Corneal Diseases Flashcards
Etiology of ulcerative keratitis?
Trauma
Foreign body
Exposure/Paralytic keratitis
EHV (uncommon to rare)
KCS (rare)
What are the categorizations of ulcers?
Superficial
Stromal
Descemetocele
How do we approach diagnosing an ulcer?
Eyelid block is required*
1. Check for underlying cause
2. Culture/Cytology
3. Fluoroscein stain
What criteria classify an ulcer as complicated?
Secondary infection
Stromal degredation
Iridocyclitis (uveitis)
What is a differentiating feature of a fungal ulcer?
“Mote” or clear zone at the periphery of the ulcer
Goals of therapy for corneal ulcers?
- Control & prevent corneal infection
- Inhibit corneal proteolysis
- Manage secondary uveitis
- Increase patient comfort
What are the different types of medical management for ulcerative keratitis?
- Topical antibacterials until healed
- Topical antifungals
- Topical atropine (if cycloplegia)
- Systemic NSAIDs
- Anti-proteases
What surgical procedures are indicated with ulcerative keratitis?
- Stromal antimicrobial injection
- Keratectomy (conjunctival flaps)
Clinical findings associated with corneal perforation?
- Iris prolapse/fibrin
- Corneal edema
- Hyphema/hypopyon
T/F: Corneal perforation is always surgical
TRUE
Corneal perforation prognosis is worsened by:
Blunt trauma etiology
Ulcerative etiology
Endophthalmitis
Severe hyphema
Lens rupture
Chronic rupture
Clinical findings associated with corneal abscesses?
Yellow-white stromal opacity
Severe ocular discomfort
Secondary uveitis
Management of corneal abscesses?
- Antimicrobials must penetrate corneal epithelium
- Manage secondary uveitis
- Must vascularize to resolve
AVOID TOPICAL STEROIDS
What is the surgical treatment option for corneal abscess?
Excision with conjunctival flap; keratoplasty procedures
What is band keratopathy?
Corneal mineralization/calcification
Degenerative condition
Band keratopathy is often associated with:
Chronic uveitis (ERU)
What are the 4 classifications of IMMK?
Epithelial
Superficial Stromal
Mid-Stromal
Endothelial
What are the lesions typically seen with epithelial IMMK?
Multifocal punctate to coalescing non-ulcerated epithelial opacities
No vascularization/no discomfort
What are the lesions typically seen with superficial stromal IMMK?
Stromal haze, vascularization, & cellular infiltrate (green/yellow appearance)
What are the lesions typically seen with mid-stromal IMMK?
Stromal haze, vascularization, & cellular infiltrate (green/yellow appearance)
What are the lesions typically seen with endothelial IMMK?
Severe regional or (more commonly) diffuse corneal edema
Medical treatment for IMMK:
- Topical steroids and/or cyclosporine (lifelong tx)
How does the classification of IMMK affect treatment?
Epithelial and stromal have some efficacy with topical steroids and cyclosporine;
mostly ineffective for endothelial IMMK
Describe the surgical treatment of IMMK
Lesion excision for stromal forms can be curative
Cyclosporine implants
Photodynamic therapy
