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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
Papillary conjunctivitis
- Trachoma - VKC (giant) - SLK (fine) - Floppy eyelid - mucous fishing syndrome - blepharitis
26
GPC ddx
- CL (mostly RGP) - suture - prosthesis - other FB - VKC - atopic
27
Keratinization of conj
``` Vitamin A Squamous tumors Chronic irritation trachoma OCP, SJS ```
28
Nummular keratitis
HSV, VZV Lyme Others...
29
Keratitis with vestibular symptoms
``` Cogan's PAN Syphillis Wegener's Sarcoid VKH/SO CPA tumor ```
30
Chronic unilateral conjunctivitis
``` Lid malposition Gtts Bacterial or viral conjunctivitis Parinaud's Inflammatory (episcleritis, scleritis, or AC inflammation) OCP/SJS ```
31
Inflammatory conj nodules
``` Phlyctenule Ptyregium Squamous papilloma, CIN, or SCC Trauma Pyogenic granuloma Epidermal inclusion cyst Dermoid, lipodermoid Nodular scleritis, episcleritis ```
32
Filamentary keratitis
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
33
Cicatricial conjunctivitis
DAIT Drugs - many drops - SJS Autoimmune - OCP - VKC - Allergy - sarcoid Infectious - trachoma - EKC, HSV, VZV - any other infections Trauma - chemical - mechanical - post-surgery
34
Congenital cloudy cornea
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 ```
35
Corneal pannus
``` CL use Trauma (chemical, mechanical) HSV, other infectious keratitis Blepharitis Ptyregium ```
36
Corneal crystals
Cystinosis Schnyder's crystalline dystrophy (assoc with systemic high cholesterol) Lattice degen (amyloid) Infectious crystalline keratopathy (strep viridans) Multiple myeloma Gout (uric acid crystals)
37
Keratoconus - associations
``` Eye rubbing Down's Floppy eyelids Dry eye, blepharitis Atopy, vernal LCA ```
38
Blue sclera
Nevus of Ota Deep nevus/melanoma Thinned sclera (scleromalacia, necrotizing scleritis) Connective tissue dz (Ehler's Danlos, RA, osteogenesis imperfecta)
39
Leukoplakia
Vit A deficiency (Bitot spots) Squamous papilloma, CIN, SCC Ptyregium, pinguecula
40
Spontaneous breaks in DM
``` Trauma (usually vertical for forceps) Congenital glaucoma (Haab striae, usually horizontal) Vogt striae (concentric to cone in KC) ``` Hydrops from KC
41
Spontaneous hyphema - adults and kids
Both: - bleeding diathesis - trauma - after intra-ocular surgery Kids: - Juvenile xanthogranuloma - RB - Leukemia Adults: - Fuch's hetereochromic iridocyclitis - NVI/A - Iris nevus/melanoma - anticoagulants
42
Diffuse KP
NGAU GAU Fuch's heterochromic iridocyclitis Infectious keratitis Endophthalmitis PK rejection
43
Verticellata
"C-FAIC" ``` Chlorpromazine Fabry's disease Amiodarone Indomethacin Chloroquine ```
44
HSV vs VZV epithelial keratitis
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
45
Copper deposits in cornea
Kayser Fleischer ring | Chalcosis
46
Kayser Fleischer ring
``` Wilson's dz Copper IOFB Primary biliary cirrhosis Multiple myeloma Lymphoma, leukemia ```
47
Guttata ddx
``` Old age (Hassle Henle bodies) Fuch's old KP pigment from PDS Interstitial keratitis Macular corneal dystrophy ```
48
How deep is an LRI
600 um (75% thickness?)
49
Salmon patch ddx
``` Lymphoma, lymphoid hyperplasia Amyloid Sarcoid Vascular tumor (cap hemangioma) Amelanotic nevus ```
50
Scleritis - risk of untreated dz
DEATH. 25% die in 5 years from systemic disease in necrotizing scleritis Local: - scleral thinning and perforation
51
Scleritis - causes
``` Idiopathic SLE RA Wegener's GCA B27+ PAN Crohn's Infectious (TB, syphillis, HSV, leprosy, HZV) ```
52
How do you treat scleritis
Systemic rx needed: - NSAID if mild - steroid if more severe - may need immunosuppression Sub-tenon steroid is contraindicated (may increase risk of perforation)
53
Corneal hypoesthesia ddx
``` HSV, HZV, acanthamoeba Corneal trauma, surgery, PK, Lasik CN V palsy (trauma, tumor, surgery) Congenital (Riley Day) Toxic (chemical burns, crack cocaine use) ```
54
Conj melanoma can come from what (and relative %)
From Pam - 67% from nevus - 25% de novo - 10% 20-30% of conj pam can become malignant (?)
55
Neonatal conjunctivitis causes
Viral: HSV Bacterial: gonorrhea, chlamydia, staph, strep, e coli, etc Chemical: silver nitrate
56
DDx of interstitial keratitis
In kenya, cogan saw two laughing hyenas making love ``` Cogan Syphillis TB Lyme HSV Measles/Mumps LGV, leischmeniasis ```
57
Signs of penetrating ocular trauma
``` 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
What is Giemsa stain for
Fungi Acanthamoeba Chlamydia HSV
59
What is Gomori stain for
Fungi | Acanthamoeba
60
What is PAS stain for
Anything with a basement membrane
61
For a corneal ulcer, what plates/media do you want
``` 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
How do you classify fungi with examples. What drug is each group most sensitive to
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
What do you treat dapsone with? What do you have to check first?
OCP or leprosy | Check G6PD first
64
Who gets infectious crystalline keratopathy?
After PK with chronic steroid use. | Rx with vanco
65
Levels of evidence
``` Systematic review with meta analysis RCT Cohort studies Case series Case report Expert opinion ```
66
Band keratopathy - local and systemic causes
Local: - phthisis - IK - silicone oil - uveitis Systemic - hypercalcemia - vitamin D toxicity - hyperparathyroid - hypophosphatemia - milk alkali syndrome - renal failure - sarcoidosis
67
Types of collagen
I - corneal stroma II - vitreous III - corneal stromal scars IV - any basement membrane
68
What can you get from specular microscopy (3)
Endothelial cell count Pleimorphism (variation in shapes) Pleomegathism (variation in size)
69
Fluorescein vs rose bengal vs lissamine green
Fluorescein - epithelial defects | Rose / green - devitalized epithelium
70
Wilson's dz gives you what findings (ocular & systemic), and how to treat
Kayser Flesicher ring & sunflower cataract (same as chalcosis) Systemic: tremor, dysarthria, ataxia Rx with penicillamine
71
What sphingolipidoses give you a cherry red spot
Tay Sachs Sandhoff (Neimann pick gives you red spot, but it's a lipidosis)
72
What are the mucopolysacharidoses and what findings do they give you
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
What are the lipidoses and what do they give you
Fabry's - corneal verticellata | Gaucher, Neimann Pick - cherry red spot
74
Grades of chemical damage to cornea/limbus
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
Dx criteria for Sjogren (4)
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
How do you treat chemical exposure to the eye (immediate vs later vs late)
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
Squamous tumors of the conj and how to treat them
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
Compare PAM vs racial melanosis
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
How do you manage someone with suspected conj melanoma
Take photos No touch excision with wide margins Partial sclerectomy Watch for recurrences (often amelanotic)
80
Vascular lesions of the conj
Cavernous hemangioma Kaposi sarcoma Lymphangioma
81
Describe BCC pathology
``` Nests of basaloid cells peripheral pallisading Nests pull away from surrounding tissue ("clefting") Low cytoplasm Few mitotic figures ```
82
Describe SCC pathology
Eosinophilic cells in nests and strands Invade through BM into dermis Intracellular bridges + mitotic figures
83
What is the inheritance pattern of corneal dystrophies (with exceptions)
All are AD except macular AR
84
What corneal dystrophies go to the limbus
M's: Macular and Meesman's
85
What corneal dystrophies have systemic associations
Lattice type 2 (Meratoja - systemic amyloid) | Schnyder's Crystalline dystrophy (high cholesterol in 1/3)
86
What stains for MPS
Alcian blue & colloidal iron | remember because iron is also blue
87
What stains for amyloid
Congo red & Crystal violent | both are C, and red/violet are similar colours
88
What stains for hyaline
Masson trichrome
89
Name 5 anterior corneal dystrophies
``` ABMD Meesman's Thiel Benke Reis Buchler Gelatinous drop like dystrophy ```
90
Name 8 stromal dystrophies
Macular Granular Lattice ``` CHSD Schnyder's crystalline dystropher Fleck dystrophy Central cloudy dystrophy of francois Avellino ```
91
Name 3 endothelial dystrophies
CHED PPMD Fuch's
92
What is each type of IgG responsible for
``` IgG - crosses placenta IgM - primary immune response IgA - in tears/secretions IgD - in newborns IgE - mast cells (atopy) ```
93
What are the useful HLA associations in ophthalmology
B27 - 4 things (AS, Reiters, psoriatic, IBD) A29 - Birdshot B51 - Behcet DR4 - SO, VKH
94
PRK contraindications and risks
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
LASIK contraindications and risks
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
PK storage media
``` Moisture chamber @ 4 degrees M-K medium Dexol Optisol (*best one) Cryopreservation - forever ``` Discontinued: K-sol, corneal storage medium (CSM)
97
Describe epithelial ingrowth and when/how to treat
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
Features of VKC
"GLHT-SRK" (bad acryonym, sorry) GPC Limbal follicles Horner-Trantas dots Shield ulcers Ropy mucous Filamentary keratitis
99
Features of trachoma
"Hey FATSO" ``` Herbert pits Follicles sup>inf Arlt's line, cicatricing conjunctivitis Trichiasis, lid malposition Superior pannus, superior papillae Opacification of the cornea ```
100
How to treat trachoma
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
Contrast DLK vs infectious keratitis
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
What is Michaels & Zeuss stain for
OCP
103
When do you use glutaraldehyde for tissue fixation
EM for rhabdomyosarcoma - see cross striations
104
What are the 4 types of hypersensitivity and give examples of each
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
Features of SLK
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
How to treat SLK
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
PK rejection risks
``` Young age Infectious etiology for PK Non-compliance with therapy Vascularization at the graft-host junction Ongoing AC inflammation Previous rejection ```
108
Signs of PK rejection
``` Stromal edema Endothelial rejection line (Khodadoust line) KP AC rxn High IOP ```
109
GVHD features
Dry eye (decreased production) Cicatrication of the conj, symblepharon Lid malpositions Some drugs give optic neuritis (cyclosporine - resolves with discontinuation)
110
How to treat dry eye
``` 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
How do stromal dystrophies present?
Macular - decreased va Granular - asymptomatic, decreased va, or RCE Lattice - decreased va

Ophthalmology (22 decks)

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