Corneal Degeneration and Ectasia

Question 1

What is degeneration?

Answer 1

A process in which normal elements of corneal tissue are converted representing a change in tissue

Question 2

Degeneration could be due to ______ and _______

Answer 2

Involution and metabolic disease

Question 3

The change in tissue that occurs with degeneration could be _____ or _____

Answer 3

benign or detrimental to normal physiology

Question 4

Describe the ongoing process in the photo

Answer 4

Epithelial Cell migration

Question 5

What are the non sight threatening corneal degenerations?

Answer 5

• Crocodile Shagreen (mosaic)
• Arcus Senilis
• Limbal Girdle of Vogt
• Farinata
• Terrien’s Marginal Degeneration
• Mooren’s Ulcer
• Amyloid

Question 6

What are the sight threatening opacifying corneal degenerations?

Answer 6

• Salzmann’s Nodular
• Amyloid
• Spheroidal
• Band Keratopathy

Question 7

What is the condition indicated in the photo?

Answer 7

Crocrodile Shagreen

Question 8

What is the significance in the finding of arcus in a patient < 40yrs old?

Answer 8

The patient most likely has hyperlipidemia

Question 9

What condition is presented in the photo?

Answer 9

Arcus

Question 10

Describe the conditions portrayed in the pictures

Answer 10

• Anterior crocrodile shagreen: at the level of Bowman’s layer
• Posterior crocodile Shagreen: at the posterior corneal stroma & Descemet’s

Question 11

How many types of Limbal Girdle of Vogt are there?

Answer 11

Two

Question 12

Describe Type I Limbal Girdle of Vogt

Answer 12

• Lucid interval – deposition ends at Bowman’s. Swiss cheese holes. Sharp edge centrally
• Early form of band keratopathy

Question 13

Describe Type II Limbal Girdle of Vogt

Answer 13

“True Vogt’s”
•To limbus – elastoid degeneration of subepithelial collagen. Extensions centrally

Question 14

Describe the condition in the photo

Answer 14

Limbal Girdle of Vogt

Question 15

ID the condition in the photo and specify which category

Answer 15

Type 1 Limbal Girdle of Vogt

Question 16

ID what condition is in the picture and specify which category it is

Answer 16

Type 2 limbal Girdle of Vogt

Question 17

What are farinata?

Answer 17

white dust-like particles
pre-Descemet’s
with aging

Question 18

Furrow Degeneration refers to ____

Answer 18

painless, noninflammatory peripheral corneal thinning, adjacent to corneal arcus that occur without vascularization

Question 19

Stocker’s line

Answer 19

Refers to the occasional line of iron deposition can be seen adjacent to the head of the pterygium

Question 20

Describe the boxed feature in the photo

Answer 20

Stocker’s line

Question 21

ID the highlighted feature in the photo

Answer 21

Hudson-Stahli line

Question 22

ID the features in the photo

Answer 22

Iron lines

Question 23

ID the condition in the photo

Answer 23

Terrien’s Marginal Degeneration

Question 24

ID the condition in the photo

Answer 24

Terrien’s Marginal Degeneration

Question 25

What is a differential diagnosis for Terrien's Marginal Degeneration?

Answer 25

Mooren's Ulcer

Question 26

Terrien's Marginal Degeneration usually occurs in which geographic region?

Answer 26

Superior region

Question 27

Terrien's is not a perforating disease. T/F

Answer 27

T | (Epithelium is intact)

Question 28

List some charax of Terrian's Marginal Degeneration

Answer 28

* bilateral * thinning of peripheral corneal stroma starts superior-nasal then circumferential * fine line of lipid deposit * marginal opacification with superficial vascularization * males \>\> females * any age and \>40

Question 29

What conditions are indicated in the photos?

Answer 29

Vascularization and pseudo-pterygium due to Terrien's

Question 30

Describe the condition in the picture and indicate its common charax

Answer 30

non-infectious, unknown etiololgy (most likely autoimmuned)

Question 31

what are the symptoms associated with Mooren's

Answer 31

Photophobia, red eye, pain

Question 32

What are the signs of Mooren's?

Answer 32

* disrupted corneal epithelium near limbus * typically progressive (circumferentially and centrally) * thinning, stromal melting, potentially perforation

Question 33

what staining method is used to examine Mooren's?

Answer 33

NaFl staining

Question 34

What are the types of Mooren's?

Answer 34

* Type I: typically seen in the older patient, unilateral, better response to treatment * Type II: younger (African descent) 20-30 yr old, bilateral, poor response to treatment

Question 35

How would you differentiate Mooren's from Terrien's?

Answer 35

* Terrien’s epithelium intact, no NaFl stain (not true ulceration) * Terrien’s rarely painful, inflammatory * Terrien’s rarely aggressive * Terrien’s rarely move centrally * Terrien’s rarely perforates

Question 36

What is the systemic disease workup for Mooren's?

Answer 36

•Mandatory referral for vasculitis or collagen vascular disease Autoimmune disease

Question 37

What is the treatment for Mooren's?

Answer 37

supportive treatment with topical steroids to control inflammation •Conjunctival resection, radiation •Bandage CL •Topical cyclosproine or systemic immunosupression •Perforation: tx with cyanoacrylate or lamellar keratoplasty

Question 38

ID the condition in the photo and indicate some of its charax

Answer 38

Polymorphic Amyloid Degeneration Deep stromal, bilateral and similar to Lattice Dystrophy

Question 39

ID the condition in the photo

Answer 39

Spheroidal Degeneration

Question 40

ID the conditin in the photo

Answer 40

Salzmann's Nodular degeneration