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Ocular Disease part 2 > Cornea Degeneration and Ectasia > Flashcards

Cornea Degeneration and Ectasia Flashcards

1
Q

which layer of the cornea is capable of regeneration? which ones are not?

A

epithelium is the only layer to undergo mitotic division (Bowman’s, stroma, Descemet’s and endothelium do not regenerate)

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2
Q

what are the cell junctions present in the corneal epithelium?

A

desmosomes and gap junctions and connect to Bowman’s layer via hemidesmosomes

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3
Q

what type of pumps are in the corneal endothelium and what is the purpose?

A

Na-K-ATPase pumps to keep the stroma from having too much fluid

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4
Q

what is a degneration?

A

a process in which normal elements of corneal tissue are converted (age-related or metabolic diseases) - can be benign or detrimental to normal function

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5
Q

what are 7 corneal degenerations that are non-sight threatening?

A

crocodile shagreen, arcus, limbal girdle of vogt, farinata, terriens marginal degeneration, moorens ulcer and amyloid

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6
Q

what are 2 non-sight threatening corneal degenerations that have the possibility of turning to sight threatening?

A

mooren’s ulcer and amyloid

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7
Q

what are 3 exmples of degenerations that are opacificiations and sight threatening?

A

salzmanns nodular, spheroidal and band keratopathy

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8
Q

what is crocodile shagreen?

A

age related, benign, common condition, easily seen with slit lamp = plaques of fibrous tissue

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9
Q

where is crocodile shagreen located anteriorly and posteriorly?

A

anterior = bowman’s layer

posterior = posterior corneal stroma and descemet’s

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10
Q

what are the symptoms and treatment for crocodile shagreen?

A

no symptoms and no treatment required

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11
Q

what is arcus?

A

lipid/cholesterol deposits in Bowman’s (not common under age 40)

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12
Q

why does arcus have a lucid interval between the limbus?

A

the lipid deposition ends at bowman’s - it has an abrupt ending

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13
Q

what does type 1 limble girdle of vogt look like?

A

has a lucid interval - deposition ends at bowman’s swiss cheese holes and sharp edges centrally early form of band keratopathy

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14
Q

what does type 2 limble girdle of vogt look like?

A

goes to limbus - elastoid degeneration of sub-epithelial collagen extensions centrally

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15
Q

what is farinata?

A

white dust-like particles, pre-descemet’s and occurs with aging (may resemble pigment dispersion syndrome)

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16
Q

what is the leading line of a pterygium called?

A

stocker line (iron line)

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17
Q

what is a hudson-stahli line?

A

occurs in the interpalpebral zone from tear stagnation (iron deposits in tear film) = typically after chronic inflammatory condition

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18
Q

what is Terrien’s marginal degeneration?

A

thinning of the cornea (starts superiorly then circumferential), asymptomatic, bilateral and epithelium stays intact, fine line of lipid deposit, superficial vascularization, males >> females and 40+

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19
Q

what is a differential diagnosis for Terrien’s marginal degeneration?

A

Mooren’s ulcer

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20
Q

what symptoms will patients have with Mooren’s ulcer?

A

non-infectious (unknown etiology - autoimmune likely), painful, red, photophobia

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21
Q

where does Mooren’s ulcer begin?

A

near limbus, typically progressive (circumferentially and centrally) = thinning, stromal melting, potentially perforation (epithelium is not intact)

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22
Q

what is Mooren’s ulcer type 1?

A

typically seen in older patients, unilateral and better responses to treatment

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23
Q

what is Mooren’s ulcer type 2?

A

seen in younger (african descent) 20-30 y/o, bilateral and poor response to treatment (rare)

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24
Q

how do you differentiate between Mooren’s and Terrien’s?

A

Terriens has intact epithelium, no NaFl staining, rarely painful/inflammatory, and rarely perforates

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25
Q

what type of systemic work up is needed to Mooren’s ulcer?

A

vasculitis or collagen vascular disease (autoimmune diseases)

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26
Q

what is the treatment for Mooren’s ulcer?

A

mostly supportive = topical steroids, conjunctival resection/radiation, bandage CL, topical cyclosporine or systemic immunosupression (perforation = cyanoacrylateor lamellar keratoplasty)

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27
Q

what is polymorphic amloid degeneration?

A

occurs deep stroma, bilateral and appears similar to lattice degeneration - mostly benign

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28
Q

what is spheroidal degeneration?

A

common from UV exposure (actinic), usually interpalpebral, golden brown deposits

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29
Q

what is Salzmann’s nodular degeneration?

A

elevated white masses on cornea - tend to be peripheral (milky/glossy), can have a red/irritated eye

30
Q

what causes salzmann’s nodular degeneration and who typically gets it?

A

females, > 50 y/o, chronic ocular surface disease/inflammation (especially viral) - hyaline plaques replace bowman’s

31
Q

what are the symptoms and treatment for salzmann’s nodular degeneration?

A

symptoms = dry eye symptoms, VA if central treatment = lubricants, steroid, bandage CL (PK if severe)

32
Q

what is band keratopathy?

A

interpalpebral CA++ deposits in bowman’s with clear zone separating the limbus - swiss cheese appearance

33
Q

why does band keratopathy have swiss cheese appearance?

A

clear areas and small circular areas where nerve endings perforate bowman’s (similar to Vogt 1)

34
Q

what causes band keratopathy?

A

inflammatory disease (mercury), systemic conditions that cause increased Ca, chronic ocular pathology and degenerative conditions or idiopathic

35
Q

what is the treatment/plan for band keratopathy?

A

monitor, ocular lubricants for mild cases, refer for hypercalcemic work-up, chelation using 2% EDTA for severe cases, PTK

36
Q

what are 3 corneal ectasias?

A

keratoconus, keratoglobus, pellucid marginal degeneration

37
Q

when does keratoconus typically occur and what causes it?

A

bilateral, usually after puberty (rarely congenital), progressive then stabilizes, males = females, >asians, may have an inheritance pattern

38
Q

what is the pathology for keratoconus?

A

irregular epithelium, breaks in bowman’s, fibrosis beneath epithelium, stromal scarring, corneal thinning

39
Q

what is the pathophysiology for keratoconus?

A

epithelial lysosomal enzyme expression increase, reduction inhibition of proteolytic enzymes, abnormal corneal collagen, lamellae, keratocyte populations

40
Q

what is charleaux’s sign?

A

an irregular red reflex from retinoscopy or retro-illumination in keratoconus

41
Q

what is Rizutti’s sign?

A

a triangle of light seen on the distal iris in keratoconus

42
Q

what is munson’s sign?

A

when a patient with keratoconus looks down it forms a “V” shape

43
Q

what is vogt striae and fleischer ring?

A

lines seen in cornea with keratoconus (fleischer ring = iron deposits around base of cone)

44
Q

what is the treatment for keratoconus?

A

optical correction, specialty RGP/hybrid CL, PK, no refractive surgery, intacts, collagen crosslinking

45
Q

what are corneal hydrops?

A

spontaneous rupture/break in descemet’s - can result in flattening of cornea, clears on its own - may scar

46
Q

what is posterior keratoconus?

A

posterior diffuse or localized curvature (normal anterior surface), unilateral, non-progressive, female > male

47
Q

what is keratoglobus?

A

bilateral, congenital or acquired, diffuse corneal thinning > peripheral (1/3 to 1/5 normal thickness)

48
Q

what does pellucid marginal degeneration look like?

A

the thinned area is confined to corneal side of inferior limbus (4:00-8:00), pot belly cornea, ATR astigmatism (kissing dove pattern)

49
Q

what are dermoids?

A

collection of ectodermal tissues: sweat glands, hair follicles, sebaceous glands

50
Q

what is a lipodermoid?

A

benign fatty tumor beneath conjunctiva laterally

51
Q

what are trisomy 21, 17-18, and 13?

A

21 = downs syndrome

17-18 = edwards syndrome

13 = bartholin-patau syndrome

52
Q

what happens with a vitamin A deficiency?

A

bitot spot, impaired goblet cell function, keratinization

53
Q

what disease is caused by sphingolipidoses disorder?

A

Fabry’s disease

54
Q

what is fabry’s disease?

A

x-linked recessive, posterior spoke like deposits in lens along sutures = verticillata

55
Q

what is cystinosis and alkaptonuria caused by?

A

diseases of protein and amino acid metabolism

56
Q

what does cystinosis look like?

A

cystine crystal deposits throughout cornea

57
Q

what type of deposits does ciprofloxacin give?

A

chalky white deposits where epithelium is absent

58
Q

where do mercury deposits occur? what causes them?

A

(orange-brown) in bowman’s typically from preservatives

59
Q

where do silver deposits occur?

A

argyrosis in descemet’s

60
Q

what type of deposits occur from epinephrine drops?

A

adrenochrome

61
Q

what type of deposits do the drug thorazine cause? and where do they occur?

A

stellate sub-capsular throughout the stroma

62
Q

what causes wilson’s disease?

A

defect in copper metabolism - Cu+ deposit in descemet’s peripherally with no clear interval

63
Q

what is this picture of?

A

corneal hydrops

64
Q

what is this picture of?

A

band keratopathy

65
Q

what is this picture of?

A

crocodile shagreen

66
Q

what is this picture?

A

furrow degeneration

67
Q

what is this topography of?

A

keratoconus

68
Q

what is this topography of?

A

pellucid marginal degeneration

69
Q

what is this picture of?

A

Salzmann’s nodular degeneration

70
Q

what is this picture of?

A

vogt striae in keratoconus

71
Q

what is this picture of?

A

limbal girdle of vogt type 1

Ocular Disease part 2 (7 decks)

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