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
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
3
Q
Monitor xeroderma pigmentosum for this
A
Ocular neoplasms in 11%
SCC, BCC, melanoma on surface and eyelids
4
Q
Earliest pathologic corneal changes found in keratoconus
A
Bowman layer
Breaks in Bowman followed by fibrous growth through the break
5
Q
A
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
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
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
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
10
Q
Cause of this condition?
A
disruption of descemet membrane
acute corneal hydrops
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
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
13
Q
Prefered management to treat symptoms
A
conjunctival resection
(conjunctivochalasis - redundant bulbar conjunctival tissue)
14
Q
Protein deficiency leading to this condition?
A
plasminogen deficiency
(ligneous conjunctivitis) Fibrinogen (factor I) needed for platelet aggregation
15
Q
Cochet-Bonnet esthesiometer
A
used to evaluate corneal sensation
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
17
Q
Diagnosis, genetics and mechanism
A
Corneal verticillata
Fabry disease
X-linked recessive
deficiency of a-galactosidase
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
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!
20
Q
eosinophilic extracellular deposits that exhibit birefringence
A
amyloid deposits
21
Q
Bitot spots contain this bacteria
A
Corynebacterium xerosis - foamy appearance
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
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”
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%
25
ICE syndrome has 3 classical clinical presentations
**(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
26
How long after initial infection would this exam finding be seen?
Within 7 to 14 days after onset of s/s, multifocal subepithelial corneal infiltrates can appear with d/c vision and photophobia
27
Diagnosis?
**Distichiasis**
extra rowe of eyelashes from th e ducts of the meibomian glands
28
loss of eyebrows or eyelashes
madarosis
29
Vital dye likely to produce symoptoms of odular iritation
**rose bengal** - stains conjunctivae better than corneal
30
lashes originating from meibomian gland orifices
trichiasis
31
Surgical option for chemical chorneal burn with complete conjunctivalization of cornea.
**Simple limbal epithelial transplantation (SLET)**
32
Interface that provides majority of refractive power for human eye?
air to tear film
33
Anorexia nervosa causes loss of this tear film component
**mucin** (xerosis - abnormal dryness of conjunctiva, from vitamin A deficiency)
34
How does this occur?
**elevated IOP**, corneal endothelial damage, blood in AC
corneal blood staining
35
Why is tissue from donors younger than 2 years generally not used in corneal transplation?
**Tissue is steeply curved and flaccid**
| (eyebanks accept donors 2 years to 75)
36
By how much does immunization of varicella-zoster vaccine reduce incidence of zoster?
**50%** reduction in new cases
66% reduction in postherpetic neuralgia
37
Diagnosis
**Neurotrophic ulceration**
**sectoral iris atrophy**
classically rounded edge of ulcer indicating chronicity - from varicella-zoster keratitis from nasociliary branch of trigeminal nerve V1
38
Diagnosis
Large, greasy, "mutton-fat" keratic precipitates in a teenager with biopsy-proven sarcoidosis
39
40
Diagnosis
Patchy **iris atrophy** of herpetic iridocyclitis, best visualized with a broad, short beam under coaxial illumination at low power.
41
Small, white, **stellate KP** diffusely distributed in a patient with Fuch heterochromic iridocyclitis
42
Cause of corneal finding
**Indomethacin (#4)**, amiodarone (MC), chloroquine (#2), hydroxychloroquine (#3), phenothiazines (chlorpromazine), fabry
*Corneal verticillata* or vortex keratopathy -
43
Histopathology is this stain demonstrating?
**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
44
In patients with renal failure, what elevated serum electrolyte can cause the condition shown? Laboratory workup should include these labs?
**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.
45
Corneal deposits are composed of what material
**Hyaline**
**Granuluar** corneal stromal dystrophy
AD
irregular well-circumscribed deposits
46
Diagnosis
primary acquired melanosis
47
Glaucoma drop a/w conjunctival hyperemia
prostaglandind analogue (latanoprost)
48
glaucoma drop aw toxic follicular conjunctivitis?
**brimonidine**
pilocarpine
atropine
epinephrine
49
Tx fusarium superficial keratitis
natamycin
50
Tx yeast (Candida) superficial keratitis
Amphotericin B
51
75 yo with reduced vision 20/150 and IOP 37 mm Hg. Preferred first-line treatment?
**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
52
Best culture media for Acanthamoeba
nonnutrient agar with bacterial overlay
(killed enterobacter aerogenes or Escherichia coli)
53
Lowenstein-Jensen agar
mycobacteria
54
Sabouraud agar
fungi
55
Thioglycollate broth
aerobic and anaerobic bacteria
56
Cultures for bacterial and fungal infections
blood, chocolate, Sabouraud agars, thioglycollate broth
57
When to use topical steroids in traumatic iritis?
Only if significant inflammation is present. Otherwise use topical cycloplegics only.
Taper steroid carefully to prevent rebound anterior uveitis
58
Pathologic abnormality is demonstrated on ultrasound biomicroscopy?
**cyclodialysis cleft**
separation of ciliary body from the scleral spur
provides direct access of aqueous to the suprachoroidal space resulting in hypotony
59
Biopsy of the eyelid lesion would likely show
eosinophilic intracytoplasmic inclusions (Henderson-Patterson bodies) within epidermal cells surrounding a necrotic core
60
Vacuolized cytoplasm with multinucleated cells
herpetic vesicle
61
Poor prognositc factor
**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
62
Test to confirm working Dx of conjunctival inflammation
**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
63
Most common causative organism that causes the condition shown?
* Streptococcus viridans*
* (alpha-hemolytic streptococcus)*
infectious crystalline keratopathy seen s/p transsplant with long-term use of topical steroids
64
Histological findings expected on lesion biopsy?
**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
65
Tx for this condition
superficial keratectomy
66
Cause of this finding in patient from Pakistan?
Chlamydia trachomatis (serotypes A-C)
Trachoma
bandlike or stellate tarsal scarring (superior)
67
Extraocular manifestation of this disorder
**a deforming arthritis of the distal joints**
scleromalacia perforans - Scleral thinning without inflammation
Seen in longstanding RA
68
Categories of noninfectious scleritis
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
Child with short stature. Organ system condition is associated with?
**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
Patient presents with photophobia. Treatment?
topical application of **cysteamine**
Cystinosis - deposition of fine iridescent and polychromatic cystine crystals in cornea. Densest in peripheral cornea
71
30 yo white woman with SLE c/o pain and poor vision OS. Definitive treatment?
**systemic steroids**
| (peripheral ulcerative keratitis)
72
H/o fingernail to eye with abrasion 2 weeks ago now with second recurrence of pain without additioanl trauma. How to prevent recurrence?
RCE following trauma
## Footnote
**hypertonic saline ointment**
73
Painless slowly progressive visual loss with BCVA 20/60 and pachymetry 607 um. Diagnosis?
Fuchs dystrophy (FECD)
74
Diagnosis
Advanced Fuchs endothelial dystrophy. Stromal edema, Descemet folds, and endothelial guttae
75
Diagnosis
FECD
76
Stages of FECD
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
Treatment for this disease
irregular astigmatism with inferior steepening, a clasic finding in KCN
## Footnote
**hard contact lens fitting**
78
DDx for this finding
*calcium deposition at level of bowman membrane*
Hyperparathyroidism
Excessive vitamin D
Renal failure (photphate)
Paget disease of bone
Sarcoidosis (ACE)
79
Treatment for trichiasis
radiofrequency ablation (electrolysis)
80
reduce longterm formation of symblepharon in SJS
amniotic membrane transplantation
81
Diagnosis
DDx
Topical anesthetic overuse
Bacterial
Fngal
Herpetic
Amebic
82
Adenoviral serotypes AW conjunctivitis
8, 19, 37
83
Cause of this finding?
**Topical medication (dorzolamide)**
Contact Dermatoblepharitis (Type IV T-cell mediated 24-72 hours after agent)
84
Stain used for this disease?
Masson trichrome
Granular dystrophy (discrete deposits with clear intervening stroma)
85
Primary mechanism of vision loss in patients with this condition?
**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
Typical presentation of this condition
presents in 4th or 5th decade with decreased vision due to high against-the-rule, olbiue, or irregular astigmatism.
87
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?
**epithelial debridement f/b patching or bandage with soft CL**
basement membrane dystrophy showing thick geographic map lines or "putty marks"
88
Diagnosis and findings on pathology
Epithelial basement membrane dystrophy: "map" changes.
Duplication of basement membrane
89
How common is this condition?
Epithelial basement membrane dystrophy (EBMD) is the most common type of corneal dystrophy, affecting 2% of the population.
"Dot changes"
90
Finding expected on histopathology for this condition?
Intraepithelial deposition of fibrillar material
91
Diagnosis?
Epithelial basement membrane dystrophy: "fingerprint" changes. (A) These changes are easily seen by retroillumination. (B) Duplication of the epithelial basement membrane
92
What topical treatment regimen is recommended for ocular surface squamous neoplasia?
**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
Cleaning products spilled in eye. Best predictor of late corneal neovascularization and pannus formation from limbal stem cell deficiency?
**degree of scleral and limbal ischemia**
(100% ischemic (blanching) in this picture)
94
Indication for use of the implant shown?
**multiple corneal graft failures**
Boston Type 1 keratoprosthesis
95
Organism
**gonococcal- or Neisseria-associated hyperpurulent conjunctivitis**
Culture and give 1 gram intramuscular ceftriaxone
96
Treatment for this infection?
**Natamycin 5% (a polyene)** is the only commercially available topical in the USA
Filamentous fungal keratitis: Grayish infiltrate with filamentous or feathery edge
97
Most efficacious agent available to treat yeast keratitis
Topical amphotericin B (0.15%-0.30%)
98
History and likely etiology?
Plant matter or immunocompromised
Fusarium solani, Aspergillus sp., Curvularia sp., Candida albicans, and rare Dimorphic fungi (Histoplasma, Sporothrix, etc.).
99
Long-term treatment of atopic dermatitis a/w atopic keratoconjunctivitis uncontrolled by topical therapies?
**Oral cyclosporine**
1/3 of patients with atopic dermatitis will develop atopic keratoconjunctivitis AKC (Type IV reaction)
100
Property of adenovirus makes it resistant to routine disinfection precautions (ethyl alcohol)
absence of viral envelope
101
Painless progressive vision loss of both eyes. Preferred management?
**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
Hyperacute conjunctivitis with gram-negative intracellular diplococci. Treatment?
If corneal ulceration present?
If penicillin allergy?
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
Most common association?
**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
105
Seen in 15% of healthy patients and these 3 syndromes
**Axenfeld-Rieger syndrome**
**Arteriohepatic dysplasia (Alagille syndrome)**
**Velocardiofacial syndrome (22q11 deletion syndrome)**
106
Likely cause of his diagnosis? Suden onset of follicular conjunctivitis with muptiple petechial hemorrhages of bulbar and tarsal conjunctiva.
**enterovirus type 70**
coxsackievirus
less commonly adenovirus
acute hemorrhagic conjunctivitis (AHC)
107
7-day old infant with Giemsa stain showing intracytoplasmic inclusions. Treatment
Systemic erythromycin
108
10 year old with tearing, light sensitivity, redness, whitening of cornea, developmental delay, unusual shape nose and widely spaced teath.
**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
DDx for this finding
TIC TAC'S
TB
Inheritied syphilis (congenital)
Trypanosomiasis
Acquired syphilis
Cogan's syndrome
Sarcoidosis
110
Organism
**protozoa**
Note: perineuritis (arrows)
111
Arteries that supply blood to bulbar conjunctiva
anterior ciliary arteries
arise from muscular branches of ophthalmic artery
112
Describe the ophthalmic division of the trigeminal nerve
CN V1 passes into the orbit through the superior orbital fissure and divides into 3 branches: **frontal, lacrimal, nasociliary.**
**CORNEA SENSATION = NASOCILIARY**
113
MC after traumatic endophthalmitis
bacillus cereus, gram-positive, spore-forming rod sometimes found in normal conjunctiva
114
8-year old boy with irritated and red eyes. Diagnosis?
**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
Contraindicated in neurotrophic keratopathy after stroke?
**topical beta blockers**
anesthetics, NSAIDs, carbonic anhydrase inhibitors, trifluridine, BAK
ocular medications that impair wound healing
116
Device best for detecting abnormalities in posterior corneal curvature?
**Scheimpflug-based** (eg, Pentacam, Orbscan)
117
Chalky white deposits that adhere to conreal epithelial defects. Most likely medication
**ciprofloxacin** (topical fluoroquinolines, esp cipro crystals)
118
AW megalocornea
zonular instability
Note Megalocornea is XL, \>13 mm
119
Patient p/w recurrent pain and redness in both eyes. Other ocular or extraocular manifestation may develop from the known genetic mutation
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
Contraindication for using corneal tissue for transplantation
**history of leukemia**
unknown death
congenital rubella
Reye syndrome 3 months
CFJ, PML
DS
Behavioral
Prior refractive
HBV/HIV/HCV
121
Importance of these structures
**Palisades of Vogt**
house corneal epithelial stem cells at the limbus
122
Management of suture track leak
place bandage contact lens and start timolol 0.5%
123
Aerobic bacteria grow best on
blood agar, chocolate agar, and in thioglycollate broth
124
Anaerobic bacteria grow best on
anaerobic blood agar, phenylethyl alcohol agar in an anaerobic chamber, thioglycollate or chopped meat broth
125
Mycobacteria grow on
blood agar and Lowenstein-Jensen agar
126
Preferred culture medium for Haemophilus species
Chocolate agar
Haemophilus is gram-negative coccobacillus and requires enriched media
127
AW bleb infections after glaucoma filtering surgeries
Haemophlus and streptococci
128
Conjunctival finding in atopic keratoconjunctivitis (AKC)
**small and medium-sized papillae**
chronic inflammation
milky conjunctival edema with possible subepithelial fibrosis
129
Conjunctival finding in vernal keratoconjunctivitis
giant papillary reactions
130
Function as dendritic antigen-presenting cells in the conjunctiva and cornea
**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
Pterygium lowest recurrence rate
**free conjunctival autograft (0%-4%)**
Rotational and primary closure (39%)
Bare (88%)
132
Gene that caused this finding if AW liver dysfunction
Posterior embryotoxon + liver dysfunction = Alagille syndrome
## Footnote
**JAG1 gene (AD)**
133
Characteristics of Alagille syndrome
Heart defects
Liver dysfunction causing jaundice
Posterior embryotoxon + pigmentary retinopathy
134
Globe rupture with prolapsed iris tissue and thin translucent membrane adherent to stromal surface. Next step
reposit prolapsed iris tissue with removal of membrane (early epithelialziation of iris surface from cornea or conjunctiva epithelium to prevent epithelial ingrowth)
135
Acanthamoeba diagnostics
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
Acid-fast stains are used if you suspect
mycobacteria and/or Nocardia
137
Phlyctenulosis is AW
staphylococcal blepharitis
delayed or cell-mediated hypersensitivity raction to staphylococcus or other microbial antigens
138
How does cornea prevent rejection of corneal transplants
apoptosis through upregulation of Fas ligand
139
AW megalocornea
zonular insufficiency
140
Pediatric corneal condition with highest chance of graft failure after PK
**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
MC clinical manifestation of primary ocular herpes simplex
**blepharoconjunctivitis**
follicular with vesicles on skin or eyelid margin that progress to blistered, crusted lesions
142
POD5 s/p DMEK
Next step
**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
Diagnosis
**Conjunctiva melanoma**
pigmented conjunctiva, caruncle, or fonix
144
Diagnosis
**Recurrent melanomas are often amelanotic.** It doesn't matter if primary tumor was pigmented or not.
145
Diagnosis
Sebaceous gland carcinoma
146
Diagnosis
Amelanotic conjunctival nevus
147
Testing for this condition
direct immunofluorescence or immunoperoxidase demonstrating complement 3, IgG, IgM, and or IgA localized in the epithelial basement membrane zone BMZ
148
Additional findings in this patient
Marfanoid body habitus
MEN2B - pheochromocytoma, medullary carcinoma of thyroid, mucosal neuromas
Refsum
Hansen
Riley-Day
NF
Acanthamoeba
149
Preauricular skin tags
**Goldenhar-Gorlin or oculoauriculovertebral syndrome**
strabismus, limbal dermoids, upper eyelid colobomas
hearing difficulties
150
Microspherophakia
**Weill-Marchesani syndrome**
(short stature, ectopia lentis, brachydactyly)
151
Cause toxic follicular conjunctivitis
adrenergic agonists
apraclonidine
brimonidine
epinephrine
152
Toxic keratoconjunctivitis with diffuse punctate epitheliopathy
Proparacaine and gentamicin
153
Corneal disorder most amenable to treatment by superficial keratectomy alone
**Salzmann nodular degeneration**
154
UV-induced injury to corneal epithelium. Treatment?
**patching with cycloplegia and topical antibiotic ointment**
Healing usually occurs within 24-72 hours
155
Older age, eczema, year round smptoms, corneal vascularization, PSC
**Atopic keratoconjunctivitis**
Depressed systemic cell-mediated immunity making them more susceptible to **_HSV_** and colonization of eyelids with **_S aureus_**
[photo - subepithelial fibrosis]
156
What else should you look for in this patient?
**eyelid colobomas (upper\>lower)**
**preauricular skin tags**
**hemifacial microsomia**
**vertebral abnormalities**
*(Gondenhar-Gorlin or oculo-auriculo-vertebral syndrome (OAV))*
157
elongated ciliary processes
persistent fetal vasculature
158
Optimal illumination method to view corneal endothelium by slit-lamp exam?
**specular reflection**
159
Bx of conjunctival tissue adjacent to corneal would show
immune-mediated vaso-occlusive disease
PUK
unilateral
MC RA
160
Cornea contributes how much refractive power to the eye
**74%**
43-44 of 58 D oft he eye's refractive power
161
Blood agar
most bacteria
162
Chocolate agar
most bacteria (especially Neisseria gonorrhoeae and Haemophilus)
163
thioglycollate broth
aerobic and anaerobic bacteria
164
used to move a nonprogressive corneal scar out of the visual axis in an otherwise healthy cornea
rotational corneal autograft
165
H/o chronically inflammed chalazion. Treatment
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
RP + abetalipoproteinemia
bassen-kornzweig
167
RP + high phytanic acid
Refsum disease
