

DDx of SPK

A

Eyelids

  • eyelid malposition
  • poor eyelid closure
  • trichiasis

Poor secretion of tears

  • Primary (Sjogren)
  • Secondary due to inflammation (Sarcoid infiltration of lacrimal gland)
  • Secondary due to drops (anti-cholinergics, anti-histamines)

Inflammation

  • infections
  • blepharitis
  • CL use
  • BAK, drop toxicity
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15
Q

DDx of dendrites

A 
HSV
VZV
Acanthamoeba
Healing abrasion
CL trauma
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16
Q

Pre-auricular lymph nodes

A 
Parinaud's oculo-glandular
EKC
HSV
Gonorrhea, chlamydia
Trachoma
Lid cellulitis/dacryoadenitis
Newcastle
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17
Q

Definition of Parinaud’s oculo-glandular syndrome

A

GRANULOMATOUS follicular conjunctivitis with regional lymphadenopathy

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18
Q

Disciform keratitis ddx

A

HSV
VZV
early PBK

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19
Q

Acanthamoeba rx

A 
Brolene
PHMB
Chlorhexidine
Neomycin
Ketoconazole
Doxy (?)
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20
Q

Gonorrhea rx

A

IV ceftriaxone + bacitracin ointment/vigamox gtts

Co-treat for chlamydia

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21
Q

Chalmydia rx

A

Erythro oral + ongt
Doxy/azithro oral
Find and treat sexual partners

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22
Q

Parinauds bugs

A

SS, TT, ABC

Syphillis
Sporotrichosis

TB
Tularemia

Actinomyces
Bartonella Henslae
Coccidiomycosis

Ricksettia
LGV

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23
Q

Acute follicular conjunctivitis

A

Infectious

  • Newcastle (lasts 1 week)
  • viral (EKC, HSV, VZV)
  • bacterial (chlamydia, staph, strep)

Immune

  • hayfever
  • allergy to drops
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24
Q

Chronic follicular conjunctivitis

A

Infectious

  • Viral (EKC, HSV, VZV)
  • bacterial (chalmydia, staph, strep)
  • Parinaud’s
  • trachoma

Immune

  • hayfever
  • allergy to drops
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25
Q

Papillary conjunctivitis

A
  • Trachoma
  • VKC (giant)
  • SLK (fine)
  • Floppy eyelid
  • mucous fishing syndrome
  • blepharitis
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26
Q

GPC ddx

A
  • CL (mostly RGP)
  • suture
  • prosthesis
  • other FB
  • VKC
  • atopic
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27
Q

Keratinization of conj

A 
Vitamin A
Squamous tumors
Chronic irritation
trachoma
OCP, SJS
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28
Q

Nummular keratitis

A

HSV, VZV
Lyme
Others…

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29
Q

Keratitis with vestibular symptoms

A 
Cogan's
PAN
Syphillis
Wegener's
Sarcoid
VKH/SO
CPA tumor
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30
Q

Chronic unilateral conjunctivitis

A 
Lid malposition
Gtts
Bacterial or viral conjunctivitis
Parinaud's
Inflammatory (episcleritis, scleritis, or AC inflammation)
OCP/SJS
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31
Q

Inflammatory conj nodules

A 
Phlyctenule
Ptyregium
Squamous papilloma, CIN, or SCC
Trauma
Pyogenic granuloma
Epidermal inclusion cyst
Dermoid, lipodermoid
Nodular scleritis, episcleritis
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32
Q

Filamentary keratitis

A

Basically the same ddx as dry eye

Eyelids

  • eyelid malposition
  • poor eyelid closure

Poor secretion of tears

  • Primary (Sjogren)
  • Secondary due to inflammation (Sarcoid infiltration of lacrimal gland)
  • Secondary due to drops (anti-cholinergics, anti-histamines)

Inflammation

  • infections
  • blepharitis
  • CL use
  • VKC

Infections:
- HSV, EKC, VZV

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33
Q

Cicatricial conjunctivitis

A

DAIT

Drugs

  • many drops
  • SJS

Autoimmune

  • OCP
  • VKC
  • Allergy
  • sarcoid

Infectious

  • trachoma
  • EKC, HSV, VZV
  • any other infections

Trauma

  • chemical
  • mechanical
  • post-surgery
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34
Q

Congenital cloudy cornea

A

G-STUMPED (don’t forget the G!!)

Congenital glaucoma
Sclero-cornea
Trauma
Ulcer
MPS (Hurler, Scheie)
Peter's anomaly or anterior segment dysgenesis
Endothelial dz (CHED, PPMD)
Dermoid cyst
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35
Q

Corneal pannus

A 
CL use
Trauma (chemical, mechanical)
HSV, other infectious keratitis
Blepharitis
Ptyregium
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36
Q

Corneal crystals

A

Cystinosis
Schnyder’s crystalline dystrophy (assoc with systemic high cholesterol)
Lattice degen (amyloid)
Infectious crystalline keratopathy (strep viridans)
Multiple myeloma
Gout (uric acid crystals)

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37
Q

Keratoconus - associations

A 
Eye rubbing
Down's 
Floppy eyelids
Dry eye, blepharitis
Atopy, vernal
LCA
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38
Q

Blue sclera

A

Nevus of Ota
Deep nevus/melanoma
Thinned sclera (scleromalacia, necrotizing scleritis)
Connective tissue dz (Ehler’s Danlos, RA, osteogenesis imperfecta)

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39
Q

Leukoplakia

A

Vit A deficiency (Bitot spots)
Squamous papilloma, CIN, SCC
Ptyregium, pinguecula

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40
Q

Spontaneous breaks in DM

A 
Trauma (usually vertical for forceps)
Congenital glaucoma (Haab striae, usually horizontal)
Vogt striae (concentric to cone in KC)

Hydrops from KC

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41
Q

Spontaneous hyphema - adults and kids

A

Both:

  • bleeding diathesis
  • trauma
  • after intra-ocular surgery

Kids:

  • Juvenile xanthogranuloma
  • RB
  • Leukemia

Adults:

  • Fuch’s hetereochromic iridocyclitis
  • NVI/A
  • Iris nevus/melanoma
  • anticoagulants
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42
Q

Diffuse KP

A

NGAU
GAU

Fuch’s heterochromic iridocyclitis
Infectious keratitis
Endophthalmitis
PK rejection

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43
Q

Verticellata

A

“C-FAIC”

Chlorpromazine
Fabry's disease
Amiodarone
Indomethacin
Chloroquine
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44
Q

HSV vs VZV epithelial keratitis

A

HSV:

  • dendritis
  • terminal bulbs
  • bed stains with fluorescein
  • edges stain with rose bengal or lissamine green

VZV:

  • may be pseudo-dendrites
  • no terminal bulbs
  • minimal staining
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45
Q

Copper deposits in cornea

A

Kayser Fleischer ring

Chalcosis

46
Q

Kayser Fleischer ring

A 
Wilson's dz 
Copper IOFB
Primary biliary cirrhosis
Multiple myeloma
Lymphoma, leukemia
47
Q

Guttata ddx

A 
Old age (Hassle Henle bodies)
Fuch's
old KP
pigment from PDS
Interstitial keratitis
Macular corneal dystrophy
48
Q

How deep is an LRI

A

600 um (75% thickness?)

49
Q

Salmon patch ddx

A 
Lymphoma, lymphoid hyperplasia
Amyloid
Sarcoid
Vascular tumor (cap hemangioma)
Amelanotic nevus
50
Q

Scleritis - risk of untreated dz

A

DEATH. 25% die in 5 years from systemic disease in necrotizing scleritis

Local:
- scleral thinning and perforation

51
Q

Scleritis - causes

A 
Idiopathic
SLE
RA
Wegener's
GCA
B27+
PAN
Crohn's
Infectious (TB, syphillis, HSV, leprosy, HZV)
52
Q

How do you treat scleritis

A

Systemic rx needed:

  • NSAID if mild
  • steroid if more severe
  • may need immunosuppression

Sub-tenon steroid is contraindicated (may increase risk of perforation)

53
Q

Corneal hypoesthesia ddx

A 
HSV, HZV, acanthamoeba
Corneal trauma, surgery, PK, Lasik
CN V palsy (trauma, tumor, surgery)
Congenital (Riley Day)
Toxic (chemical burns, crack cocaine use)
54
Q

Conj melanoma can come from what (and relative %)

A

From Pam - 67%
from nevus - 25%
de novo - 10%

20-30% of conj pam can become malignant (?)

55
Q

Neonatal conjunctivitis causes

A

Viral: HSV
Bacterial: gonorrhea, chlamydia, staph, strep, e coli, etc
Chemical: silver nitrate

56
Q

DDx of interstitial keratitis

A

In kenya, cogan saw two laughing hyenas making love

Cogan
Syphillis
TB
Lyme
HSV
Measles/Mumps
LGV, leischmeniasis
57
Q

Signs of penetrating ocular trauma

A 
Seidel +ve
Shallow AC
Peaked pupil
Iris-K touch in a focal area
Extruded eye contents
360 degree sub-conj hemorrhage
Low IOP
Lens capsule defect
Acute lens opacity
58
Q

What is Giemsa stain for

A

Fungi
Acanthamoeba
Chlamydia
HSV

59
Q

What is Gomori stain for

A

Fungi

Acanthamoeba

60
Q

What is PAS stain for

A

Anything with a basement membrane

61
Q

For a corneal ulcer, what plates/media do you want

A 
Gram stain slides
Blood agar (most bacteria)
Chocolate agar (Hemophilus, Neisseria)
Saborrhaud's (fungi)
Thioglycolate broth (anaerobes)
Non-nutrient agar with e coli overlay (acanthamoeba)
Lowenstein-Jensen (mycobacteria)
62
Q

How do you classify fungi with examples. What drug is each group most sensitive to

A

Molds vs yeast
Yeast are septated or non septated

Molds (CC) = cryptococcus, candida. Rx with ampho-B
Septated yeast (FA) = fusarium, aspergillus. Rx with natamycin
Non-septated yeast (MR) = mucor, rhizopus. Rx with ampho-B

All can be treated with the conazoles.

63
Q

What do you treat dapsone with? What do you have to check first?

A

OCP or leprosy

Check G6PD first

64
Q

Who gets infectious crystalline keratopathy?

A

After PK with chronic steroid use.

Rx with vanco

65
Q

Levels of evidence

A 
Systematic review with meta analysis
RCT
Cohort studies
Case series
Case report
Expert opinion
66
Q

Band keratopathy - local and systemic causes

A

Local:

  • phthisis
  • IK
  • silicone oil
  • uveitis

Systemic

  • hypercalcemia
  • vitamin D toxicity
  • hyperparathyroid
  • hypophosphatemia
  • milk alkali syndrome
  • renal failure
  • sarcoidosis
67
Q

Types of collagen

A

I - corneal stroma
II - vitreous
III - corneal stromal scars
IV - any basement membrane

68
Q

What can you get from specular microscopy (3)

A

Endothelial cell count
Pleimorphism (variation in shapes)
Pleomegathism (variation in size)

69
Q

Fluorescein vs rose bengal vs lissamine green

A

Fluorescein - epithelial defects

Rose / green - devitalized epithelium

70
Q

Wilson’s dz gives you what findings (ocular & systemic), and how to treat

A

Kayser Flesicher ring & sunflower cataract (same as chalcosis)
Systemic: tremor, dysarthria, ataxia

Rx with penicillamine

71
Q

What sphingolipidoses give you a cherry red spot

A

Tay Sachs
Sandhoff

(Neimann pick gives you red spot, but it’s a lipidosis)

72
Q

What are the mucopolysacharidoses and what findings do they give you

A

All the H’s and S’s

Type I: Hurler, Schie - corneal changes
Type II: Hunter
Type III: San fillipo

All give RPE changes, but only type I give corneal changes too

73
Q

What are the lipidoses and what do they give you

A

Fabry’s - corneal verticellata

Gaucher, Neimann Pick - cherry red spot

74
Q

Grades of chemical damage to cornea/limbus

A

I - limbus ok, mild epi defect
II - >1/3 limbal blanching. Mild stromal haze
III - >1/2 limbal defect, stromal haze obscuring iris
IV - complete limbal blanching, no view of AC

75
Q

Dx criteria for Sjogren (4)

A
  1. Dry eye (KCS)
  2. Xerostomia (dry mouth, decreased parotid flow)
  3. Labial biopsy
  4. Evidence of systemic dz on blood work (RF, ANA, ANCA, etc)
76
Q

How do you treat chemical exposure to the eye (immediate vs later vs late)

A

3 principals to any corneal damage: remove inciting factors, support surface healing, and prevent infection

  1. flush, flush, flush. Use a q-tip to remove any particles from fornices.
  2. Lubricate aggressively
  3. Antibiotics, consider PF
  4. Collagenase inhibitors (oral doxy, vitamin C)

If not helping:

  • consider gunderson flap, amniotic membrane
  • lyse symblepharon
  • tarsorrhaphy

Long term:

  • limbal stem cell transplant
  • PK
77
Q

Squamous tumors of the conj and how to treat them

A

Benign –> malignant:

  1. Squamous papilloma: excise with cryo
  2. CIN: excise with wide margins, cryo to edges, consider MMC/5FU
  3. SCC: 4 mm margins. Cryo and MMC/5FU
  4. Mucoepidermoid carcinoma: as SCC but may also need enuc or exenteration if extensive spread.
78
Q

Compare PAM vs racial melanosis

A

Racial is congenital in darker skinned people. No chance of malignancy.

PAM is acquired. In lighter skin. 20-30% chance of malignancy - bx if becomes thickened. Otherwise watch it with photos.

79
Q

How do you manage someone with suspected conj melanoma

A

Take photos
No touch excision with wide margins
Partial sclerectomy
Watch for recurrences (often amelanotic)

80
Q

Vascular lesions of the conj

A

Cavernous hemangioma
Kaposi sarcoma
Lymphangioma

81
Q

Describe BCC pathology

A 
Nests of basaloid cells
peripheral pallisading
Nests pull away from surrounding tissue ("clefting")
Low cytoplasm
Few mitotic figures
82
Q

Describe SCC pathology

A

Eosinophilic cells in nests and strands
Invade through BM into dermis
Intracellular bridges
+ mitotic figures

83
Q

What is the inheritance pattern of corneal dystrophies (with exceptions)

A

All are AD except macular AR

84
Q

What corneal dystrophies go to the limbus

A

M’s: Macular and Meesman’s

85
Q

What corneal dystrophies have systemic associations

A

Lattice type 2 (Meratoja - systemic amyloid)

Schnyder’s Crystalline dystrophy (high cholesterol in 1/3)

86
Q

What stains for MPS

A

Alcian blue & colloidal iron

remember because iron is also blue

87
Q

What stains for amyloid

A

Congo red & Crystal violent

both are C, and red/violet are similar colours

88
Q

What stains for hyaline

A

Masson trichrome

89
Q

Name 5 anterior corneal dystrophies

A 
ABMD
Meesman's
Thiel Benke
Reis Buchler
Gelatinous drop like dystrophy
90
Q

Name 8 stromal dystrophies

A

Macular
Granular
Lattice

CHSD
Schnyder's crystalline dystropher
Fleck dystrophy
Central cloudy dystrophy of francois
Avellino
91
Q

Name 3 endothelial dystrophies

A

CHED
PPMD
Fuch’s

92
Q

What is each type of IgG responsible for

A 
IgG - crosses placenta
IgM - primary immune response
IgA - in tears/secretions
IgD - in newborns
IgE - mast cells (atopy)
93
Q

What are the useful HLA associations in ophthalmology

A

B27 - 4 things (AS, Reiters, psoriatic, IBD)
A29 - Birdshot
B51 - Behcet
DR4 - SO, VKH

94
Q

PRK contraindications and risks

A

CI:

  • thin cornea
  • ectasia (KC, pellucid)
  • unstable refraction
  • dry eye
  • current infection
  • collagen vascular disease
  • pregnancy
  • keloids

Risks:

  • ectasia
  • corneal haze
  • infectious keratitis
  • recurrent corneal erosion
  • glare
  • haloes
  • under/overcorrection/astigmatism
95
Q

LASIK contraindications and risks

A

CI:

  • thin cornea
  • ectasia (KC, pellucid)
  • unstable refraction
  • dry eye
  • current infection
  • pregnancy
  • connective tissue diseases

Risks:

  • ectasia
  • corneal haze
  • infectious keratitis
  • glare
  • haloes
  • under/overcorrection/astigmatism

Flap complications:

  • buttonhole
  • free flap
  • flap dislocation (during or after surgery)
  • interface haze
  • epithelial ingrowth, fibrous downgrowth
  • DLK
96
Q

PK storage media

A 
Moisture chamber @ 4 degrees
M-K medium
Dexol
Optisol (*best one)
Cryopreservation - forever

Discontinued: K-sol, corneal storage medium (CSM)

97
Q

Describe epithelial ingrowth and when/how to treat

A

If advancing to visual axis, causing flap melt, or disloding the flap, raising the flap causing astigmatism, etc.

Raise the flap, irrigate/scrape out the cells, and replace the flap. Some people suture/glue the flap down. Some people scrape off the epithelium overlying the flap area where the ingrowth happened.

98
Q

Features of VKC

A

“GLHT-SRK” (bad acryonym, sorry)

GPC
Limbal follicles
Horner-Trantas dots

Shield ulcers
Ropy mucous
Filamentary keratitis

99
Q

Features of trachoma

A

“Hey FATSO”

Herbert pits
Follicles sup>inf
Arlt's line, cicatricing conjunctivitis
Trichiasis, lid malposition
Superior pannus, superior papillae
Opacification of the cornea
100
Q

How to treat trachoma

A

Prevention: clean water, better facial hygiene
Treatment: acutely, can give antibiotics (azithro, doxy, erithro + ongt)
After the scarring has set in: lubrication, fix lid positions, fix trichiasis. Maybe cornea surgery for extensive scarring?

101
Q

Contrast DLK vs infectious keratitis

A

DLK:
1-6 d after LASIK
Eye is quiet, not inflamed
Haze is grainy, like sand. Not dense or confluent
Va may be mildly affected or asymptomatic

Infection:
3-10 d after LASIK
angry, red eye with conj injection
pain, often decreased va
ac rxn, kp
visible infiltrate
102
Q

What is Michaels & Zeuss stain for

A

OCP

103
Q

When do you use glutaraldehyde for tissue fixation

A

EM for rhabdomyosarcoma - see cross striations

104
Q

What are the 4 types of hypersensitivity and give examples of each

A

ACID

I - acute: hayfever, allergy to gtts, vernal, atopic, GPC
II - complement mediated: OCP, Moorens
III - immune complex deposition: SJS, marginal infiltrates, disciform, SEI
IV - delayed: VKH, SO, phlectenules, graft rxn, IK, granulomas

105
Q

Features of SLK

A

Super conj: thick, redundant, injected, has PEE that stain with fluorescein or rose
Papillae of superior tarsus
Filamentary keratitis

Associated with thyroid in 50%
70% female

106
Q

How to treat SLK

A

Attack the conj:
1 surgical resection
2 chemical cautery (silver nitrate solution, never use the stick… whatever the stick is?!?)
3 thermal cautery

lubricate
large bandage CL

107
Q

PK rejection risks

A 
Young age
Infectious etiology for PK
Non-compliance with therapy
Vascularization at the graft-host junction
Ongoing AC inflammation
Previous rejection
108
Q

Signs of PK rejection

A 
Stromal edema
Endothelial rejection line (Khodadoust line)
KP
AC rxn
High IOP
109
Q

GVHD features

A

Dry eye (decreased production)
Cicatrication of the conj, symblepharon
Lid malpositions
Some drugs give optic neuritis (cyclosporine - resolves with discontinuation)

110
Q

How to treat dry eye

A 
Fix lid malposition
Lubricate (gtts, ongt)
Punctal plugs
BCL
serum drops
moisture chamber goggles
use humidifer at home
treat blepharitis (WC, scrubs, doxy)
restasis
111
Q

How do stromal dystrophies present?

A

Macular - decreased va
Granular - asymptomatic, decreased va, or RCE
Lattice - decreased va

Ophthalmology (22 decks)

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