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NBEO Part 2 > Cornea & Conjunctiva & Sclera > Flashcards

Cornea & Conjunctiva & Sclera Flashcards

1
Q

RTC for recurrent corneal erosions

A

1 day, RTC every 1-2 days to ensure healing

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2
Q

Treatment of RCE

A

Erythromycin ung QID
lubricating tears q2h
Bandage CL if erosion is large

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3
Q

Cause of RCE?

A

Secondary to trauma that causes initial corneal abrasion (fingernail or tree branch)

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4
Q

What is this corneal finding?

A

Mutton-fat (granulomatous) keratic precipitates
*associated with granulomatous anterior uveitis (aka iritis)

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5
Q

Which organisms can penetrate an intact corneal epithelium? (4)

A
  1. Corynebacterium diptheriae
  2. Haemophilus
  3. Listeria
  4. Neisseria gonorrhoea
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6
Q

Bacterial conjunctivitis in kids is caused by?

A

Haemophilus influenzae

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7
Q

Bacterial conjunctivitis in adults is caused by?

A

S. Aureus

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8
Q

True or false
Preauricular lymphadenopathy is present in bacterial conjunctivitis

A

FLASE

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9
Q

RTC for giant papillary conjunctivitis

A

2 to 4 weeks

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10
Q

Treatment for corneal abrasion in patients who wear CL

A

AB that protects against pseudomonas (fluoroquinolone or tobramycin QID)

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11
Q

If patient with corneal abrasion is extremely photophobic, what can you prescribe them?

A

Cycloplegic agent such as homatropine

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12
Q

RTC for small corneal abrasion

A

2 to 5 days later and FU until healed

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13
Q

True or False
Patching is recommended for CL wearers for corneal abrasion caused by vegetative or organic matter

A

FLASE
* do NOT patch these patients

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14
Q

Treatment for corneal abrasion for non-CL wearer

A

Antibiotic ointment Q2H or Q4H
Or
Antibiotic drops to ensure sterility
(Fluoroquniolone QID)

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15
Q

Patient presents with unilateral arcus. What should you do next?

A

Refer for carotid artery doppler contralateral to the eye with arcus to check for potential artery occlusion

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16
Q

Corneal arcus initially appears where on the peripheral cornea?

A

Inferior
Superior
Then coalesces circumferentially

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17
Q

Cholesterol deposits in which layer of the cornea in Corneal Arcus?

A

Stromal periphery

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18
Q

Punctal atresia is asymptomatic when the absence of puncta is located where?

A

Upper eyelid

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19
Q

What is punctual atresia?

A

Congenital absence of puncta

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20
Q

Treatment for punctal atresia

A

Cannulation with placement of silicone tubes

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21
Q

Tx for endophthalmitis

A

Immediate referral to OMD for Intravitreal antibiotic injection of vancomycin and ceftazidime

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22
Q

What is the most likely causative organism of acute post operative endophthalmitis?

A

Staphylococcus epidermidis

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23
Q

Iron pigment line on pterygium

A

Stocker line
* sign of stability

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24
Q

Hudson-stahli line

A

Observed in inferior mid-peripheral region of corneas of patients with advanced age

  • iron deposit line where tear film is stagnant
  • asymptomatic
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25
Q

Fleischer ring

A

At base of the cone in patients with keratoconus

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26
Q

If a rust ring is present with a metallic foreign body, how should it be removed?

A

Alger brush
* ophthalmic drill
* stop spinning if pushed too deep, can’t go to bowman’s layer

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27
Q

Symptoms of acute interstitial keratitis

A
  • Red, painful eyes with lacrimation and photophobia
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28
Q

Name the condition:
- Fine keratitic precipitates on endothelium
- Stromal neovascularizarion with corneal edema

A

Interstitial keratitis

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29
Q

What is the most common cause of interstitial keratitis?

A

Congenital syphilis
* Hutchinson triad
1. Pegged shaped teeth
2. Interstitial keratitis
3. Deafness

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30
Q

Iron deposits at the base of the cone at the corneal epithelial level in Keratoconus

A

Fleischer Ring

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31
Q

Minimal corneal thickness for CXL after removal of corneal epithelium to prevent endothelial damage

A

400 microns
* if patient has less than 400 microns they are not a candidate for CXL

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32
Q

Contraindications for CXL

A

HX of herpes infection
Concurrent infection
Severe corneal scarring or opacification
Poor wound healing
Severe ocular surface disease
Autoimmune disorders

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33
Q

RTC for corneal dellen

A

1-7 days

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34
Q

Treatment for Mucin balls (secondary from soft or hard CL wear)

A

Steepen base curve of lens

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35
Q

Poor CL fit bubbles of CO2 trapped under lens, causing indentations in corneal epithelium, leaving tiny circular depressions that pool with sodium Fl

A

Dimple Veiling
* golf ball appearance

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36
Q

How to resolve dimple veiling from poor fitting GPCL?

A

Decrease overall diameter
Decrease optic zone diameter

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37
Q

Clinical signs of bacterial corneal ulcer

A

White stromal infiltrate with overlying epithelial defect surrounding edema and conjunctival injection
* plus iritis, hypopyon, mucopurulent discharge and eyelid edema/erythema

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38
Q

Treatment for corneal ulcers located peripherally, don’t stain with FL and are less than 1mm in size

A

Broad spectrum AB
* ciprofloxacin every 2-4 hours
* because location of ulcer lower risk of vision loss

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39
Q

What size and location of a corneal ulcer should be treated with fluoroquinolone every hour around the clock?

A

Ulcers in periphery but are larger 1-1.5mm with an epithelial defect, mild anterior chamber reaction, and moderate discharge

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40
Q

What is considered a high risk corneal ulcer?

A

Centrally located or larger than 1.5 mm

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41
Q

Treatment for high risk corneal ulcers

A

Fortified (stronger med) Tobramycin or gentamycin alternated with cefazolin or vancomycin every half hour

Or

Topical fluoroquniolone
1 gtts q5min for 25 min
Then every 15 minutes for 45 min
Then every 30 minutes for 24 hours

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42
Q

RTC for bacterial corneal ulcer

A

1 day
* sight threatening, patient must be followed daily
* pay attention to size and depth, amount of epi staining/defect and symptoms of pain or anterior chamber reaction

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43
Q

What organism is MOST likely to cause CL associated keratitis?

A

Pseudomonas aeruginosa
* bacteria can produce enzymes that can easily liquefy the cornea in 1-2 days, need treatment ASAP

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44
Q

For GP lenses as oxygen permeability (Dk) increases what occurs?

A

Increase in O2 to cornea
But decrease in wettability and less durable
* less durable meaning prone to scratches, flexure and warpage

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45
Q

RTC for Terrien’s marginal degeneration

A

6 months
* minimal risk except in advanced cases, pt can be seen every 6-12 months
* slow progressive thinning of peripheral cornea, superior, in males

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46
Q

Tx for diffuse scleritis

A

Oral NSAIDS
* indomethacin 50 mg TID
*Or Ibuprofen 600 mg TID

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47
Q

If patient with diffuse scleritis does not respond well to oral NSAIDs then what is next tx?

A

Oral steroids
* starting dose 1 mg/kg/day

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48
Q

Tx contraindications for necrotizing scleritis

A

Steroid injections are contraindicated because can cause further thinning of tissue and increase risk of perforation

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49
Q

RTC for diffuse scleritis after initial tx?

A

1 week
* to ensure tx is working

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50
Q

Which systemic condition is MOST associated with diffuse scleritis?

A

Rheumatoid arthritis
* reoccurrences are common therefore need to determine underlying etiology

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51
Q

Average corneal thickness

A

520-540 microns

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52
Q

Condition characterized by small thin filaments composed of degenerating epithelial cells and mucus

A

Filamentary keratitis

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53
Q

Symptoms of filamentary keratitis

A
  • range of symptoms from mild to severe pain
  • burning, photophobia, FBS, increased blinking
  • decreased VA
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54
Q

What is the most common etiology of filamentary keratitis?

A

Keratoconjunctivitis sicca
* secondary to aqueous tear deficiency

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55
Q

How long before LASIK must a patient not wear soft contact lenses?

A

2 weeks
* 1 weeks for soft spherical
* 2 weeks for soft Toric

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56
Q

How long before LASIK must a patient not wear soft contact lenses?

A

2 weeks
* 1 weeks for soft spherical
* 2 weeks for soft Toric

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57
Q

How long before LASIK should a patient with GPCL stop wearing them?

A

Minimum 1 month, with added recommendation of 1 month for every decade of wear (or until corneal topography is stable

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58
Q

FDA minimum post treatment residual thickness requirement of the corneal bed for LASIK

A

250 microns
* minimize risk of ectasia

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59
Q

What is Superior Limbic Keratoconjunctivitis (SLK)?

A

An ocular condition characterized by chronic, recurrent inflammation of the superior limbus and bulbar conjunctiva, superior corneal epithelial keratitis, and papillary hypertrophy of the superior tarsal conjunctiva

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60
Q

Which demographic is most commonly affected by SLK?

A

Middle-aged females

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61
Q

What are the common symptoms of SLK?

A

Irritation, redness, mucous discharge, foreign body sensation, pain, photophobia, blepharospasm, pseudo-ptosis

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62
Q

True or False: SLK usually presents unilaterally.

A

False

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63
Q

What is the most accepted theory regarding the pathogenesis of SLK?

A

Occurs as a result of mechanical trauma during blinking due to abnormal forces between tight upper lids and/or loose, redundant conjunctiva

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64
Q

What role does tear film deficiency play in SLK?

A

It leads to decreased ability of the upper eyelid to move freely over the conjunctiva, causing increased movement of the bulbar conjunctiva and subsequent damage

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65
Q

What condition is associated with an increased risk of SLK?

A

Thyroid dysfunction-induced exophthalmos

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66
Q

Fill in the blank: Symptoms in patients with SLK commonly vary significantly, with periods of _______ and exacerbations.

A

remissions

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67
Q

What are some non-specific complaints patients with SLK may present with?

A

Irritation, redness, mucous discharge, foreign body sensation

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68
Q

Why is SLK likely under-diagnosed?

A

Symptoms often outweigh signs

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69
Q

What other factors have been suggested to contribute to SLK aside from mechanical trauma?

A
  • Viral infections
  • Autoimmune diseases
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70
Q

What symptom might a patient note that is specifically related to eye movement in SLK?

A

Increased irritation on upgaze

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71
Q

What is papillary hypertrophy in the context of SLK?

A

Enlargement of the papillae on the superior tarsal conjunctiva

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72
Q

What is Superior Limbic Keratoconjunctivitis (SLK)?

A

A condition characterized by bilateral, localized hyperemia and thickening of the superior bulbar conjunctiva.

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73
Q

What are the conjunctival signs of SLK?

A

Bilateral hyperemia and thickening of the superior bulbar conjunctiva, redundant and keratinized appearance, and fine punctate staining with fluorescein or rose bengal.

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74
Q

What is observed when light pressure is applied to the upper eyelid in SLK?

A

A fold of redundant conjunctiva crosses over the superior limbus.

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75
Q

What percentage of SLK cases have corneal involvement?

A

About 25-30%.

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76
Q

What are the corneal signs associated with SLK?

A

Fine epithelial staining of the superior cornea, micropannus, and potential filament development.

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77
Q

What is the primary goal of SLK treatment?

A

To reduce the abnormal mechanical interaction between the superior bulbar and palpebral conjunctiva.

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78
Q

What types of topical lubricants are used in SLK treatment?

A

Artificial tears and ointments/gels.

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79
Q

What medications can be used to reduce inflammation in SLK?

A

Topical corticosteroids and/or mast cell stabilizers.

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80
Q

What is the role of topical cyclosporine in SLK treatment?

A

Helpful in managing coexisting keratoconjunctivitis sicca.

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81
Q

When is topical acetylcysteine indicated in SLK?

A

In patients with associated filamentary keratitis.

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82
Q

How can soft contact lenses aid in the treatment of SLK?

A

They offer a barrier to mechanical trauma between the lid and superior bulbar conjunctiva.

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83
Q

Fill in the blank: The bulbar conjunctiva in SLK appears _______.

A

redundant, keratinized, and thickened.

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84
Q

True or False: Limbal papillary hypertrophy is commonly absent in SLK.

A

False.

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85
Q

What surgical procedure involves resection of the superior limbal conjunctiva?

A

Resection of the superior limbal conjunctiva and Tenon’s capsule

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86
Q

What happens to the remaining conjunctiva after resection in SLK treatment?

A

It grows on the sclera and becomes immobile

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87
Q

Which modalities have shown effectiveness in treating SLK?

A

Cryotherapy or thermocautery

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88
Q

True or False: Topical application of silver nitrate is currently available for SLK treatment.

A

False

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89
Q

What was the previous treatment option for SLK that showed some success but is no longer available?

A

Topical application of silver nitrate

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90
Q

What causes Ultraviolet Keratopathy?

A

Excessive exposure to UV light resulting in painful and severe keratopathy

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91
Q

What is a common history associated with patients suffering from Ultraviolet Keratopathy?

A

History of sunlamp usage or welding without proper ocular protection

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92
Q

List the symptoms of Ultraviolet Keratopathy.

A
  • Moderate to severe pain
  • Blurred vision
  • Photophobia
  • Excessive lacrimation
  • Foreign body sensation
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93
Q

When do symptoms of Ultraviolet Keratopathy typically onset after exposure?

A

6-12 hours after exposure

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94
Q

What are the clinical signs of Ultraviolet Keratopathy?

A
  • Conjunctival injection
  • Superficial punctate keratopathy in the interpalpebral area that may appear coalesced and stains with sodium fluorescein
  • Eyelid edema
  • Associated iridocyclitis may be present
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95
Q

What treatment is recommended for Ultraviolet Keratopathy?

A
  • Preservative-free artificial tears every two to three hours
  • Topical antibiotic drops during the day and ointment at night
  • Treatment of iridocyclitis if present
  • Topical NSAIDs and/or oral analgesics for pain management
  • Pressure patch if the ocular surface is severely compromised
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96
Q

How often should patients with Ultraviolet Keratopathy be followed up?

A

Every 1 to 2 days to ensure resolution of symptoms and clinical signs

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97
Q

Fill in the blank: Ultraviolet Keratopathy is caused by excessive exposure to _______.

A

[UV light]

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98
Q

True or False: Eyelid edema may be present in Ultraviolet Keratopathy.

A

True

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99
Q

What medication is suggested for pain management in Ultraviolet Keratopathy?

A

Topical NSAIDs and/or oral analgesics

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100
Q

What is the recommended dosage for cyclopentolate in treating associated iridocyclitis?

A

1% t.i.d.

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101
Q

What is Vernal Keratoconjunctivitis (VKC)?

A

A recurring allergic disorder characterized by severe ocular symptoms such as itching and burning, photophobia, and lacrimation

VKC often results in significant irritation and discomfort.

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102
Q

What type of hypersensitivity is involved in VKC?

A

Type I hypersensitivity

IgE and cell-mediated immune mechanisms are important in the pathogenesis.

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103
Q

In which demographic does VKC primarily present?

A

Males within the first decade of life

VKC typically resolves by the late teens in about 95% of cases.
*warmer climates

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104
Q

What role do IgE, histamine, and mast cells play in VKC?

A

They are increased in the tears of patients with VKC

These components are associated with the allergic response.

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105
Q

What is the seasonal pattern of VKC symptoms?

A

Symptoms are usually more significant in late spring and summer

Some patients may endure mild symptoms year-round.

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106
Q

What percentage of VKC patients have a history of atopy or family history of allergic disorders?

A

60-75%

These patients often develop other allergic conditions at a young age.

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107
Q

What is the most pronounced symptom associated with VKC?

A

Intense itching

Other symptoms may include lacrimation, photophobia, and burning.

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108
Q

What are some additional symptoms of VKC?

A

Lacrimation, photophobia, burning, foreign body sensation, thick mucoid discharge, heaviness of the eyelids

Patients often experience constant blinking, which can be misdiagnosed.

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109
Q

True or False: The periorbital skin is affected in VKC.

A

False

In contrast to allergic keratoconjunctivitis, the periorbital skin remains unaffected.

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110
Q

Fill in the blank: VKC is more common in _______ climates.

A

[warmer]

Rarely occurs in temperate regions.

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111
Q

What is primarily involved in palpebral disease?

A

The upper tarsal conjunctiva of both eyes

Significant associated corneal disease may occur due to the close relationship between corneal epithelial tissue and the inflamed upper tarsus.

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112
Q

What appearance do the papillae in palpebral disease resemble?

A

Cobblestones

They have a hard, flat-topped, polygonal appearance.

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113
Q

What type of cells infiltrate the papillae in palpebral disease?

A

Lymphocytes and eosinophils

This infiltration contributes to the inflammation observed.

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114
Q

What is commonly observed between the giant papillae in palpebral disease?

A

Thick, ropy mucus discharge

This discharge is a characteristic symptom of the condition.

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115
Q

What happens to tarsal papillae during periods of disease activity?

A

They become hyperemic and edematous

Tarsal papillae may persist even when the disease appears quiescent.

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116
Q

Which populations are most commonly affected by limbal disease?

A

African-American and Asian populations

This demographic prevalence is notable in the occurrence of limbal disease.

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117
Q

What is a characteristic feature of limbal disease?

A

Single or multiple gelatinous, thickened papillae at the limbus

These papillae are often more prevalent and severe superiorly.

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118
Q

What are Tranta’s dots?

A

Discrete, whitish, raised dots at the apices of limbal papillae

They consist of collections of eosinophils and epithelial cells, seen in vernal keratoconjunctivitis

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119
Q

What additional symptom is common in limbal disease?

A

Redness and congestion of the bulbar conjunctiva

This symptom reflects the inflammatory response in the area.

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120
Q

What is more commonly associated with corneal involvement in vernal keratopathy?

A

Palpebral disease

Corneal findings typically arise from this condition.

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121
Q

What are the earliest corneal findings in vernal keratopathy?

A

Punctate epithelial erosions noted in the superior cornea

These erosions are indicative of corneal involvement in the disease.

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122
Q

What can coalescence of punctate erosions lead to?

A

Small corneal epithelial erosions

These can evolve into larger characteristic ‘shield’ ulcers.

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123
Q

What are shield ulcers?

A

Non-infectious corneal ulcers caused by mechanical trauma and damaging toxins

They can occur in patients with Vernal Keratoconjunctivitis (VKC) and are found in the central/superior cornea.

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124
Q

What causes the release of damaging toxins in VKC?

A

Major basic protein and eosinophil peroxidases released by eosinophils

These toxins hinder corneal re-epithelialization.

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125
Q

Describe the progression of shield ulcers.

A

Initially shallow, coated with inflammatory debris, mucous, and calcium phosphate, leading to plaque formation

The base of the ulcer becomes pacified over time.

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126
Q

What percentage of VKC patients develop corneal ulcers?

A

About 10%

Of these, 6% may develop permanent decreased visual acuity.

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127
Q

What is pseudogerontexon?

A

Peripheral vascularization or pacification in recurrent limbal disease

It resembles localized arcus senilis adjacent to previously inflamed limbus.

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128
Q

What can significant limbal lesions cause in VKC patients?

A

Substantial astigmatism

This is a complication arising from the disease.

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129
Q

What is the relationship between VKC and keratoconus?

A

Patients with VKC have a higher incidence of keratoconus

This indicates a potential association between the conditions.
*associated with atopy, allergies

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130
Q

What are some supportive therapies for VKC?

A

Cool compresses and avoidance of allergens

These therapies help alleviate symptoms.

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131
Q

How effective are mast cell stabilizers and antihistamines as sole treatment for VKC?

A

Rarely sufficient as sole treatment

They may reduce the need for steroids.

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132
Q

When are corticosteroids often required in VKC?

A

For associated keratopathy and/or severe discomfort

Topical corticosteroids are commonly used in these cases.

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133
Q

What is Vernal Keratoconjunctivitis (VKC)?

A

A type of allergic conjunctivitis characterized by inflammation of the conjunctiva and cornea.

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134
Q

What is the role of Acetylcysteine (Topical) in VKC?

A

A mucolytic agent helpful in cases involving substantial mucous discharge and early plaque formation.

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135
Q

What symptoms does Cyclosporine (Topical) reduce in VKC?

A

Epithelial ulceration, limbal infiltrates, conjunctival hyperemia, and symptoms of photophobia.

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136
Q

When is Cyclosporine (Topical) often utilized?

A

In steroid-resistant cases.

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137
Q

What is the purpose of a Supratarsal Steroid Injection?

A

Reserved for non-compliant patients or those resistant to conventional treatment.

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138
Q

What is the volume of a Supratarsal Steroid Injection?

A

0.1ml of either dexamethasone or triamcinolone.

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139
Q

Name some systemic immunosuppressive agents used in VKC.

A
  • Steroids
  • Cyclosporine
  • Azathioprine
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140
Q

What additional benefit do oral antihistamines provide in VKC?

A

They may help with sleep and eye-rubbing during the night.

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141
Q

What is the purpose of a Superficial Keratectomy in VKC?

A

To remove plaques.

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142
Q

What is involved in the surgical procedure of Superficial Keratectomy?

A

Removal of the epithelium and a very superficial dissection.

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143
Q

What is an Amniotic Membrane Overlay Graft used for?

A

For severe, persistent epithelial defects with corneal ulceration.

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144
Q

True or False: Cyclosporine (Topical) has shown improvement in giant papillae.

A

False.

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145
Q

What is vortex keratopathy also known as?

A

Corneal verticillata

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146
Q

Which genetic disorder is associated with vortex keratopathy?

A

Fabry’s disease

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147
Q

Name a common medication that can cause vortex keratopathy.

A

Amiodarone

Other medications include chloroquine, hydroxychloroquine, indomethacin, and tamoxifen.

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148
Q

What are the common symptoms of vortex keratopathy?

A

Asymptomatic, glare, decreased vision

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149
Q

What is the appearance of corneal deposits in vortex keratopathy?

A

Inferocentral, bilateral yellow/brown or white powder-like

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150
Q

How do the corneal opacities in vortex keratopathy appear?

A

Swirl outward from a focal point while sparing the limbus

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151
Q

What type of inheritance pattern does Fabry’s disease follow?

A

X-linked recessive

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152
Q

List two clinical signs of Fabry’s disease.

A
  • Lenticular opacities
  • Conjunctival aneurysms
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153
Q

What treatment is typically required for vortex keratopathy?

A

Typically not required

154
Q

What happens if the medication causing vortex keratopathy is ceased?
(Aka corneal verticillata aka whorl keratopathy)

A

Resolution of the corneal deposits

155
Q

True or False: Most patients with vortex keratopathy experience significant vision problems.

A

False

156
Q

Name one type of edema associated with Fabry’s disease.

A
  • Macular edema
  • Retinal edema
  • Edema of the nerve
157
Q

What is the typical visual impact of vortex keratopathy on patients?

A

Most are asymptomatic, but some may experience glare or decreased vision

158
Q

What is episcleritis?

A

Acute inflammation of the episclera, the connective tissue lying superficial to the sclera and deep to Tenon’s capsule.

Episcleritis is usually benign and self-limiting.

159
Q

In which demographic is episcleritis most frequently observed?

A

Young adults, more commonly in women than men.

This condition tends to recur.

160
Q

What are common etiologies of episcleritis?

A
  • Idiopathic
  • Connective tissue disorders (e.g., rheumatoid arthritis)
  • Gout
  • Infections (e.g., herpes zoster)
  • Inflammatory bowel disease
  • Thyroid disease
  • Atopy
  • Rosacea

Idiopathic causes are the most common.

161
Q

What are the key symptoms of episcleritis?

A
  • Acute onset of ocular redness (sectoral or diffuse)
  • Mild tenderness and irritation
  • Patients may report epiphora
  • No discharge present

Symptoms typically indicate inflammation.

162
Q

What is the most common form of episcleritis?

A

Simple episcleritis.

It appears as diffuse or sectoral injection of the episclera.

163
Q

What characterizes nodular episcleritis?

A

A mildly tender, raised, and mobile nodule.

Vision is typically unaffected.

164
Q

How is simple episcleritis treated?

A
  • Self-resolving
  • Artificial tears (qi.d.) may be used
  • Some prefer vasoconstrictors

Treatment aims to speed up resolution and decrease symptoms.

165
Q

How does nodular episcleritis differ in treatment duration compared to simple episcleritis?

A

Nodular episcleritis typically resolves over a longer period of time than simple episcleritis.

Treatment may include similar approaches but requires patience.

166
Q

What type of medication may be prescribed for moderate to severe episcleritis?

A
  • Topical steroids (e.g., fluorometholone 0.1% or Lotemax® qi.d.)
  • Oral NSAIDs (e.g., ibuprofen 200mg to 600mg t.i.d. or qi.d.)

These help manage inflammation and pain.

167
Q

True or False: Discharge is commonly present in episcleritis.

A

False.

Discharge is not present in episcleritis.

168
Q

Fill in the blank: The connective tissue that lies superficial to the sclera and deep to Tenon’s capsule is called the _______.

A

episclera.

It is highly vascular and involved in the condition of episcleritis.

169
Q

Follow up for episcleritis

A
  • monitor every few weeks unless gets worse or persists
  • pt prescribed topical steroids RTC every 1-4 weeks to check IOP and tapering if resolution permits
170
Q

Difference between Fleischer ring and Kayser- Fleischer ring

A

Fleischer ring: iron deposits at base of keratoconus cone
Kayser-Fleischer ring: copper deposits associated with Wilson’s disease

171
Q

How many diopters of power does the cornea contribute?

A

The cornea serves as the major refractive source for the eye, accounting for roughly 43 diopters of power.

The cornea is crucial for focusing light onto the retina.

172
Q

What is the normal thickness range of the cornea?

A

420-640 microns, with an average of about 520-580 microns in humans.

Corneal thickness can vary among individuals and may affect eye health.

173
Q

What type of cells make up the corneal epithelium?

A

Stratified squamous, non-keratinized cells.

This structure is important for protection and maintaining the cornea’s integrity.

174
Q

What are the five layers of the cornea in order from superficial to innermost?

A
  • Epithelium
  • Bowman’s layer
  • Substantia propria (stroma)
  • Descemet’s membrane
  • Endothelium

Each layer has distinct functions and structural properties.

175
Q

How does the corneal epithelium regenerate?

A

Corneal epithelial cells transition from basal to columnar to wing cells and are ultimately sloughed off over a 7-day period.

This rapid turnover is vital for maintaining a healthy corneal surface.

176
Q

What is the thickness of Bowman’s layer?

A

Roughly 12 microns thick.

Bowman’s layer provides structural support for the epithelial cells.

177
Q

What happens if Bowman’s layer is penetrated?

A

Permanent scarring will occur.

Damage to this layer can have lasting effects on vision.

178
Q

What are the three zones of the corneal epithelium?

A
  • Basal cell layer
  • Wing cell layer
  • Superficial cell layer

Each zone has a specific role in the structure and function of the cornea.

179
Q

True or False: The corneal epithelium will scar when injured.

A

False.

The epithelium has remarkable regenerative capabilities.

180
Q

What types of collagen are found in Bowman’s layer?

A
  • Collagen type IV
  • Collagen type VII
  • Collagen type XII

These types contribute to the structural integrity of the cornea.

181
Q

What is the composition of the stroma in the cornea?

A

Collagen, keratocytes, and mucopolysaccharides

The stroma makes up roughly 90% of the thickness of the cornea.

182
Q

How many lamellae are present in the corneal stroma?

A

Approximately 250 lamellae

These lamellae are organized in a precise orthogonal arrangement to allow for corneal transparency.

183
Q

What maintains the space between collagen bundles in the corneal lamellae?

A

Proteoglycans

Proteoglycans are composed of proteins and carbohydrates and have a negative charge that repels each other.

184
Q

What is Dua’s Layer?

A

A possible sixth corneal layer

It is acellular and 10-15 micrometers thick, requiring more research for further understanding.

185
Q

What is Descemet’s Membrane?

A

The basement membrane for the endothelium

It thickens with age and is composed of collagen fibers.

186
Q

What is the innermost layer of the cornea called?

A

The Endothelium

This layer consists of a single flattened layer of cells forming tight junctional complexes.

187
Q

Do endothelial cells in the cornea replicate?

A

No

Endothelial cells do not replicate, which is significant for corneal health.

188
Q

Which corneal cells consume the greatest amount of oxygen?

A

Endothelial cells

They play a crucial role in maintaining corneal clarity and hydration.

189
Q

What do endothelial cells actively pump out to maintain corneal hydration?

A

Ions

This process sets up an osmotic gradient preventing corneal swelling and opacification.

190
Q

What is the typical cellular density of a healthy corneal endothelium?

A

Approximately 3,000 cells/mm²

This density is crucial for maintaining corneal function.

191
Q

What is marginal keratitis?

A

A self-limiting condition characterized by sterile infiltrate that resolves over 3-4 weeks if untreated.

Marginal keratitis may leave a residual zone of mild corneal thinning and a faint superficial scar, usually without vascularization.

192
Q

What is the typical resolution time for marginal keratitis if left untreated?

A

3-4 weeks

There may be a residual zone of mild corneal thinning in the area of the lesion.

193
Q

How quickly do infiltrates from marginal keratitis respond to steroids?

A

Usually resolve within a few days if properly treated.

This indicates that steroid treatment is effective for marginal keratitis.

194
Q

Is there a risk of bacterial invasion leading to an ulcer or corneal perforation in marginal keratitis?

A

Very unlikely

Marginal keratitis typically does not lead to bacterial complications.

195
Q

What may remain after the resolution of marginal keratitis?

A

A residual zone of mild corneal thinning and a faint superficial scar

The scar is usually without vascularization.

196
Q

Fill in the blank: Marginal keratitis is characterized by a sterile infiltrate that will resolve over _______ if left untreated.

A

3-4 weeks

197
Q

True or False: Marginal keratitis lesions can develop bacterial invasion leading to corneal perforation.

A

False

It is very unlikely for these lesions to develop bacterial invasion.

198
Q

Best initial treatment for marginal keratitis

A

Tx concurrent blepharitis
* warm compress
* eyelid hygiene
* fluoroquinolone AB QID
* bacitracin or erythromycin ung qhs

199
Q

Etiology of marginal keratitis

A

Hypersensitivity reaction to staphylococcal bacterial exotoxins
* marginal infiltrates are sterile

200
Q

What is a key characteristic of viral conjunctivitis?

A

Presence of follies and positive lymphadenopathy

201
Q

What is the primary treatment goal for viral conjunctivitis?

A

Alleviating symptoms

202
Q

What can be used for comfort in viral conjunctivitis?

A

Artificial tears

203
Q

What type of medication can help reduce inflammation in viral conjunctivitis?

A

Topical steroids

204
Q

What is the most common cause of viral conjunctivitis?

A

Adenoviral conjunctivitis

205
Q

How long is adenoviral conjunctivitis contagious?

A

Up to 14 days

206
Q

What are common symptoms of adenoviral conjunctivitis?

A

Foreign body sensation, itching, burning, gritty feeling

207
Q

What are the signs of adenoviral conjunctivitis?

A

Serous discharge, hyperemia, positive lymphadenopathy, lid edema

208
Q

What are the three types of adenoviral conjunctivitis?

A
  • Nonspecific
  • Epidemic Keratoconjunctivitis (EKC)
  • Pharyngoconjunctival fever
209
Q

What differentiates Epidemic Keratoconjunctivitis (EKC) from other types?

A

Presence of subepithelial infiltrates (SEIs)

210
Q

When do subepithelial infiltrates (SEIs) occur in EKC?

A

2-3 weeks after onset of the infection

211
Q

What is a distinguishing feature of Pharyngoconjunctival fever?

A

Presence of fever and pharyngitis

212
Q

What should patients be educated about regarding adenoviral conjunctivitis?

A

The contagious nature of the disease

213
Q

What hygiene recommendations should be made to patients with adenoviral conjunctivitis?

A

Clean their bedsheets and towels

214
Q

What is the recommended follow-up time for patients with adenoviral conjunctivitis?

A

2-3 weeks

215
Q

What is epidemic keratoconjunctivitis (EKC)?

A

A very common and contagious ocular infection of viral etiology

216
Q

What virus causes epidemic keratoconjunctivitis?

A

Adenovirus

217
Q

Which strains of adenovirus are most commonly associated with ocular infections?

A
  • Serotype 8
  • Serotype 19
218
Q

What is the ‘rule of 8s’ in relation to EKC?

A

Type 8 is the most frequently isolated strain and symptoms follow a timeline related to the number 8

219
Q

What typically occurs on the 8th day after infection with EKC?

A

The patient presents with diffuse superficial punctate keratitis (SPK)

220
Q

What follows 8 days after the presentation of SPK in EKC?

A

Formation of subepithelial infiltrates (SEIs)

221
Q

When is a patient with EKC considered no longer contagious?

A

Once subepithelial infiltrates (SEIs) are present

222
Q

What are some signs of epidemic keratoconjunctivitis?

A
  • Follicular conjunctivitis
  • Positive lymphadenopathy
  • Mild eyelid edema
223
Q

What additional symptoms may be present in EKC?

A
  • Small subconjunctival hemorrhages
  • Circumcorneal conjunctival injection
  • Pseudo-membranes
  • Iritis
224
Q

Pt education for EKC (epidemic keratoconjunctivitis)

A

EKC is very contagious!!
- wash hands
- do not share towels, pillow cases
- all infected articles should be washed in hot water and dried at high heat to sterilize

  • incubation of virus is 4-10 days
225
Q

Tx for EKC

A

PF AT’s q2h OU
Topical vasoconstrictor QID OU
Cool compress
Topical NSAIDs
Sunglasses

226
Q

What does EBMD stand for?

A

Epithelial Basement Membrane Dystrophy

Also known as ABMD, map-dot-fingerprint dystrophy, or Cogan microcystic dystrophy.

227
Q

In which decade of life does EBMD typically present?

A

Second decade of life

228
Q

What is the common visual acuity status of patients with EBMD?

A

Minimally affected, if at all

229
Q

What causes the appearance of map-like, dot-like, or fingerprint-like lesions in EBMD?

A

Deposition of fibrillary protein between Bowman’s layer and the epithelial basement membrane

230
Q

What type of staining may the opacities in EBMD display?

A

Negative staining with sodium fluorescein

231
Q

What is lattice dystrophy?

A

An autosomal dominant dystrophy with four subtypes categorized by age of onset, systemic involvement, causative mutation, and appearance

232
Q

What is the primary cause of visual acuity decrease in lattice dystrophy?

A

Deposition of amyloid

233
Q

What do the pacifications in lattice dystrophy appear as?

A

Thick or thin lines and dots

234
Q

What causes granular dystrophy?

A

Deposition of eosinophilic hyaline in the anterior stroma of cornea
* autosomal dominant

235
Q

What is the inheritance pattern of granular dystrophy?

A

Autosomal dominant

236
Q

In which decade of life does granular dystrophy typically onset?

A

First decade of life

237
Q

What is the characteristic appearance of granular dystrophy?

A

Clear limbal zone and clear stroma between opacities in early stages

238
Q

What causes macular dystrophy?

A

Deposition of glycosaminoglycans (mucopolysaccharides) in the stroma

239
Q

What is the inheritance pattern of macular dystrophy?

A

Autosomal recessive

240
Q

At what age does macular dystrophy typically cause poor vision?

A

20-30 years of age

241
Q

What surgical intervention is preferred for macular dystrophy?

A

Corneal transplant

242
Q

Which stromal dystrophy is considered the most visually devastating?

A

Macular dystrophy

243
Q

What does corneal farinata appear as?

A

Small white specks located in the interpalpebral zone of the posterior stroma

244
Q

Is corneal farinata generally bilateral or unilateral?

A

Bilateral

245
Q

Does corneal farinata usually affect vision?

A

No

246
Q

Does corneal farinata require treatment?

A

No

247
Q

What ocular complication is most associated with EBMD?

A

Recurrent corneal erosion
* because epi basement membrane is abnormal causing poor hemidesmosome formation of basal epi cells —> RCE

248
Q

What is retro-illumination used for?

A

Detection and observation of subtle corneal abnormalities

Retro-illumination helps reveal faint features that may be overlooked with bright direct light.

249
Q

How is retro-illumination achieved?

A

By forming an angle between the lighthouse and the oculars to split a parallelepiped beam

The light reflected off the iris is utilized to observe corneal features.

250
Q

What is an optic section?

A

A technique to ‘slice’ the cornea into its constituent layers for depth localization

Achieved by setting the beam width on the biomicroscope to roughly 0.5 mm.

251
Q

What is the purpose of diffuse illumination?

A

Allows for gross evaluation of structures such as lids, lashes, and conjunctiva

Accomplished by increasing the aperture size of the light beam to greater than 4 mm in width.

252
Q

What does a conical beam assess?

A

The anterior chamber for possible cells and flare related to inflammation

It involves adjusting the aperture width and height to the smallest possible size.

253
Q

How is a conical beam achieved?

A

By adjusting the aperture width and height of the light housing and shifting focus between the lens and cornea

The illumination system should be set at an angle from the oculars.

254
Q

What should be done to maximize visibility when using a conical beam?

A

Turn off all other sources of light in the examination room and ensure the examiner is dark-adapted

This enhances the assessment of the anterior chamber.

255
Q

Fill in the blank: An optic section is also used to determine _______.

A

angle estimation

256
Q

Are patients with keratoconus candidates for LASIK?

A

No. Because keratoconus is a type or corneal ectasia

257
Q

What is the purpose of corneal collagen cross-linking?

A

To strengthen and increase the stability of the cornea

This procedure aims to prevent further corneal steepening and thinning.

258
Q

What substance is applied to the cornea during the cross-linking procedure?

A

Riboflavin drops

Riboflavin is a type of vitamin B2 that plays a crucial role in the process.

259
Q

What must be removed from the cornea before applying riboflavin drops?

A

The epithelium

The removal of the epithelium allows better penetration of riboflavin.

260
Q

What type of light is used in the corneal collagen cross-linking procedure?

A

Ultraviolet-A (UVA) light

UVA light is crucial for activating the riboflavin and strengthening the corneal tissue.

261
Q

For how long is the cornea exposed to UVA light during the procedure?

A

~30 minutes

This exposure time is essential for effective cross-linking.

262
Q

What is the main goal of corneal collagen cross-linking?

A

To stabilize the cornea and prevent further vision loss

It does not aim to improve visual acuity or correct refractive error.

263
Q

True or False: Corneal collagen cross-linking is intended to improve visual acuity.

A

False

The treatment is not designed to enhance vision but to prevent deterioration.

264
Q

What condition occurs when Descemet’s membrane ruptures in keratoconus?

A

Acute hydrops

Acute hydrops is characterized by a sudden influx of aqueous into the cornea.

265
Q

What are the symptoms of acute hydrops?

A

Sudden decrease in visual acuity, redness, and pain in the involved eye

Symptoms arise from the corneal swelling and inflammation.

266
Q

What findings are typically observed during a slit lamp examination in acute hydrops?

A

Prominent central or inferior corneal edema, clouding, and conjunctival hyperemia

These findings indicate significant changes in the cornea due to hydrops.

267
Q

How does keratoconus typically present in the contralateral eye?

A

Exhibits findings of keratoconus, but without hydrops

This suggests a unilateral progression of the disease.

268
Q

Is keratoconus usually symmetric or asymmetric?

A

Asymmetric

Most cases show one eye with a more advanced stage of the disease.

269
Q

What is the typical duration for acute hydrops to resolve?

A

Approximately 8-10 weeks

This timeframe indicates the self-limiting nature of acute hydrops.

270
Q

What conservative therapies are recommended for acute hydrops?

A

5% sodium chloride drops during the day and 5% sodium chloride ointment at night

These treatments help to manage corneal swelling.

271
Q

Why might broad-spectrum antibiotics be used in acute hydrops?

A

To protect the compromised cornea from possible secondary infection

The integrity of the cornea is at risk during hydrops.

272
Q

What is a common consequence after resolution of an acute hydrops episode?

A

Corneal scarring

Scarring can occur due to the damage sustained during hydrops.

273
Q

What treatment may be utilized to minimize resultant scar formation after hydrops?

A

Steroid drops

Steroids can help reduce inflammation and scarring in the cornea.

274
Q

RTC for small corneal abrasion

A

2-5 days
* if abrasion is large, within visual axis or if pt wears CL, RTC 1-2 days until cornea healed

275
Q

what condition has these S/S:
Unilateral follicular conjunctivitis
Lymphadenopathy
Tearing, ocular irritation
Photophobia
Skin vesicles in periocular area

A

Herpes simplex virus keratitis

276
Q

Tx for herpes simplex keratitis

A

Zirgan ophthalmic drops 5x daily
Or oral acyclovir if pt not complaint with dosing schedule

277
Q

Patient with HSV keratitis is not compliant with topical medicated drops, and conditions is not improving, what is the next best treatment option?

A

Corneal debridement

278
Q

Most common etiology of episcleritis

A

Rheumatoid arthritis

279
Q

What is the first ancillary test used to differentiate episcleritis from other diagnoses?

A

Instillation of topical 2.5% phenylephrine drops

This test helps assess the vascular pattern after 10-15 minutes.

280
Q

What observation indicates a diagnosis of episcleritis when using phenylephrine drops?

A

Engorged and inflamed blood vessels of the episclera will blanch

In cases of scleritis, the vessels will not blanch.

281
Q

What is the second ancillary test for diagnosing episcleritis?

A

Mechanical manipulation with a cotton-tipped applicator

This test involves anesthetizing and moving the conjunctiva to determine the depth of injected blood vessels.

282
Q

What happens to inflamed episcleral vessels during mechanical manipulation?

A

They will move over the deeper sclera

This movement indicates that the vessels are superficial.

283
Q

What is noted about inflamed vessels in scleritis during mechanical manipulation?

A

Inflamed vessels will remain stationary

This indicates that the vessels are deeper and not affected by the manipulation.

284
Q

Tx for episcleritis

A

Topical mild steroid QID
* fluorometholone = FML
* taper to prevent rebound inflammation

285
Q

Tx for photokeratitis

A
  • PF artificial tears q2h and topical antibiotic drops or ointment (to protect against bacterial infection of exposed epithelium)
  • sunglasses
  • Moxeza qid OU
  • can also put bandage CL if corneal defects have coalesced
286
Q

Prognosis of photokeratitis if not treated

A

Very good
* condition will resolve on its own

287
Q

What types of refractive errors are LASIK and PRK approved to treat in the United States?

A

+6.00 D of hyperopia

LASIK and PRK are both currently approved for treatment of hyperopia up to +6.00 D at the corneal plane.

288
Q

Is a patient with a refractive error above +6.00 D a candidate for LASIK or PRK?

A

No

The patient would not be a candidate if the goal was to correct the full amount of her refractive error.

289
Q

What is the typical recommendation for treating hyperopia above which diopter level?

A

+4.00 to +5.00 D

Many surgeons do not typically recommend treating hyperopia above these levels due to less predictable surgical results.

290
Q

What is the potential outcome of correcting a large amount of a patient’s hyperopia with LASIK or PRK?

A

Less reliance on glasses or contact lenses

However, achieving plano OU post-surgery would be unattainable.

291
Q

What is SMILE?

A

The newest approved corneal refractive surgery technique in the United States

SMILE stands for Small Incision Lenticule Extraction.

292
Q

What range of myopia can SMILE correct?

A

-1.00 to -9.00 D

SMILE can correct myopia within this range.

293
Q

What is the maximum amount of astigmatism that SMILE can correct?

A

Up to 3.00 D

SMILE is effective for treating astigmatism up to this level.

294
Q

Is SMILE approved for hyperopic refractive errors?

A

No

SMILE is not currently approved for treating hyperopia.

295
Q

Fill in the blank: LASIK and PRK are approved for hyperopia treatment up to _______.

A

+6.00 D

296
Q

True or False: SMILE can correct hyperopia.

A

False

SMILE is not approved for hyperopic refractive errors.

297
Q

True or false
High hyperope is a candidate for ICL (Intraocular collamer lenses)

A

FALSE!!
* surgery is only approved for myopia and myopic astigmatism NOT hyperopia
* pt also not a candidate because of shallow anterior chamber depth (needs to be 3 mm or greater to qualify)

298
Q

Absolute contraindications for LASIK

A
  • Progressive keratoconus
  • pellucid marginal degeneration
  • Pregnancy or breastfeeding
299
Q

What type of lasers are utilized for creating the corneal flap during LASIK surgery?

A

Femtosecond lasers

Femtosecond lasers operate at extremely short time scales, allowing precise tissue manipulation.

300
Q

What is generated by each pulse of the femtosecond laser during LASIK surgery?

A

Free electrons and ionized molecules

These reactions are critical for the formation of gas bubbles in the corneal tissue.

301
Q

What do the microscopic gas bubbles formed in the corneal tissue lead to?

A

The formation of a cleavage plane

This cleavage plane is essential for lifting the corneal flap during LASIK.

302
Q

How are the gas bubbles created in the corneal tissue during LASIK?

A

Multiple pulses are applied adjacent to each other

This technique ensures a consistent and controlled flap creation.

303
Q

What happens after the corneal flap is created and lifted during LASIK surgery?

A

An excimer laser is used to reshape the cornea

The excimer laser provides precision in correcting vision by reshaping the corneal surface.

304
Q

Tear volume in a normal healthy adult is?

A

6.0-8.0 microliters

305
Q

What is endophthalmitis?

A

A serious intraocular infection that may occur acutely or have a delayed onset after intraocular surgery or foreign body penetration of the ocular tunic.

306
Q

What are the possible onset times for endophthalmitis?

A

Acute (within several days) or delayed (within several weeks) onset.

307
Q

What are some preventative measures against endophthalmitis?

A

Strict sterilization methods, treatment of pre-existing ocular/skin conditions, prophylactic antibiotics.

308
Q

What are the symptoms of acute postoperative endophthalmitis?

A
  • Sudden onset of decreased vision
  • Ocular pain
  • Perception of floaters
309
Q

What are the symptoms of delayed onset endophthalmitis?

A
  • Gradually changing, varying levels of decreased vision
  • Increasing levels of ocular pain
310
Q

What symptoms may occur with endophthalmitis secondary to intraocular foreign body?

A

Similar to acute postoperative endophthalmitis; symptoms may be delayed depending on the causal organism.

311
Q

What are the clinical signs of endophthalmitis?

A
  • Severe anterior chamber reaction
  • Various levels of hypopyon formation
  • Vitreous chamber reaction
  • Lid erythema
  • Chemosis
  • Conjunctival injection
312
Q

True or False: If the infection is severe, views of the fundus may be limited or completely obstructed.

A

True

313
Q

What is Endophthalmitis?

A

A severe intraocular infection that can lead to vision loss

It can occur postoperatively or due to trauma, especially in immunocompromised patients.

314
Q

What are the initial treatment steps for patients with severe Endophthalmitis with vision limited to light perception?

A
  • Hospitalization
  • Pars plana vitrectomy

These steps are crucial for patients with severe infections to manage the condition effectively.

315
Q

What are the treatment steps for patients with hand motion vision or better?

A
  • Culture specimens taken to identify the pathogen
  • Intravitreal injection of antibiotics (vancomycin, amikacin, ceftazidime)
  • Topical steroids (prednisolone acetate 1%)
  • Topical fortified antibiotics (vancomycin, cefazolin, tobramycin, fluoroquinolone)

The treatment is tailored based on the identified pathogen and patient response.

316
Q

How often should follow-up examinations occur after treatment?

A

Every 12 hours

This frequent monitoring helps assess the patient’s improvement and response to treatment.

317
Q

What improvements should a patient report after 48 hours of treatment?

A
  • Improvement in vision
  • Decrease in ocular pain
  • Diminished anterior chamber reaction

These signs indicate a positive response to the treatment regimen.

318
Q

True or False: Endophthalmitis can occur due to trauma or the introduction of bacteria in immunocompromised patients.

A

True

This highlights the importance of monitoring at-risk populations for signs of Endophthalmitis.

319
Q

What is hypopyon formation associated with?

A

Acute postoperative Endophthalmitis

Hypopyon is a clinical sign indicating the presence of pus in the anterior chamber, often seen in severe infections.

320
Q

What is Ehlers-Danlos syndrome?

A

A connective tissue disorder that results in abnormal collagen production

It affects the structure and function of connective tissues, leading to various clinical manifestations.

321
Q

How many sub-types of Ehlers-Danlos syndrome are there?

A

11 sub-types

Each sub-type displays different characteristics and clinical features.

322
Q

Which type of Ehlers-Danlos syndrome has the most ocular involvement?

A

Type 6

This type is autosomal recessive and is characterized by significant eye-related complications.

323
Q

What are common physical features of patients with Ehlers-Danlos syndrome?

A

Hyperelasticity of the skin and hyperextended joints

These features are due to the abnormal collagen production affecting the connective tissue.

324
Q

What serious complications can arise in patients with Ehlers-Danlos syndrome?

A

Spontaneous rupture of large blood vessels and prolapse of the mitral valves

These complications can lead to significant morbidity and mortality.

325
Q

What ocular complications are associated with Ehlers-Danlos syndrome?

A

Rupture of the globe, blue sclera, microcornea, megalocorea, keratoconus, retinal detachment, high myopia, ectopia lentis, cornea plana, angioid streaks

These complications are due to the fragility of connective tissues in the eye.

326
Q

True or False: Ehlers-Danlos syndrome only affects skin and joints.

A

False

It also affects vascular structures and can lead to ocular complications.

327
Q

Fill in the blank: Ehlers-Danlos syndrome results in abnormal _______ production.

A

collagen

Collagen is crucial for the strength and flexibility of connective tissues.

328
Q

What is NOT an appropriate Tx for filamentary keratitis

A

Bandage CL
* DO NOT USE FOR CHRONIC DRY EYE ETIOLOGY
* can cause epithelial hypoxia and infectious keratitis

329
Q

Tx for filamentary keratitis secondary to keratoconjunctivitis related to Sjogren syndrome

A
  • PF AT and lubricating ointment qhs
  • Punctal occlusion
  • diclofenac sodium (NSAID) for inflammation and analgesia
  • restasis
330
Q

What is a common demographic for corneal and conjunctival intraepithelial neoplasia (CIN)?

A

Fair-skinned, middle-aged, or older patients

Typically those with considerable exposure to UV light

331
Q

In which type of patients is CIN more frequently observed?

A

Immunosuppressed patients, particularly those with HIV

This includes patients with a compromised immune system

332
Q

What viral infection is associated with a high incidence of CIN?

A

Human papillomavirus (HPV)

HPV is a common virus that can lead to various types of cancer

333
Q

Describe the appearance of CIN lesions.

A

Fleshy or gelatinous, elevated, grayish lesion

Commonly observed at the limbus within the interpalpebral fissure

334
Q

How do CIN lesions typically extend?

A

Variably extends into the adjacent corneal epithelium

This may involve a superficial opacity

335
Q

What is a characteristic of the opacity associated with CIN?

A

Subtle, gray, advancing, superficial opacity

May also be avascular or have fine blood vessels

336
Q

What histological feature is characteristic of conjunctival epithelial dysplasia?

A

Dysplastic cells confined to the basal layers of the epithelium

This is the least severe form of dysplasia

337
Q

What does carcinoma in situ indicate in CIN histology?

A

Dysplastic cells have replaced the full thickness of the epithelium

This represents a more advanced stage than dysplasia

338
Q

What defines squamous cell carcinoma in the context of CIN?

A

Dysplastic cells have invaded the basement membrane and occupied the underlying stroma

This indicates the most severe form of dysplastic progression

339
Q

What are the most common risk factors for developing CIN (conjunctival intraepithelial neoplasia)?

A
  • UV light exposure
  • human papillomavirus infection
  • HIV should also be ruled out if pt under 50 years old
340
Q

Treatment for localized corneal intraepithelial neoplasia (localized to epithelium)

A

Complete excision with adequate margins
* removal of growth performed by alcohol corneal epitheliectomy and partial lamellar sxlerokeratoconjuncticectomy

341
Q

If corneal or conjunctival intraepithelial neoplasia is not treated early or successfully, the condition can progress to what lesion?

A

Squamous cell carcinoma

342
Q

Arlt line

A
  • characteristic find of trachoma (infection caused by chlamydia trachomatis)

Thick band of scar tissue runs horizontally on upper palpebral conjunctiva

343
Q

Vogt striae

A

Keratoconus
* thin parallel vertical lines
* radiate through center of cone and represent stressed collagen lamellar deep within deep corneal stroma and descemet’s

344
Q

What is the initial management for mild cases of granular dystrophy?

A

Ocular lubrication for associated dry eye symptoms

Ocular lubrication helps alleviate dryness and discomfort.

345
Q

What may be used for advanced cases of granular dystrophy with corneal erosions?

A

A bandage contact lens

Bandage contact lenses can protect the cornea and help with healing.

346
Q

List some surgical interventions that may benefit patients with advanced granular dystrophy.

A
  • Superficial keratectomy
  • Excimer laser phototherapeutic keratectomy (PTK)
  • Lamellar keratoplasty
  • Penetrating keratoplasty

These procedures can help restore vision and address corneal issues.

347
Q

How does the visual acuity of patients with granular dystrophy typically present?

A

Relatively good, with discreet borders of deposits

Areas of clear cornea between deposits contribute to better visual acuity.

348
Q

What is the outcome for the patient mentioned in the text regarding visual acuity and symptoms?

A

Mildly decreased visual acuity and symptomatic

This indicates the need for surgical intervention.

349
Q

What surgical intervention is suggested for a patient with mild visual acuity decrease due to granular dystrophy?

A

Excimer laser phototherapeutic keratectomy (PTK)

PTK can help in managing symptoms and improving vision.

350
Q

True or False: Granular dystrophy is a condition that does not recur after surgical interventions.

A

False

Recurrence is common within 3 to 5 years after PTK or corneal transplantation.

351
Q

Fill in the blank: Granular dystrophy may cause _______ if corneal erosions are present.

A

Visual acuity to be adversely affected

Corneal erosions can lead to significant vision problems.

352
Q

What is Vernal Conjunctivitis?

A

A very rare condition typically seen in boys under the age of 10 who live in hot climates and have a predilection for atopy

Characterized by seasonal outbreaks that decrease in severity over time and spontaneously resolve during puberty.

353
Q

What age group is most commonly affected by Vernal Conjunctivitis?

A

Boys under the age of 10

354
Q

In what type of climate is Vernal Conjunctivitis commonly seen?

A

Hot climates

355
Q

What are the additional symptoms of Vernal Conjunctivitis?

A

Photophobia and pain

356
Q

What are Horner-Trantas dots?

A

Collections of eosinophils at the limbus

357
Q

What type of discharge is associated with Vernal Conjunctivitis?

A

Thick ropy discharge

358
Q

What is a shield ulcer?

A

A superiorly located, sterile, well-delineated, grey infiltrate

359
Q

Where do papillae manifest in Vernal Conjunctivitis?

A

In the superior palpebral conjunctiva as large cobblestones

360
Q

What is the primary treatment for Vernal Conjunctivitis?

A

Treat the allergic conjunctivitis and the shield ulcer if present

361
Q

Signs of vernal keratoconjunctivitis

A
  • thick ropy discharge
  • Horner-Trantas dots (eosinophils at the limbus)
  • shield ulcer (superior, grey infiltrate)
  • large cobble stone papillae
362
Q

Tx for idiopathic episcleritis (first occurrence)

A

Topical naphazoline (vasoconstrictor)
Artificial tears
* first occurrence of episcerlitis
* idiopathic, self-limiting

363
Q

Tx for acne rosacea

A
  • oral doxycycline
    Or
  • oral tetracycline
    Or
  • oral erythromycin’s
364
Q

What is posterior polymorphous dystrophy?

A

A corneal condition characterized by gray/white vesicles or rings within Descemet’s membrane

Often described as a ‘railroad track’ lesion

365
Q

How does posterior polymorphous dystrophy typically present?

A

Bilateral, asymmetrical, and very slowly progressive

Most patients are asymptomatic and do not require treatment

366
Q

What is a potential complication of posterior polymorphous dystrophy?

A

Development of glaucoma due to formation of peripheral anterior synechia

This may block the trabecular meshwork

367
Q

What may be required if severe corneal decompensation occurs in posterior polymorphous dystrophy?

A

Corneal transplant

Severe corneal decompensation is quite rare

368
Q

True or False: Most patients with posterior polymorphous dystrophy require treatment.

A

False

Most patients are asymptomatic

369
Q

Fill in the blank: Posterior polymorphous dystrophy is often described as a _______ lesion.

A

railroad track

Refers to the appearance of the vesicles or rings

370
Q

What is calcific band keratopathy?

A

A condition involving white/hazy calcium ion deposits in the superficial cornea, especially Bowman’s membrane

It appears in a Swiss cheese-like pattern.

371
Q

Where does calcific band keratopathy occur in the eye?

A

In the interpalpebral region of the superficial cornea

Particularly affects Bowman’s membrane.

372
Q

What are common symptoms of calcific band keratopathy?

A

Decreased vision and foreign body sensation

Patients often report these sensations.

373
Q

What are some secondary causes of calcific band keratopathy?

A
  • Chronic dry eye
  • Exposure keratopathy
  • Chronic ocular inflammation (uveitis, iritis)

These conditions contribute to the development of calcific band keratopathy.

374
Q

What patient history may contribute to the occurrence of calcific band keratopathy?

A
  • Multiple ocular surgeries
  • Ocular trauma
  • Longstanding glaucoma

These factors increase the risk of developing the condition.

375
Q

What systemic conditions can lead to calcific band keratopathy?

A
  • Hypercalcemia
  • Sarcoidosis
  • Vitamin D toxicity

These systemic issues can result in calcium deposits in the eye.

376
Q

How are elevated phosphorus levels related to calcific band keratopathy?

A

Elevated phosphorus levels, such as in chronic renal failure, are associated with this condition

High phosphorus levels can exacerbate the deposition of calcium.

377
Q

What is band keratopathy?

A

A condition caused by calcium deposition at the level of Bowman’s membrane

Band keratopathy often leads to visual impairment and can be associated with various systemic conditions.

378
Q

What causes corneal arcus?

A

Lipid leakage into the cornea from limbal blood vessels

Corneal arcus is often seen in older adults and can be a sign of hyperlipidemia in younger individuals.

379
Q

What are pterygia?

A

Proliferation of fibrovascular tissue onto the cornea

Pterygia can cause discomfort and may lead to vision problems if they encroach on the visual axis.

380
Q

What is granular dystrophy?

A

A condition that results from a deposition of eosinophilic hyaline in the anterior stroma

Granular dystrophy is a hereditary corneal dystrophy characterized by the presence of discrete, gray-white opacities.

381
Q

Kayser-Fleischer ring

A

Copper in corneal periphery at the level of Descemet’s membrane, associated with Wilson’s disease

NBEO Part 2 (20 decks)

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