Corneal Degenerations

Question 1

a process in which normal elements of a tissue are transformed is termed what

Answer 1

degeneration

Question 2

degeneration is associated with what

Answer 2

aging of tissues

Question 3

degeneration can result from what

Answer 3

metabolic diseases

Question 4

are degenerations benign or detrimental to normal function

Answer 4

can be either one

Question 5

which degeneration is caused by vacuoles within corneal stroma & irregular alignment of stromal lamellae

Answer 5

Crocodile Shagreen

Question 6

this clinical finding is indicative of which degeneration:

• grayish-white polygonal stromal opacities separated by clear space
• often involves anterior 2/3 of stroma
• can involve posterior 1/3 of stroma

Answer 6

Crocodile Shagreen

Question 7

what symptoms do pts with Crocodile Shagreen have

Answer 7

asymptomatic

Question 8

what is the most common peripheral corneal opacity

Answer 8

Arcus Senilis

Question 9

what age population does Arcus Senilis occur in & are there any predisposing factors

Answer 9

• occurs in elderly pts w/ no predisposing systemic pt.

Question 10

if Arcus Senilis is seen in a pt under 40, what does this mean & what should be done

Answer 10

may be associated w/ dyslipidemia → order lipid panel

Question 11

these signs are indicative of which degeneration:

• stromal lipid deposition that typically starts in superior & inferior perilimbal corrnea & progresses circumferentially
• separated from limbus by a clear zone

Answer 11

Arcus Senilis

Question 12

if Arcus Senilis is very dense, what appearance can it give

Answer 12

“blue eye” appearance

Question 13

these clinical findings are indicative of which degeneration:

• whitish crescentic perilimbal bands at 9 &/or 3 o’clock
• can have “swiss cheese” hole pattern
• can have a clear interval between girdle & limbus

Answer 13

Limbal Girdle of Vogt

Question 14

which type of Limbal Girdle of Vogt may be an early form of band keratopathy

Answer 14

type I

Question 15

which type of Limbal Girdle of Vogt is more common

Answer 15

type II

Question 16

which type of Limbal Girdle of Vogt is caused by subepithelial degeneration & calcium deposits

Answer 16

type I

Question 17

which type of Limbal Girdle of Vogt is caused by degeneration of subepithelial collagen

Answer 17

type II

Question 18

which degeneration is caused by an accelerated calcium salt deposits in Bowman’s, epithelial basement membrane, & anterior stroma

Answer 18

band keratopathy

Question 19

these clinical findings are indicative of which degeneration:

• interpalpebral
• initially gray deposits → can become chalky-white as it progresses
• often begins at 3 & 9 o’clock, then spreads horizontally
• sharply demarcated edge separated from limbus by clear zone

Answer 19

band keratopathy

Question 20

these ocular manifestations can cause which degeneration:

• chronic low-grade anterior uveitis (especially in juvenile rheumatoid arthritis)
• phthisis bulbi
• chronic stromal edema
• silicone oil in anterior chamber

Answer 20

band keratopathy

Question 21

what are other causes of band keratopathy besides ocular manifestations

Answer 21

• age-related

- metabolic disorder

Question 22

these metabolic conditions can cause which degeneration:

• hypercalcemia due to hyperparathyroidism
• vitamin D toxicity
• sarcoidosis
• renal failure

Answer 22

band keratopathy

Question 23

what can band keratopathy result in

Answer 23

• ocular irritation
• irregular astigmatism
• decreased VA

Question 24

how can you manage ocular irritation in band keratopathy

Answer 24

topical lubricants

Question 25

how can you manage irregular astigmatism in band keratopathy if visual axis is clear

Answer 25

RGP CLs

Question 26

what is the more common treatment for band keratopathy

Answer 26

chelation

Question 27

these treatments are for which degeneration: - chelation - diamond burr - laser phototherapeutic keratectomy - lamellar keratoplasty

Answer 27

band keratopathy

Question 28

what degeneration is histologically similar to pinguecula

Answer 28

pterygium

Question 29

how is a pterygium different from a pinguecula

Answer 29

pterygium invades Bowman's layer | pinguecula does not involve the cornea

Question 30

what degeneration is caused by elastotic degeneration of vascularized subepithelial stromal collagen

Answer 30

pterygium

Question 31

this clinical finding is indicative of which degneration: - triangular fibrovascular subepithelial growth of degenerative bulbar conjunctival tissue over the limbus into the interpalpebral cornea

Answer 31

pterygium

Question 32

pts who live in hot climates or have chronic UV exposure or have ocular surface dryness can develop which degeneration

Answer 32

pterygium

Question 33

these symptoms are indicative of which degeneration: - small lesions are asymptomatic - can cause dellen at advancing edge - decreased vision from induced astigmatism & obscuration of visual axis - acute pain if inflamed

Answer 33

pterygium

Question 34

these signs are indicative of which degeneration: - fibrovascular corneal lesion - linear epithelial iron depositions: Stocker's line

Answer 34

pterygium

Question 35

how can you treat a pterygium

Answer 35

ocular lubricants & UV protection

Question 36

how do you treat a severe pterygium

Answer 36

excisional surgery (but can recur after)

Question 37

what is a rare, non-inflammatory, slowly progressive & usually bilateral degeneration that occurs most commonly in middle-aged women

Answer 37

Salzmann nodular degeneration

Question 38

this clinical finding is indicative of which degeneration: - opacities progress to elevated whitish or blue-gray nodular lesions that can lead to epithelial thinning & stromal scarring

Answer 38

Salzmann nodular degeneration

Question 39

which degeneration can occur in any form of chronic corneal irritation or inflammation such as: - dry eye - chronic blepharitis - chronic allergic conjunctivitis

Answer 39

Salzmann nodular degeneration

Question 40

these symptoms are indicative of which degeneration: - gradual, painless vision loss - foreign body sensation - induced hyperopia & irregular astigmatism

Answer 40

Salzmann nodular degeneration

Question 41

how do you treat Salzmann nodular degeneration & what do you do in severe cases

Answer 41

- manage underlying etiology - topical lubricants - surgical intervention if severe

Question 42

which degeneration is an uncommon idiopathic thinning of the peripheral corneal stroma that occurs in men a lot more than women

Answer 42

Terrien's marginal degeneration

Question 43

these clinical findings are indicative of which degeneration: - thinning starts superiorly → circumferentially with lipid deposits at leading edge - marginal opacification w/ superficial vascularization - irregular astigmatism develops as disease progresses

Answer 43

Terrien's marginal degeneration

Question 44

will Terrien's marginal degeneration stain with NaFl & why

Answer 44

no, epithelium is intact

Question 45

how can you manage pts w/ Terrien's marginal degeneration in regards to significant thinning

Answer 45

polycarbonate safety lenses

Question 46

how can you manage the irregular astigmatism in pts w/ Terrien's marginal degeneration

Answer 46

CLs

Question 47

in more advanced cases of Terrien's marginal degeneration, how would you treat them

Answer 47

surgery

Question 48

how can you differentiate Terrien's marginal degeneration with arcus senilis

Answer 48

arcus senilis has no stromal thinning

Question 49

how can you differentiate Terrien's marginal degeneration with Mooren's ulcer

Answer 49

Mooren's ulcer will have significant pain & photophobia

Question 50

how can you differentiate Terrien's marginal degeneration with marginal keratitis

Answer 50

marginal keratitis will have significant symptoms

Question 51

how can you differentiate Terrien's marginal degeneration with pellucid marginal degeneration

Answer 51

pellucid marginal degeneration occurs inferiorly