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Ocular Disease > Corneal Degeneration > Flashcards

Corneal Degeneration Flashcards

1
Q

What is represented in this picture?

A

Crocodile Shagreen with plaques of fibrous tissue

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2
Q

Why does arcus occur?

A

There are lipid/cholesterol deposits in Bowman’s

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3
Q

What does the lucid interval in arcus mean?

A

The superficial lipid deposition ends at Bowman’s layer so it won’t go into the limbus.

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4
Q

What is Type I Limble Girdle of Vogt?

A

Lucid interval where deposition ends at Bowman’s, looks like swiss cheese holes with sharp edges centrally.

Early form of band keratopathy.

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5
Q

What is type II Limble Girdle of Vogt?

A

True Vogt’s

Goes to limbus because of elastoid degeneration of subepithelial collagen

Extensions centrally

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6
Q
A

Vogt I

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7
Q
A
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8
Q
A

Vogt I and Calcified Scleral Plaque

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9
Q

What is Farinata?

A

White dust like particles pre-Descemet’s with aging

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10
Q

What is Furrow Degeneration?

A

Non inflammatory mild thinning with occasional vessel extensions

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11
Q

What disease is in this picture?

A

Terrien’s Marginal Deneration

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12
Q

How does Terrien’s Marginal Degeneration present?

A

Asymtomatic

Bilateral

Epithelium Intact

Marginal opacification with superficial vascularization

Young adult to elderly

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13
Q

How does the peripheral thinning of the cornea progress in Terrien’s Marginal Degeneration and what other complications occur with it?

A

Starts in the peripheral corneal stroma superior-nasal then goes circumferential

Astigmatism and rarely perforation

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14
Q

What percent of terrien’s patients are male?

A

75%

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15
Q

At what age does Terrien’s Marginal Degeneration onset?

A

Young adult to elderly

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16
Q

What is a differential diagnosis to Terrien’s Marginal Degeneration?

A

Mooren’s Ulcer

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17
Q

What is shown in these photo’s of Terrien’s Marginal Degeneration?

A

Vascularizatio and a Pseduo-pterygium

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18
Q

What is this disease?

A

Mooren’s Ulcer

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19
Q

What are the signs and symptoms of Mooren’s ulcer?

A

Painful

Red Eye

Photophobia

Typically progressive near the limbus

Thinning

Stromal melting

Potential perforation

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20
Q

What is Mooren’s Type I?

A

Typically older patients, unilateral and responds well to treatment

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21
Q

What is Mooren’s type II?

A

Younger (indian/african) 20-30 yr old, bilateral and poor response to treatment.

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22
Q
A

Mooren’s Ulcer

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23
Q

How do you differentiate between Terrien’s and Mooren’s Ulcer?

A

Terrien’s Does Not/Is Rarely

Stain w/ NaFl

Painful/Inflammatory

Aggressive

Moves Centrally

Perforates

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24
Q

What must you do if you suspect vasculitis or collagen vascular disease?

A

You must do a mandatory referral to rheumatology for a systemic work up.

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25
What is the course of treatment for Mooren's Ulcer?
Nothing well established and mostly supportive Conjunctival resection, radiation Bandage CL Topical steroid, cyclosporine or systemic immunosuppression If perforation: treat with cyanoacrylate or lamellar keratoplasty
26
What autoimmune diseases is Peripheral Ulcerative Keratitis associated with?
Rheumatoid Arthritis Wegener's Granulomatosis et al
27
What is Limbal Crescent Ulceration and what disease is it associated with?
It is associated with Peripheral Ulcerative Keratitis (PUK) It includes an epithelial defect, thinning Progresses circumferentially & maybe centrally, with potential extensions into sclera Risk of progressing rapidly to perforation
28
What disease is Peripheral Ulcerative Keratitis usually associated with?
Episcleritis or Scleritis
29
What is the main treatment for Peripheral Ulcerative Keratitis?
Rheumatology referral to confirm for systemic immunosuppression
30
What can you **_not_** treat Peripheral Ulcerative Keratitis with?
Topical Steroids
31
How does polymorphic amyloid degeneration present?
Deep stroma, bilateral appears similar to Lattice Dystrophy
32
Spheroidal Degeneration
33
Salzmann's Nodular Degeneration
34
Salzmann's Nodular Degeneration
35
How does Salzmann's normally present?
\> females \> 50 yo May be inflammatory Dry Eye Symptoms Decreased VA if central Irregular astigmatism
36
What are the Salzmann's nodules made of?
Hyaline nodules that replace Bowman's that are elevated, and bluish white
37
What is Salzmann's Nodular Degeneration often associated with?
Chronic ocular surface disease and/or previous inflammation, especially viral There is rarely no clear history of preceding eye disease
38
How do you manage Salzmann's Nodular Degeneration?
Lubricants, steroid if inflammed, bandage contact lenses **Severe Cases**: nodules can be removed by corneal specialist, penetrating keratoplasty
39
Band Keratopathy
40
What is band keratopathy?
Interpalpebral Ca++ deposits in Bowman's with clear zone seperating the limbus
41
Why does Band Keratopathy have a swiss cheese appearance?
Clear areas and small circular areas where nerve endings perforate the Bowman's layer are seen within the band.
42
How to differentiate between Vogts and Band Keratopathy?
Vogt's II: no lucid interval, no swiss cheese, bilateral, does not spread across central cornea Vogt's I: very similar but doesn't cross centrally
43
Band Keratopathy
44
How should you treat and manage Band Keratopathy?
Monitor Ocular Lubricants for mild cases Refer for hypercalcemic work up by PCP **Severe Cases:** Chelation using 2% EDTA PTK: Phototherapeutic keratectomy (excimer laser)
45
What is Phthsis Bulbi?
A degenerative atrophic condition of chronic sick eye that may see band keratopathy involving all layers of the cornea.
46
How does Keratoconus present?
Bilateral: Forme fruste After puberty it progresses then stabilizes Greater in asians Greater association with Down's, Ehlers-Danlos, Marfan's Oculodigital Sign
47
Keratoconus
48
Keratoconus
49
What kind of pathologies are often associated with Keratoconus?
Irregular epithelium Breaks in Bowman's Fibrosis beneath epithelium Stromal scarring Corneal thinning
50
What kind of test results will make you think Keratoconus? (K values, astimatism, etc.)
Keratometry \>47.2 Inferior steepening 1.2D \> superior Skewing of axis of astigmatism \> 21 degrees
51
What is Charleaux's Sign?
Oil droplet sign upon retroillumination
52
What sign is this?
Rizutti's sign (triangle of light on distal iris)
53
What sign is this?
Munson's sign
54
What is in this picture and which one can be reduced with digital pressure?
Vogt Striae and Fleischer Ring Vogt Striae can be reduced with digital pressure
55
Fleischer ring under cobalt blue light
56
Prominent corneal nerves
57
How to treat keratoconus?
Appropriate optical correction ``` Speciatly RGP, cleral RPG, hybrid CL Penetrating keratoplasty (20%) ``` Intacts Collagen Crosslinking
58
How do you **_NOT_** treat keratoconus?
Refractive surgery
59
Intacs
60
Corneal Hydrops
61
Corneal Hydrops
62
What are corneal hydrops?
Acute break in Descemet's
63
What are the yellow and red arrows pointing at?
Red = break in Descemet's Yellow = corneal edema
64
How does Posterior Keratoconus present?
Posterior curvature increase Normal anterior surface Non-inherited Unilateral Non-progressive Females \>\> male
65
Keratoglobus
Bilateral Congenital or Aquired Diffuse corneal thinning \> peripherally
66
Where does Pellucid Marginal Degeneration most often occur?
Inferior limbus from 4:00 to 8:00
67
What is a name for how the cornea looks while affected by Pellucid Marginal Degeneration?
"Pot belly" cornea
68
What kind of topography pattern will be seen with Pellucid Marginal Degeneration?
"kissing dove" topography pattern
69
Pellucid Marginal Degeneration
70
Pellucid Marginal Degeneration
71
Pterygium
72
Pinguecula
73
What is this pterygium related feature?
The Pterygium Stocker Line
74
Hudson-Stahli Line
75
Iron Lines

Ocular Disease (7 decks)

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