cornea pt 1: Corneal anomalies, dysgenesis, and degenerations Flashcards
Recurrent Corneal Erosion is a problem with which layer of the cornea
basement membrane
it is called recurrent because …
its recurrent breakdowns of the epithelium due to the defective adhesions in the basement membrane
what causes RCE?
trauma like a clean slice to the cornea or its spontaneous
How long does it take a wound that caused RCE to heal?
8-12 weks. The epithelial cells undergo mitosis.
RCE symptons occur most often ____ (am or pm)
pain, FBS occurs most often in AM
recurrentces of RCE is how often?
every monthy or every year
name the preventative txts for RCE
plently of fluids, avoid dry environments, wake up with eyes closed, protective glasses
Someone has RCE. Their slit lamp findings were normal. But on second look you say microsysts (that didn’t staing) , surface irregularity, nafl staining. How are you going to txt?
genteal every night until tube is gone, Freshkote, Muro 128 5%(solution and/or ung)
you decide to employ a bandage cl on your patient with RCE. What else should you add to this bandage cl? What are you going to be careful of with bandage cl? In terms of withdrawl.
Ofloxacin (prophylatic antibiotic ) , not to withdraw too soon. Need about 4 weeks.
What is the rx for doxycycline? And why is it used in RCE management?
50-100mg, once or twice a day . Its used to inhibit the MMP9s with rce
an anomaly is
Something different, abnormal, peculiar, or not easily classified; a deviation from the common rule, type, arrangement, or form
normal adult cornea diameter:
12
Microcornea defined:
10; can be bilateral or unilateral
pts with microcornea are more prone to
angle closure glaucoma
Megalocornea is more common in F or M
M
t/f. Patients with Megalocornea are not prone to glaucoma.
true. They have nomal iop
Megalocornea is defined as
bilateral anterior segment enlargement
greater than 13 mm after 2 years is
megalocornea
Anteriorly displaced, prominent Schwalbe’s line
Posterior Embryotoxon
management of posterior embryotoxon
no txt necessary
what is schwalbe line
is the termination of decemats membrane marks transition between cornea to sclera
Axenfeld- Rieger’s Anomaly
posterior embryotoxon,iris stromal hypoplasia,iris strands that attach to posterior embryotoxon
What would make Axenfeld-reiger’s anomaly a syndrome?
Glaucoma
what is the least appropiate option for Axenfeld reigers
trabeculoplasty
The best option for axenfeld reiger is aqueous suppressants. Beta blockers or CI
true
Peters’ Anomaly description
central corneal opacity; focal absence of Descemet’s membrane and endothelium, iridocorneal adhesions, shallow AC
Peters’ Syndrome involves
Glaucoma and pt starts to develop systemic problems.
patients may also have ______ with peter’s . tip: another ocular diagnosis.
cataract especially if lens adhering to cornea
txt for peter’s anomaly
treat glaucoma, penetrating keratoplasty
yellow-white hazy ring of stromal deposits, cholesterol, has a lucid interval between ring and limbus
Arcus Senilis (aka Gerontoxon)
arcus senilis starts inferior to superior and encircles cornea
TRUE
posterior embroytoxin starts inferior to superior and encircles cornea
FALSE. It starts in perphiery
arcus senilis is common in which race?
African americans.
incidence of arcus senilis ?
50-60 y.o; and older than 80 nearly everyone
management of arcus senilis ?
lipid panal
main worry of unilateral arcus sensilis?
the cartoid artery could be blocked. Listening to bruit here
small, irregular chalk-like opacities – subepithelial, irregularly shaped but collectively have a crescent
White Limbal Girdle of Vogt
white limbal girdle of vogt is located at the limbus more in the termporal .
false. Nasal more than termporal
whats the difference btwn type I and type II White Limbal Girdle of Vogt
Type I – separated by limbus by narrow lucid area; no lucid area between limbus and opacities
most common corneal degeneration
White Limbal Girdle of Vogt
txt for white limbal girdle of vogt
none. It has no clinical significance. Just a finding.
grayish-white polygonal stromal opacities separated by clear spaces
Mosaic (Crocodile) Shagreen
which layer of cornea is Mosaic (Crocodile) Shagreen located?
stroma. Most noticeably centrally , rarely impacts vision. Involutional
dust-like gray dots and flecks in the deep corneal stroma
Cornea Farinata
cornea farinata’s degenerative pigment must be differentiated from
guttata. Guttata is in the endothelium. Cornea farinata is in the stroma.
refractile, punctate, comma-shaped and filamentous amyloid deposits most common centrally and posteriorly in stroma
Polymorphic Amyloid Degeneration
DDX: cornea farinata and lattice dystrophy
Polymorphic Amyloid Degeneration
Polymorphic Amyloid Degeneration is associated with systemic dz
false. Its not associated with disease. You thinking of lattice corneal dystrophy type II with FAP.
progressive non-inflammatory conical-shaped corneal thinning (ectasia), usually inferior to center of cornea
Keratoconus
easy way to remember cornea farinata
it has a flower like appearance
keratoconus is non progressive
false. Its progressive. Onset is young adulthood and progresses throughout life
which of the following is not a late change of keratoconus? A. visible fleischer’s ring, vogt’s lines (vertical stress lines in desments membrane, increased thing of interior stroma, munsons sign, steep mires on keratometry
steep mires on keratometry. That’s an early change not a late change. Other early changes involve refraction too.
corneal scarring, prominent nerves, and acuity 20/60 or worse are late changes in
Keratoconus
a pertinent negative in keratoconus
fletchers sign
acute corneal hydrops is an additional complication keratoconus. What are acute corneal hydrops?
Ruptures in Descemet’s membrane which allows aqueous fluid to invade the cornea. Management with bandage cl, pressure patch, cycloplegic and nacl 5%
this condition has been associated with marfan syndrome, down syn, ehlers danols syndr, atic disease. Atopic kertoconjunctivies VKC, RP, and FLOPPY eyelid syndrome
Keratoconus
management of keratoconus
spx, rgp cl, corneal intacs, corneal cross linkin, penetrating keratoplasty
limbus to limbus corneal thinning
Keratoglobus
Keratoglobus may be associated with what systemic syndrome?
Ehlers-Danlos syndrome
what is true about keratoglobus?
treatment options are limited and not very successful
t/f kertoglobus pts are more prone to trauma.
ture. They have a ectasia (cornela thining)
narrow arcuate band of inferior corneal thinning (4-8 o clock); peripheral band of normal cornea, stoma clear
Pellucid Marginal Degeneration
area of protrusion of normal cornea occurs superior to the thinning band
Pellucid Marginal Degeneration
DDX for pellucid marginal degeneration
Keratoconus. The pellucid doesn’t have a Fletchers ring, and theing of pellucid is 4-8 o clock postion
what type of surgery do you want to avoid in pellucid marginal degen pts?
refractive
noninflammatory and asymptomatic and non progressive corneal degeneration. Is pellucid.
false. Marginal furrow degen is noninflamm and asymptomic. ITS also nonprogressive.
thinning of cornea in area adjacent to limbus
Marginal Furrow Degeneration aka Senile Corneal Furrow degen
Terrien’s Marginal Degeneration is more common in
males .
marginal thinning of cornea with opacification and superficial vasculariation; yellow-white line (lipid deposit) noted central to
thinned edge
Terrien’s Marginal Degeneration
easy way to remember prllucid degener appearance
kissing claws
t/f epi is intact in terriens marginal degen.
true . Theres no inflammation so its intact.
what is the least appropiate option for terriens marginal
lamellar or pentrationg kertoplase.
there is treatment to slow the progression of terriens marginal
fasle . Theres no txt for to slow its progression.
terriens marginal degen are often asymptomatic unless astigma occurs
true
elevated gray-white (or sometimes light blue) corneal nodules; single or multiple separated by clear cornea
Salzmann’s Nodular Degeneration
Often found in eyes with chronic dryness or inflammation, more common in women than males
Salzmann’s Nodular Degeneration
most common association of alzmann’s Nodular Degeneration (other than dryness
phlyctenular keratitis
salzmanns can be asymtomatic or sympatheic. For symptomatic txt :
txt is lubricants, rgp cl, nodule removal (PTK, PK, LAMERLLAR, SUPERFICIAL
band keratopathy is associated with ____ _____
chronic inflammation
calcium deposits in the subepithelial space, Bowman’s layer and anterior stroma Swiss cheese appearance
Band Keratopathy
band keratopathy is associated with hyerpcalceimia, hyperparathyoidism, excissive vitamin d intack, renal failure, sarcoidosis, juvenile idiopatch arthris.
true and there are many others.
txt for band kertophaty
Ocular lubricants, Manage RCE, EDTA, Surgical
Deposition of iron, yellowish-brown line in the corneal epithelium, Causes no symptoms. Often in the junction between middle and lower third, No clinical significance
Hudson Stähli Line
chronic progressive, painful peripheral ulceration of the cornea,
Mooren’s Degeneration (Mooren’s Ulcer)
Unilateral, older patients, responds well to medical treatment
Mooren’s Degeneration (Mooren’s Ulcer) Type 1
Bilateral, usually younger individuals, progressive destruction of cornea despite treatment
Mooren’s Degeneration (Mooren’s Ulcer) Type 2
Mooren’s Degeneration (Mooren’s Ulcer) Type 2 responds well to topical steriods and conjunctival resection.
FALSE. Type 1 responds well to topical steroids, type 2 of moorens ulcer has poor prognosis, reduce likilihood of perferation is all we can do.
