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BCSCSAP Review > Cornea > Flashcards

Cornea Flashcards

1
Q

Pathogens that can invade through an intact corneal epithelium

A

Neisseria gonorrhoeae

Neisseria meningitidis

Corynebacterium diphtheriae

Listeria monocytogenes

Shigella

Haemophilus influenzae

Fusarium

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2
Q

Remove a suture from this meridian to decrease post-op astigmatism

A

90°

Steep axis at 90 and 270, theefore sutures should be removed

start topical abx and re-evaluate in 1 month with repeat corneal topography and manifest refraction

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3
Q

Monitor xeroderma pigmentosum for this

A

Ocular neoplasms in 11%

SCC, BCC, melanoma on surface and eyelids

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4
Q

Earliest pathologic corneal changes found in keratoconus

A

Bowman layer

Breaks in Bowman followed by fibrous growth through the break

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5
Q
A
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6
Q

62 yo M rosacea with blepharitis, marginal keratitis and AFib on warfarin with h/o 2 MI. Tx (oral) for ocular rosacea with least risk for adverse reaction?

A

Erythromycin

Not doxycycline b/c tetracyclines can potentiate anticoagulant effects, also reduce efficacy of OCP

NOT azithromycin b/c FDA warning that might be hazardous to patients with CV disease

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7
Q

25 yo FBS worse at end of day

Best blood test?

A

antibodies to La/SS-B antigens (more specific) and

SSA/Ro

rose bengal staining inferior conjunctivae and ropy mucous discharge -> DES

r/o SS

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8
Q

35 yo M blurry vision OD with recurrent episodes of pain and redness. Preferred treatment?

A

acyclovir 400 mg 2 times daily

(prophylaxis)

HSV stromal keratitis

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9
Q

Treatment for visually significant herpetic interstitial keratitis?

A

prednisolone 1% drops every 2 hours +

topical trifluridine QID or acyclovir 400 mg BID or valacyclovir 500 mg daily

Taper prednisolone every 1-2 weeks depending on clinical improvement

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10
Q

Cause of this condition?

A

disruption of descemet membrane

acute corneal hydrops

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11
Q

Diagnosis

A

limbal stem cell deficiency (LSCD)

whorl-like pattern caused by migration to ocular surface of conjunctival cells. 25%-33% limbus must be intact to ensure normal ocular resurfacing

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12
Q

clear corneal depression with thinning at limbus, adjacent to raised area of conjunctiva. Diagnosis and treatment?

A

Dellen - occurs due to dehydration of the epithelium and stroma

patching and topical lubrication

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13
Q

Prefered management to treat symptoms

A

conjunctival resection

(conjunctivochalasis - redundant bulbar conjunctival tissue)

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14
Q

Protein deficiency leading to this condition?

A

plasminogen deficiency

(ligneous conjunctivitis) Fibrinogen (factor I) needed for platelet aggregation

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15
Q

Cochet-Bonnet esthesiometer

A

used to evaluate corneal sensation

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16
Q

Hypercalcemia, renal failure, monoclonal spike on SPEP. What ocular finding is a/w this condition?

A

corneal crystalline deposits

(all layers of the cornea)

hyperviscosity of retinal vasculature, pars plana cysts, proptosis from orbital bony invasion

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17
Q

Diagnosis, genetics and mechanism

A

Corneal verticillata

Fabry disease

X-linked recessive

deficiency of a-galactosidase

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18
Q

Causes for this and synonyms

A

Fabry disease or prlonged amiodarone intake

Fleischer vortex

vortex keratopathy

whorl keratopathy

also caused by chloroquine, hydroxychloroquine, indomethacin, phenothiazines

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19
Q

Biopsy of conjunctiva is expected to show..

Consequences of failure to diagnose?

A

loss of goblet cells

severe case of xerophthalmia due to Vitamin A deficiency

Severe drying of conjunctiva with water beading on surface

Systemic vitamin A deficiency has a mortality rate of 50% if untreated!

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20
Q

eosinophilic extracellular deposits that exhibit birefringence

A

amyloid deposits

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21
Q

Bitot spots contain this bacteria

A

Corynebacterium xerosis - foamy appearance

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22
Q

Cause of this condition? Next step in management?

A

Superior limbic keratoconjunctivitis (SLK)

superior bulbar conjunctival laxity with secondary inflammation from mechanical trauma

a/w thyroid dysfunction

Note: Differentiate from FES by eyelids that can be everted with minimal effort

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23
Q

Expected findings on pathology

A

superior bulbar conjunctiva with histology showing hyperproliferation (increased C-N ratio), acanthosis, loss of goblet cells, keratinization, nuclear pyknosis with “snake nuclei”

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24
Q

Diagnosis and consequence

A

Iridocorneal endothelial (ICE) syndrome caused by proliferation of corneal endothelium over the TM eventually causing PAS and secondary angle-closure glaucoma

Glaucoma develop in 50%

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25
Q

ICE syndrome has 3 classical clinical presentations

A

(1) Essential iris atrophy - abnormal endothelium and descemet membrane growing over iris surface creating PAS, heterochromia, corectopia and iris thinning, atrophy and holes

(2) Iris Nevus Syndrome (Cogan-Reese) - pseudo-nevi of iris caused by compression of iris stroma by ICE membrane

(3) Chandler syndrome - corneal guttata and corneal edema

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26
Q

How long after initial infection would this exam finding be seen?

A

Within 7 to 14 days after onset of s/s, multifocal subepithelial corneal infiltrates can appear with d/c vision and photophobia

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27
Q

Diagnosis?

A

Distichiasis

extra rowe of eyelashes from th e ducts of the meibomian glands

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28
Q

loss of eyebrows or eyelashes

A

madarosis

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29
Q

Vital dye likely to produce symoptoms of odular iritation

A

rose bengal - stains conjunctivae better than corneal

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30
Q

lashes originating from meibomian gland orifices

A

trichiasis

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31
Q

Surgical option for chemical chorneal burn with complete conjunctivalization of cornea.

A

Simple limbal epithelial transplantation (SLET)

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32
Q

Interface that provides majority of refractive power for human eye?

A

air to tear film

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33
Q

Anorexia nervosa causes loss of this tear film component

A

mucin (xerosis - abnormal dryness of conjunctiva, from vitamin A deficiency)

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34
Q

How does this occur?

A

elevated IOP, corneal endothelial damage, blood in AC

corneal blood staining

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35
Q

Why is tissue from donors younger than 2 years generally not used in corneal transplation?

A

Tissue is steeply curved and flaccid

(eyebanks accept donors 2 years to 75)

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36
Q

By how much does immunization of varicella-zoster vaccine reduce incidence of zoster?

A

50% reduction in new cases

66% reduction in postherpetic neuralgia

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37
Q

Diagnosis

A

Neurotrophic ulceration

sectoral iris atrophy

classically rounded edge of ulcer indicating chronicity - from varicella-zoster keratitis from nasociliary branch of trigeminal nerve V1

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38
Q

Diagnosis

A

Large, greasy, “mutton-fat” keratic precipitates in a teenager with biopsy-proven sarcoidosis

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39
Q
A
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40
Q

Diagnosis

A

Patchy iris atrophy of herpetic iridocyclitis, best visualized with a broad, short beam under coaxial illumination at low power.

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41
Q
A

Small, white, stellate KP diffusely distributed in a patient with Fuch heterochromic iridocyclitis

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42
Q

Cause of corneal finding

A

Indomethacin (#4), amiodarone (MC), chloroquine (#2), hydroxychloroquine (#3), phenothiazines (chlorpromazine), fabry

Corneal verticillata or vortex keratopathy -

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43
Q

Histopathology is this stain demonstrating?

A

disruption in protective mucin coating

rose bengal - devitalized conjunctiva. Also toxic to epithelium

Stain dead and devitalized cells and mucus but epithelial cells inadequately protected by oculr surface mucins

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44
Q

In patients with renal failure, what elevated serum electrolyte can cause the condition shown? Laboratory workup should include these labs?

A

phosphate and calcium

Band keratopathy - calcium hydroxyapatite deposited in a horizontal band across the cornea. Elevated serum calcium while elevated serum phosphate can also drive precipitation of calcium even with normal calcium levels.

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45
Q

Corneal deposits are composed of what material

A

Hyaline

Granuluar corneal stromal dystrophy

AD

irregular well-circumscribed deposits

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46
Q

Diagnosis

A

primary acquired melanosis

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47
Q

Glaucoma drop a/w conjunctival hyperemia

A

prostaglandind analogue (latanoprost)

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48
Q

glaucoma drop aw toxic follicular conjunctivitis?

A

brimonidine

pilocarpine

atropine

epinephrine

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49
Q

Tx fusarium superficial keratitis

A

natamycin

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50
Q

Tx yeast (Candida) superficial keratitis

A

Amphotericin B

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51
Q

75 yo with reduced vision 20/150 and IOP 37 mm Hg. Preferred first-line treatment?

A

topical corticosteroids and oral acyclovir

central stromal edema with underlying keratic precipitates + elevated IOP = herpes simplex virus endotheliitis (herpetic disciform keratitis)

immunologic response to viral antigens

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52
Q

Best culture media for Acanthamoeba

A

nonnutrient agar with bacterial overlay

(killed enterobacter aerogenes or Escherichia coli)

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53
Q

Lowenstein-Jensen agar

A

mycobacteria

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54
Q

Sabouraud agar

A

fungi

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55
Q

Thioglycollate broth

A

aerobic and anaerobic bacteria

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56
Q

Cultures for bacterial and fungal infections

A

blood, chocolate, Sabouraud agars, thioglycollate broth

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57
Q

When to use topical steroids in traumatic iritis?

A

Only if significant inflammation is present. Otherwise use topical cycloplegics only.

Taper steroid carefully to prevent rebound anterior uveitis

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58
Q

Pathologic abnormality is demonstrated on ultrasound biomicroscopy?

A

cyclodialysis cleft

separation of ciliary body from the scleral spur

provides direct access of aqueous to the suprachoroidal space resulting in hypotony

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59
Q

Biopsy of the eyelid lesion would likely show

A

eosinophilic intracytoplasmic inclusions (Henderson-Patterson bodies) within epidermal cells surrounding a necrotic core

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60
Q

Vacuolized cytoplasm with multinucleated cells

A

herpetic vesicle

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61
Q

Poor prognositc factor

A

lymphatic invasion

poor prognosis: increased tumor thickness, unfavorable location (caruncle, palpebral conjunctiva, fornix), invasion

Histologic poor prognosis: mixed cell type, lymphatic invasion, moderate-to-severe atypia, >5 mitotic figures per 10 high-power fields, lack of inflammatory response induced by tumor

conjunctival melanoma

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62
Q

Test to confirm working Dx of conjunctival inflammation

A

conjunctival bx with immunofluorescence analysis - submit half in formaline and half in (Michel or Zeus) or saline for direct IF analysis

Picture: conjunctival fibrosis and fornix foreshortening (chronic cicatricial conjunctivitis)

DDx CCC includes trauma/chemical injury, previous severe infection, neoplasm, MMP/OCP

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63
Q

Most common causative organism that causes the condition shown?

A
  • Streptococcus viridans*
  • (alpha-hemolytic streptococcus)*

infectious crystalline keratopathy seen s/p transsplant with long-term use of topical steroids

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64
Q

Histological findings expected on lesion biopsy?

A

localized replacement of Bowman layer by hyaline and fibrillar material

Confocal microscopy: elongated basal epithelial cells and activated keratocytes in anterior stroma near nodules

Salzmann nodules -noninflammatory corneal degenerations in ocular inflammation or idiopathic

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65
Q

Tx for this condition

A

superficial keratectomy

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66
Q

Cause of this finding in patient from Pakistan?

A

Chlamydia trachomatis (serotypes A-C)

Trachoma

bandlike or stellate tarsal scarring (superior)

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67
Q

Extraocular manifestation of this disorder

A

a deforming arthritis of the distal joints

scleromalacia perforans - Scleral thinning without inflammation

Seen in longstanding RA

68
Q

Categories of noninfectious scleritis

A

necrotizing and nonnecrotizing inflammation

Necrotizing is nodular or diffuse (brawny scleritis)

Both patterns demonstrate granulomas with rim of lymphocytes and plasma cells that are peripheral to histiocytes

69
Q

Child with short stature. Organ system condition is associated with?

A

Nephropathy - renal failure, can lead to kidny failure by 10 years of age

MC in infantile form of cystinosis (and least common in adult-onset form)

70
Q

Patient presents with photophobia. Treatment?

A

topical application of cysteamine

Cystinosis - deposition of fine iridescent and polychromatic cystine crystals in cornea. Densest in peripheral cornea

71
Q

30 yo white woman with SLE c/o pain and poor vision OS. Definitive treatment?

A

systemic steroids

(peripheral ulcerative keratitis)

72
Q

H/o fingernail to eye with abrasion 2 weeks ago now with second recurrence of pain without additioanl trauma. How to prevent recurrence?

A

RCE following trauma

hypertonic saline ointment

73
Q

Painless slowly progressive visual loss with BCVA 20/60 and pachymetry 607 um. Diagnosis?

A

Fuchs dystrophy (FECD)

74
Q

Diagnosis

A

Advanced Fuchs endothelial dystrophy. Stromal edema, Descemet folds, and endothelial guttae

75
Q

Diagnosis

A

FECD

76
Q

Stages of FECD

A

1 Central, nonconfluent corneal guttae (central first)
Typically asymptomatic

2 Corneal guttae coalesce
Endothelial cell thinning and enlargement
Loss of hexagonal shape
Painless decrease in vision and glare

3 Stromal edema and/or bullae
Ruptured bullae: painful and can lead to scarring and infection

4 Cornea: densely opaque and vascularized
Subepithelial fibrosis

77
Q

Treatment for this disease

A

irregular astigmatism with inferior steepening, a clasic finding in KCN

hard contact lens fitting

78
Q

DDx for this finding

A

calcium deposition at level of bowman membrane

Hyperparathyroidism

Excessive vitamin D

Renal failure (photphate)

Paget disease of bone

Sarcoidosis (ACE)

79
Q

Treatment for trichiasis

A

radiofrequency ablation (electrolysis)

80
Q

reduce longterm formation of symblepharon in SJS

A

amniotic membrane transplantation

81
Q

Diagnosis

A

DDx

Topical anesthetic overuse

Bacterial

Fngal

Herpetic

Amebic

82
Q

Adenoviral serotypes AW conjunctivitis

A

8, 19, 37

83
Q

Cause of this finding?

A

Topical medication (dorzolamide)

Contact Dermatoblepharitis (Type IV T-cell mediated 24-72 hours after agent)

84
Q

Stain used for this disease?

A

Masson trichrome

Granular dystrophy (discrete deposits with clear intervening stroma)

85
Q

Primary mechanism of vision loss in patients with this condition?

A

Astigmatism

Terrien marginal degeneration - slowly progressive non-inflammatory, unilateral or asymmetrically bilateral peripheral corneal thinning and is associated with corneal neovascularization, opacification and lipid deposition

86
Q

Typical presentation of this condition

A

presents in 4th or 5th decade with decreased vision due to high against-the-rule, olbiue, or irregular astigmatism.

87
Q

pain on waking for years, worse in past few months, pain and photophobia on opening eyes now with 3 mm fluorescein indicating recurrent CE. Treatment?

A

epithelial debridement f/b patching or bandage with soft CL

basement membrane dystrophy showing thick geographic map lines or “putty marks”

88
Q

Diagnosis and findings on pathology

A

Epithelial basement membrane dystrophy: “map” changes.

Duplication of basement membrane

89
Q

How common is this condition?

A

Epithelial basement membrane dystrophy (EBMD) is the most common type of corneal dystrophy, affecting 2% of the population.

“Dot changes”

90
Q

Finding expected on histopathology for this condition?

A

Intraepithelial deposition of fibrillar material

91
Q

Diagnosis?

A

Epithelial basement membrane dystrophy: “fingerprint” changes. (A) These changes are easily seen by retroillumination. (B) Duplication of the epithelial basement membrane

92
Q

What topical treatment regimen is recommended for ocular surface squamous neoplasia?

A

topical interon-a2b 1 million IU/mL QID for 3-4 months

alternatives:Subconjunctival/perilesional INF-a2b can be given weekly as alternative (10% flu-like symptoms), topical mitomycin C (MMC) (more SE but shorter duration) or wide-margin surgical excision with cryotherapy

93
Q

Cleaning products spilled in eye. Best predictor of late corneal neovascularization and pannus formation from limbal stem cell deficiency?

A

degree of scleral and limbal ischemia

(100% ischemic (blanching) in this picture)

94
Q

Indication for use of the implant shown?

A

multiple corneal graft failures

Boston Type 1 keratoprosthesis

95
Q

Organism

A

gonococcal- or Neisseria-associated hyperpurulent conjunctivitis

Culture and give 1 gram intramuscular ceftriaxone

96
Q

Treatment for this infection?

A

Natamycin 5% (a polyene) is the only commercially available topical in the USA

Filamentous fungal keratitis: Grayish infiltrate with filamentous or feathery edge

97
Q

Most efficacious agent available to treat yeast keratitis

A

Topical amphotericin B (0.15%-0.30%)

98
Q

History and likely etiology?

A

Plant matter or immunocompromised

Fusarium solani, Aspergillus sp., Curvularia sp., Candida albicans, and rare Dimorphic fungi (Histoplasma, Sporothrix, etc.).

99
Q

Long-term treatment of atopic dermatitis a/w atopic keratoconjunctivitis uncontrolled by topical therapies?

A

Oral cyclosporine

1/3 of patients with atopic dermatitis will develop atopic keratoconjunctivitis AKC (Type IV reaction)

100
Q

Property of adenovirus makes it resistant to routine disinfection precautions (ethyl alcohol)

A

absence of viral envelope

101
Q

Painless progressive vision loss of both eyes. Preferred management?

A

Polycarbonate lenses and discussion that the vision loss may slowly progress with time

superior limbal thinning with intact epithelium without inflammation c/w Terrien’s marginal degeneration

102
Q

Hyperacute conjunctivitis with gram-negative intracellular diplococci. Treatment?

If corneal ulceration present?

If penicillin allergy?

A

gonococcal conjunctivitis from Neisseria gonorrhoeae

intramuscular ceftriaxone 1 g with close observation

If ulceration - admit for IV ceftriaxone 1 g IV q12 hours x 3 days

Pen allergy: spectinomycin 2 g IM or oral fluoroquinolones (cipro or ofloxacin x 5 days)

103
Q

Most common association?

A

15% otherwise normal eye (8-30%)

posterior embryotoxin - thickened and anterior displaced Schwalbe line

Look for peripheral iris strands to Schwalbe line, iris stromal hypoplasia, glaucoma

104
Q
A
105
Q

Seen in 15% of healthy patients and these 3 syndromes

A

Axenfeld-Rieger syndrome

Arteriohepatic dysplasia (Alagille syndrome)

Velocardiofacial syndrome (22q11 deletion syndrome)

106
Q

Likely cause of his diagnosis? Suden onset of follicular conjunctivitis with muptiple petechial hemorrhages of bulbar and tarsal conjunctiva.

A

enterovirus type 70

coxsackievirus

less commonly adenovirus

acute hemorrhagic conjunctivitis (AHC)

107
Q

7-day old infant with Giemsa stain showing intracytoplasmic inclusions. Treatment

A

Systemic erythromycin

108
Q

10 year old with tearing, light sensitivity, redness, whitening of cornea, developmental delay, unusual shape nose and widely spaced teath.

A

Untreated congenital syphilis, onsent of interstitial keratitis usually between 6 and 12 years of age.

Corneal edema -> abnormal vascularization i ndeep stroma adjacent to descemet mmbrane.

109
Q

DDx for this finding

A

TIC TAC’S

TB

Inheritied syphilis (congenital)

Trypanosomiasis

Acquired syphilis

Cogan’s syndrome

Sarcoidosis

110
Q

Organism

A

protozoa

Note: perineuritis (arrows)

111
Q

Arteries that supply blood to bulbar conjunctiva

A

anterior ciliary arteries

arise from muscular branches of ophthalmic artery

112
Q

Describe the ophthalmic division of the trigeminal nerve

A

CN V1 passes into the orbit through the superior orbital fissure and divides into 3 branches: frontal, lacrimal, nasociliary.

CORNEA SENSATION = NASOCILIARY

113
Q

MC after traumatic endophthalmitis

A

bacillus cereus, gram-positive, spore-forming rod sometimes found in normal conjunctiva

114
Q

8-year old boy with irritated and red eyes. Diagnosis?

A

Vernal keratoconjunctivitis (VKC)

giant papillae on upper tarsus and limbal follicles (Horner-trantas dots)

Types I and IV hypersensitvity reactions

eosinophils, lymphocytes, plasma cells, monocytes

115
Q

Contraindicated in neurotrophic keratopathy after stroke?

A

topical beta blockers

anesthetics, NSAIDs, carbonic anhydrase inhibitors, trifluridine, BAK

ocular medications that impair wound healing

116
Q

Device best for detecting abnormalities in posterior corneal curvature?

A

Scheimpflug-based (eg, Pentacam, Orbscan)

117
Q

Chalky white deposits that adhere to conreal epithelial defects. Most likely medication

A

ciprofloxacin (topical fluoroquinolines, esp cipro crystals)

118
Q

AW megalocornea

A

zonular instability

Note Megalocornea is XL, >13 mm

119
Q

Patient p/w recurrent pain and redness in both eyes. Other ocular or extraocular manifestation may develop from the known genetic mutation

A

lattice corneal dystrophy +RES, a common complication with lattice.

Type II lattice dystrophy (Meretoja syndrome) AW mutation in gelsolin gene includes systemic amyloidosis, FACIAL NERVE PALSY, polyneuropathies and cutis laxa/dermatochalasis, (inelastic skin), pendulous ears.

120
Q

Contraindication for using corneal tissue for transplantation

A

history of leukemia

unknown death

congenital rubella

Reye syndrome 3 months

CFJ, PML

DS

Behavioral

Prior refractive

HBV/HIV/HCV

121
Q

Importance of these structures

A

Palisades of Vogt

house corneal epithelial stem cells at the limbus

122
Q

Management of suture track leak

A

place bandage contact lens and start timolol 0.5%

123
Q

Aerobic bacteria grow best on

A

blood agar, chocolate agar, and in thioglycollate broth

124
Q

Anaerobic bacteria grow best on

A

anaerobic blood agar, phenylethyl alcohol agar in an anaerobic chamber, thioglycollate or chopped meat broth

125
Q

Mycobacteria grow on

A

blood agar and Lowenstein-Jensen agar

126
Q

Preferred culture medium for Haemophilus species

A

Chocolate agar

Haemophilus is gram-negative coccobacillus and requires enriched media

127
Q

AW bleb infections after glaucoma filtering surgeries

A

Haemophlus and streptococci

128
Q

Conjunctival finding in atopic keratoconjunctivitis (AKC)

A

small and medium-sized papillae

chronic inflammation

milky conjunctival edema with possible subepithelial fibrosis

129
Q

Conjunctival finding in vernal keratoconjunctivitis

A

giant papillary reactions

130
Q

Function as dendritic antigen-presenting cells in the conjunctiva and cornea

A

Langerhans cells

are major histocomplatibility complex (MHC) class II + dendritic APCs

Take up antigens and present them to CD4+ T cells priming for immune response.

131
Q

Pterygium lowest recurrence rate

A

free conjunctival autograft (0%-4%)

Rotational and primary closure (39%)

Bare (88%)

132
Q

Gene that caused this finding if AW liver dysfunction

A

Posterior embryotoxon + liver dysfunction = Alagille syndrome

JAG1 gene (AD)

133
Q

Characteristics of Alagille syndrome

A

Heart defects

Liver dysfunction causing jaundice

Posterior embryotoxon + pigmentary retinopathy

134
Q

Globe rupture with prolapsed iris tissue and thin translucent membrane adherent to stromal surface. Next step

A

reposit prolapsed iris tissue with removal of membrane (early epithelialziation of iris surface from cornea or conjunctiva epithelium to prevent epithelial ingrowth)

135
Q

Acanthamoeba diagnostics

A

nonnutrient agar with E coli or Enterobacter aerogenes overlay

or

buffered charcoal-yeast extract agar

or

in vivo confocal microscopy (esp cyst form)

or

Giemsa or periodic acid-Schiff (PAS), calcofluor white, acridine orange stain

136
Q

Acid-fast stains are used if you suspect

A

mycobacteria and/or Nocardia

137
Q

Phlyctenulosis is AW

A

staphylococcal blepharitis

delayed or cell-mediated hypersensitivity raction to staphylococcus or other microbial antigens

138
Q

How does cornea prevent rejection of corneal transplants

A

apoptosis through upregulation of Fas ligand

139
Q

AW megalocornea

A

zonular insufficiency

140
Q

Pediatric corneal condition with highest chance of graft failure after PK

A

Peters anomaly type II

anterior segment findings more severe - adhesions among cornea, iris, and lens. Corneal neovascularization; glaucoma, cataract, corneal staphyloma

56% clear at 6 months and 44% at 3 years

141
Q

MC clinical manifestation of primary ocular herpes simplex

A

blepharoconjunctivitis

follicular with vesicles on skin or eyelid margin that progress to blistered, crusted lesions

142
Q

POD5 s/p DMEK

Next step

A

injection of gas into AC (‘rebubble’)

Corneal edema after DMEK from peripheral graft detachment

DMEK detachment not involving visual axis or <30% can be observed

persistent edema 1-2 months - repeat endothelial keratoplasty

143
Q

Diagnosis

A

Conjunctiva melanoma

pigmented conjunctiva, caruncle, or fonix

144
Q

Diagnosis

A

Recurrent melanomas are often amelanotic. It doesn’t matter if primary tumor was pigmented or not.

145
Q

Diagnosis

A

Sebaceous gland carcinoma

146
Q

Diagnosis

A

Amelanotic conjunctival nevus

147
Q

Testing for this condition

A

direct immunofluorescence or immunoperoxidase demonstrating complement 3, IgG, IgM, and or IgA localized in the epithelial basement membrane zone BMZ

148
Q

Additional findings in this patient

A

Marfanoid body habitus

MEN2B - pheochromocytoma, medullary carcinoma of thyroid, mucosal neuromas

Refsum

Hansen

Riley-Day

NF

Acanthamoeba

149
Q

Preauricular skin tags

A

Goldenhar-Gorlin or oculoauriculovertebral syndrome

strabismus, limbal dermoids, upper eyelid colobomas

hearing difficulties

150
Q

Microspherophakia

A

Weill-Marchesani syndrome

(short stature, ectopia lentis, brachydactyly)

151
Q

Cause toxic follicular conjunctivitis

A

adrenergic agonists

apraclonidine

brimonidine

epinephrine

152
Q

Toxic keratoconjunctivitis with diffuse punctate epitheliopathy

A

Proparacaine and gentamicin

153
Q

Corneal disorder most amenable to treatment by superficial keratectomy alone

A

Salzmann nodular degeneration

154
Q

UV-induced injury to corneal epithelium. Treatment?

A

patching with cycloplegia and topical antibiotic ointment

Healing usually occurs within 24-72 hours

155
Q

Older age, eczema, year round smptoms, corneal vascularization, PSC

A

Atopic keratoconjunctivitis

Depressed systemic cell-mediated immunity making them more susceptible to HSV and colonization of eyelids with S aureus

[photo - subepithelial fibrosis]

156
Q

What else should you look for in this patient?

A

eyelid colobomas (upper>lower)

preauricular skin tags

hemifacial microsomia

vertebral abnormalities

(Gondenhar-Gorlin or oculo-auriculo-vertebral syndrome (OAV))

157
Q

elongated ciliary processes

A

persistent fetal vasculature

158
Q

Optimal illumination method to view corneal endothelium by slit-lamp exam?

A

specular reflection

159
Q

Bx of conjunctival tissue adjacent to corneal would show

A

immune-mediated vaso-occlusive disease

PUK

unilateral

MC RA

160
Q

Cornea contributes how much refractive power to the eye

A

74%

43-44 of 58 D oft he eye’s refractive power

161
Q

Blood agar

A

most bacteria

162
Q

Chocolate agar

A

most bacteria (especially Neisseria gonorrhoeae and Haemophilus)

163
Q

thioglycollate broth

A

aerobic and anaerobic bacteria

164
Q

used to move a nonprogressive corneal scar out of the visual axis in an otherwise healthy cornea

A

rotational corneal autograft

165
Q

H/o chronically inflammed chalazion. Treatment

A

topical corticosteroids

or

intralesional corticosteroids

or

excision with cauterization to the base (with postop topical corticosteroids)

Pyogenic granuloma - reactive hemangiomas consiting of granulation tissue and proliferating capillaries as a part of a healing response to minor trauma, surgery or a chronically inflammed chalazion

166
Q

RP + abetalipoproteinemia

A

bassen-kornzweig

167
Q

RP + high phytanic acid

A

Refsum disease

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