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CORNEA Flashcards

1
Q

3 Mechanisms of dry eye

A

1) inflammation 2) tear film instability 3) tear hyperosmolarity

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2
Q

Superior papillary reaction

A

1) Allergic: VKC, AKC, GPC
2) Infectious: bacterial (trachoma)
3) Inflammatory: floppy eyelid, SLK, blepharitis
4) Trauma: toxic keratopathy, mucus fishing
5) Masquerade: Sebaceous cell or other

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3
Q

Distichiasis

A

1) congenital
2) acquired

  • inflammatory: SJS, OCP, chronic blepharitis
  • infectious: trachoma
  • trauma: chemical burn
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4
Q

drugs that inhibit wound healing

A
  1. topical anesthetic
  2. NSAIDS
  3. trifluridine
  4. B blockers
  5. CAIs
  6. BAK
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5
Q

Pannus

A
  1. infection - staph blepharitis, trachoma, phylectenulosis, HSV keratitis
  2. degeneration - pterygium, pingleculum
  3. inflammatory - rosacea, SLK
  4. Allergy - AKC, VKC,
  5. trauma - CL wear
  6. congenital eye abnormalities- aniridia
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6
Q

Dry eye - Aqueous deficient vs evaporative

A
  1. Aqueous deficient
    1. Sjogrens - primary or secondary (RA, SLE, scleroderma)
    2. Non sjogrens - lacrimal deficieny (GVHD, immune reaction after radiation, lymphoma, amyloid, sarcoid), lacrimal gland obstruction, reflex block (surgery, CL, topical anes, parkinsons), systemic drugs (diuretics, anti psych, antihistamines, anticholinergic)
  2. Evaporative
    1. intrinsic - MG deficient, lid abnormality, low blink rate, accutane
    2. extrinsic- vit a def, preservatives and other topical drugs, CL wear, ocular surface disease
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7
Q

Conj granuloma

A
  1. sarcoid
  2. CSD
  3. FB
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8
Q

Non suppurative stromal keratitis (interstitial keratitis)

A
  1. Infection
    1. bacterial- congenital and acquired syphilis, lyme, TB, leprosy, chlamydia (LGV and trachoma)
    2. viral- HSV, VZV, EBV, mumps
    3. parasite - acanthamoeba, onchoceriasis
  2. Inflammation
    1. reactive arthritis
    2. coagns
    3. sarcoid
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9
Q

GPC

A
  1. CL
  2. AKC
  3. VKC
  4. prosthesis related
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10
Q

Parinaud Oculoglanduar syndrome

A
  1. afipia
  2. actinomyces
  3. bartonella
  4. coccidiomycosis
  5. syphilis
  6. sporotrichosis
  7. tularemia
  8. TB
  9. ricketsia
  10. LGV
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11
Q

crystalline keratopathy

A
  1. infectious
    1. strep viridans, other bacteria and fungus
  2. systemic diseases
    1. lymphoproliferative- MM and monoclonal gammopathy
    2. cystinosis
    3. gout
    4. lipid disorders- LCAT, fish eye, tangier, secondary lipid
  3. dystrophies
    1. macular dystrophy
    2. granular dystrophy
    3. lattice dystrophy
    4. schnyder dystrophy and bietti dystrophy
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12
Q

Dendrite

A
  1. infectious
    1. HSV - central ulceration with blubs
    2. VZV - smaller without central ulceration (negative staining) or terminal blubs
    3. adenovirus
    4. EBV
    5. acanthamoeba
  2. Inflammatory
  3. Systemic
    1. medications causing whorl keratopathy
    2. fabry
    3. tyrosinemia
  4. Iatrogenic/trauma
    1. epi healing line
    2. soft CL wear
    3. neurotrophic K
    4. topical medications (antiviral and b blocker)
    5. Epi deposits (iron lines, systemic meds and fabrys)
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13
Q

Necrotizing keratitis

A
  1. infectious
    1. viral- HSV
    2. bacteria-
    3. fungal
    4. parasite- acanthamoeba
  2. Systemic - RA, Wegners, PAN, SLE, relapsing polychondritis
  3. Trauma
    1. anes abuse
    2. retained FB
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14
Q

Follicular conjunctivitis

A
  1. Chronic infectious
    1. viral- trachoma, chlamydia, moraxella, molluscum, parinauds
    2. drugs- brimonidine, pilo, HA, sulfa, antivirals
  2. Acute
    1. viral- adenovirus, hemorrhagic conjunctivitis, newcastle, chlamydia, HSV, EBV
    2. drops- brimonidine
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15
Q

Corneal Anesthesia

A
  1. Congenital
    1. riley day, goldenhar, moebius
  2. Systemic
    1. diabetes, leprosy, hypolipoproteinemias, prev radiation
  3. Local
    1. HSV, VZV
    2. toxicity with topical meds- anes, NSAIDS, B blkers, CAIs, BAK, viroptic)
    3. Dystrophies
    4. damage to CN V - surgery, Lasik
    5. chronic CL wear
  4. Neurological
    1. CVA
    2. Aneurysm
    3. MS
    4. Tumour
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16
Q

episcleritis

A
  1. idopathic
  2. medications- topiramate pamidronate
  3. inflammatory
    1. sjogrens
    2. RA
    3. gout
    4. rosacea
  4. infectious
    1. VZV
    2. syphilis
    3. TB
    4. lyme
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17
Q

Posterior embryotoxin

A
  1. A-R
  2. Alagille
  3. ichythosis
  4. velocardiofacial
  5. idiopathic or normal finding
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18
Q

LSCD

A
  1. Idiopathic
  2. Trauma
    1. chemical burns and radiation
  3. Iatrogenic
    1. local- surgery, radiation and radiotherapy, CL use, topical meds- MMC, pilo, B blocker, antibiotics
    2. systemic- hydroxyurea, GVHD
  4. Autoimmune
    1. SJS, OCP
  5. Eye disease
    1. neoplasia, neurotrophic keratitis, infections (trachoma) atopy, peripheral K ulcers
  6. Congenital and hereditary
    1. aniridia, sclerocornea, MEN, xeroderma pigmentosum
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19
Q

Cicatrizing conjunctivitis

A
  1. Infectious
    1. trachoma, adenovirus, corynebacterium, streptococcal
  2. Allergic
    1. AKC, SJS, blepharoconjunctivitis
  3. Autoimmune
    1. OCP, sarcoidosis, lupus, scleroderma, GVHD, linear IgA dermatosis
  4. Miscellaneous
    1. roseacea
    2. chemical burns
    3. trauma
    4. drugs - timolol, epinephrine, AT, echothiopate
    5. radiation
    6. neoplasia
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20
Q

When to culture and use fortified drops

A
  1. culture:
    • infiltrates extend onto middle of K
    • infiltrates extend to deep stroma
    • infiltrates > 2mm
    • history of fungal, amebic, mycobacterial infection
    • blood, chocolate, sabourauds, thioglycolate broth
  2. Fortified
    • large/vision threatening/in vis axis
    • prior abx failure
    • suspect MRSA
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21
Q

DDX PUK

A
  1. Ocular
    1. microbial - bacterial, viral, acanthamoeba, fungal
    2. mooren ulcer
    3. traumatic or post surgical
    4. terrien marginal degeneration
    5. exposure keratopathy
    6. roseacea
  2. Systemic
    1. microbial - bacterial, viral, helminthiasis
    2. inflammatory - RA, SLE, Wegners, PAN, behcets, sarcoid, UC, relapsing polychondritis
    3. neoplastic
22
Q

Conj Vascularity Tortuosity and Hyperemia

A
  1. inflammation- infection, allergy, toxicity, neoplasia
  2. direct irritation - FB, aberrant lashes
  3. reflex response
  4. systemic or topical vasodilators
  5. autonomic dysfunction- horners
  6. vascular engorement
  7. trauma
  8. associated disease- rosacea, fabry, htn, dm, sickle, MM, polycythemia vera
  9. hereditary - ataxia tel
23
Q

SPK

A
  1. superior
    1. CL related
    2. FB under upper eyelid
    3. Floppy eyelid
    4. SLK
    5. VKC
  2. interpalpebral
    1. Dry eye
    2. neurotropic keratopathy
    3. UV burn
  3. inferior
    1. blepharitis
    2. exposure keratopathy
    3. topical drug toxicity
    4. conjunctivitis
    5. trichiasis
    6. entropion/ectropion
24
Q

RCE Etiologies

A
  1. anterior corneal dystrophy- EBMD, RBC, TBD, Meesman
  2. previous trauma
  3. stromal corneal dystrophy
  4. corneal degeneration - band, salzman
  5. laser eye, PKP,
25
Q

Exposure keratopathy

A
  1. Structural
    1. eye lid deformity
    2. proptosis
    3. floppy eyelid syndrome
    4. after ptosis repair
  2. Neurological
    1. poor blink due to parkinsons
    2. seventh CN palsy
    3. altered mental status
      3.
26
Q

Band K

A
  1. Local
    1. inflammation - uveitis, IK
    2. trauma or surgery
    3. phthisis bulbi
    4. silicone oil
    5. mercury fumes
    6. corneal dystrophy
    7. myotonic dystrophy
    8. longstanding glaucoma
  2. Systemic
    1. hypercalcemia- hyperparathyroidism, renal failure, sarcoidosis, MM, pagets, vit D toxicty, milk alkali syndrome
    2. hyperphosphatemia
    3. gout
27
Q

scleritis

A
  1. infectious
    1. bacteria: syphilis, TB, leprosy, pseudomonas, cat scratch, nocardia
    2. viral- HZV
    3. fungal
  2. inflammatory
    1. CTD: RA, SLE, seronegative spondyloarthropathies - inflam bowel, ank spond
    2. vasculitis: GCA, wegner, PAN
  3. trauma
  4. gout

Work up: CBC, ESR, ANA, anti DNA antibodies, RF, ANCA, urinanalysis, serum uric acid, syphilis, CXR, sarcoidosis

28
Q

Pre auricular LN

A

Bacterial: Parinaud’s, chlamydia / gonorrhea, trachoma

Viral: EKC, primary HSV, id cellulitis / dacryoadenitis, acute hemorrhagic conjunctivitis (enterovirus, pneumococcus)

Neoplastic of conj, K

29
Q

hyperacute conjunctivitis

A

N. gonorrhea

N. meningitidis

staph

strep

hemophilus aegyptius

enteric G-ve bacilli

30
Q

phylectenulosis

A

S. aureus

TB

Candida

rosacea

HSV

31
Q

Filamentary keratitis

A
  1. infection- HSV, VZV
  2. trauma - abrasion, toxicity with medications, recurrent erosion, retained FB, post surgical, CL use
  3. local causes- SLK, patching, dry eye (sjogrens, anticholinergic medications, GPC, ptosis, neurogenic cornea, K exposure (7th CN palsy)
  4. Systemic diseases- DM
32
Q

keratinization of conj epi

A
  1. infection- trachoma
  2. inflammatory- OCP, erythema multiforme, SLK
  3. vit A def
  4. trauma- radiation, mechanical/chemical
33
Q

Hyphema DDX

A

adults- clotting abnormalities, herpetic disease, rubeosis, ris hamangioma

children- JXG, RB, leukemia

  1. vascular anomaly- rubeosis, vascular tufts, vascular pupillary membranes
  2. Inflammatory- HZV, Fuch’s
  3. vascular erosion- JXG, iris nevus / melanoma
  4. hematologic- anticoagulants, thrombocytopenia
  5. late surgical- UGH
    6.
34
Q

salmon patch

A
  1. Lyphmoid - lymphoid, lymphoma
  2. deposits- amyloid
  3. tumours -dacryoadenoma, amelanotic nevus, amelanotic malanoma, lymphangioma, capillary hemangioma
35
Q

subconj heme

A
  1. Ocular

Conjunctival, orbital, or cranial trauma

Acute viral or bacterial conjunctivitis

Pterygium, pinguecula

  1. Systemic

Sudden venous congestion (Valsalva maneuver)

Vascular fragility

Thrombocytopenia and impaired clotting

Systemic febrile illness

Ocular surface neovascularization

36
Q

K scarring

A
  1. Superior- SLK, trachoma, VKC
  2. Central - disciform keratitis, keratoconus (hydrops), Fuchs, BK, lipid keratopathy, band keratopathy
  3. Inferior - neurotrophic, keratopathy, exposure keratopathy, marginal keratitis
  4. Diffuse- IK, trauma, SJS, OCP, trachoma
37
Q

Mutton fat KP

A
  1. Autoimmune
    1. Sarcoidosis
    2. VKH
    3. SO
    4. MS
  2. Infectious
    1. Syphilis
    2. Lyme disease
    3. Tuberculosis
    4. Herpes zoster
    5. toxo
    6. leprosy
    7. Coccidioidomycosis
    8. Brucellosis
    9. Idiopathic
38
Q

qualities of lesion concerning for malignancy

A
  1. elevated
  2. feeder vessel
  3. pigmented
  4. fixed to underlying tissues

ALWAYS do DFE and palpation of lymphadenopathy

Excision with 4 mm margins, no touch technique, K epi use alcohol assisted epi curettage with surgical blade and avoid violation of BM (natural barrier to tumour extension into K stroma), after removed use clean instruments in order to reduce change of seeding, may need conj autograft or AMN transplant with possible stem cell transplant

should refer to dermatologist for skin evaluation

39
Q

signs of dysplasia of sessile papilloma

A
  1. leukoplakia/keratinization
  2. symblepharon
  3. inflammation
  4. invasion
40
Q

Poor prognostic indicators for conj melanoma

A
  1. eyelid margin involvement
  2. thickness > 1.8mm
  3. invasion to deeper tissues
  4. lymphatic invasion
  5. mixed cell type
  6. palpebral conj/caruncle/fornix involvement
  7. pagetoid spread
  8. residual involvement
41
Q

indications for treatment of AKC

A
  1. PUK
  2. OSD
  3. pain
  4. progressive cicatrization
42
Q

Four signs of toxic keratopathy

A
  1. PEE
  2. vortex keratopathy
  3. peripheral K infiltrates
  4. follicular conjunctivitis
43
Q

causes of secondary localized amyloidosis

A
  1. infectious
    1. IK
    2. trachoma
    3. leprosy
    4. syphilis
  2. inflammation
    1. uveitis
    2. ROP
  3. degeneration
    1. KC
  4. trauma
    1. CL wear
    2. trichiasis
44
Q

Salzmann nodular degeneration

A
  1. Phylectenulosis
  2. trachoma
  3. IK
  4. VKC
  5. measles
  6. blepharitis
  7. trichiasis
  8. trauma
    9.
45
Q

systemic conditions associated with dry eye

A
  1. autoimmune
    1. primary and secondary sjogrens
  2. infiltrative
    1. lymphoma/amyloidosis/sarcoidosis
  3. infectious
    1. trachoma/HIV
  4. neuropathic
    1. parkinsons/alzheimers/cranial neuropathies/MS
  5. endocrine
    1. androgen deficiency
  6. miscellaneous
46
Q

Path of SLK

Treatment of SLK

A
  1. hyperproliferation
  2. acanthosis
  3. loss of goblet cells
  4. keratinization

topical anti inflammatory, large BCL punctal occlusion, cautery to super bulbar conj, resection of bulbar conj, topical cyclosprine, autologous serum drops, amniotic membrane, conj fixation sutures

47
Q

Describe the three drops used in CIN

A

Interferon-α2b (IFNα2b)

  • cytokine produced by immune cells to combat microbes and viruses
  • mechanism of action is thought to be related to its antiproliferative, cytotoxic, and antigenic properties
  • It may be injected subconjunctively or used topically as an eye drop.
  • 1 million IU/mL QID
  • well tolerated, difficult to obtain

Topical MMC

  • antimetabolite that alkylates DNA and disrupts the production of RNA
  • 0.02% or 0.04% QID - lower concentration is usually prescribed continuously for two weeks whereas, the higher concentration may be used for a week followed by 1 week off treatment
  • ocular pain, possible limbal stem cell loss, and other ocular surface toxicity
  • Punctal plug occlusion is advised to decrease the risk of punctual stenosis

5- fluorouracil (5-FU)

  • blocks DNA synthesis by acting as a pyrimidine analog after incorporation into RNA
  • 1% QID
  • Others prescribe it for 4 to 5 days every month; however, this dosing is associated with a higher recurrence rate
  • mild ocular irritation and occasional conjunctivitis
48
Q

Nummular keratitis

A

brucellosis

EKC

HZV

HSV

EBV

onchocerciasis

varicella

Lyme

49
Q

Blue sclera

A
  1. Congenital -
    1. Osteogenesis imperfecta type 1
    2. ehlers danlos type VI
    3. ocular melanosis
  2. Acquired
    1. scleral thinning from RA etc
    2. minocycline staining
50
Q

keratoconus associations

A

Down’s

atopy

Systemic

  • Marfan’s
  • mitral valve prolapse
  • Ehler-Danlos

Ocular

  • vernal
  • eye rubbing
  • LCA
  • Floppy eye lid
51
Q

Kaiser fleisher ring

A
  • Wilsons
  • copper IOFB
  • primary biliary cirrhosis
  • chronic active hepatitis
  • exogenous chalcosis
  • progressive intrahepatic cholestasis of childhood
  • multiple myeloma
  • pulmonary carcinoma
  • monoclonal gammopathies
  • chronic lymphocytic leukemia

DDX (6 decks)

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