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Corneal Diseases Flashcards

1
Q

Tough fibrous (outer) coat of sclera

A

Post. 5/6th of globe
White & opaque
Radius = 12 mm

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2
Q

Tough fibrous (outer) coat of cornea

A

Ant. 1/6th of globe
Transparent
Radius = 8mm

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3
Q

Junction of cornea & sclera contains?

A
  1. Trabecular network
  2. Canal of schlemn
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4
Q

Size of cornea (vertical)

A

10.6 mm

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5
Q

Size of cornea (horizontal)

A

11.7 mm

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6
Q

Size of cornea (thickness of central portion)

A

0.52 mm

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7
Q

Size of cornea (thickness of peripheral portion)

A

1 mm

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8
Q

Structure of cornea (ant. to post.)

A
  1. Epithelium
  2. Bowman zone
  3. Stroma
  4. Descement membrane
  5. Endothelium
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9
Q

Blood supply

A

Central = avascular
Corneoscleral limbus = ant. conjunctival branches of ant. ciliary arteries

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10
Q

Nerve supply

A

Branches of ophthalmic division of trigeminal nerve

Descemet membrane & endothelium aren’t innervated

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11
Q

Superficial signs of corneal disease

A
  1. Punctate epithelial erosions
  2. Punctate epithelial keratitis
  3. Epithelial edema
  4. Filaments
  5. Pannus
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12
Q

Punctate epithelial erosions

A

Tiny, slightly depressed, epithelial defects
- stains with fluorescein, NOT rose bengal
- develop in varieties of keratopathies

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13
Q

Punctate epithelial keratitis

A

Hallmark of viral infections

  • swollen epithelial cells
  • visible unstained
  • stains rose bengal
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14
Q

Epithelial edema is a sign of

A
  1. Endothelial decompensation
  2. Severe acute elevation of IOP
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15
Q

Filaments

A

Small coma shaped mucus strains lined with epithelium

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16
Q

Pannus

A

Inflammatory/degenerative ingrowth of fibrovascular tissue from limbus

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17
Q

Stromal lesions

A

Infiltrates
Edema
Vascularization

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18
Q

Infiltrates

A

Focal areas of active stromal inflammation

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19
Q

Edema

A

Increased corneal thickness
Decreased transparency

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20
Q

Lesions of Descement membrane

A

Breaks
Folds (striate keratopathy)

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21
Q

Breaks seen in

A
  1. Corneal enlargement
  2. Keratoconus
  3. Birth trauma
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22
Q

Folds (striate keratopathy) seen in

A
  1. Surgical trauma
  2. Ocular hypotony
  3. Stromal edema
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23
Q

Management of corneal disease

A
  1. Control of infection, inflammation
  2. Promotion of re-epithlialization
    - lubrication, lid closure, bandage of soft contact lens
  3. Prevention of perforation
    - tissue adhesive glue, conjunctival flap, systemic immunosuppressive agents
  4. Corneal grafting
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24
Q

Etiology of microbial keratitis

A
  • trauma
  • post-herpetic corneal disease
  • bullous keratopathy
  • corneal exposure
  • dry eye
  • diminished corneal sensation
  • contact lens wearers
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25
Pathogens that produce corneal infection (despite intact epithelium)?
1. Neisseria gonorrhoeae 2. Corynebacterium diphtheriae 3. Listeria 4. Haemophilus
26
Stap aureus and strep pneumoniae infection findings?
Oval, yellow white, densely opaque stromal suppuration surrounded by relatively clear cornea
27
Pseudomonas infections findings
- thick mucopurulent exudate - diffuse liquefactive necrosis - semi-opaque ground glass appearance of adjacent stroma
28
Enterobacteriaceae
- shallow ulceration - grey white pleomorphic suppuration - diffused stromal opalescence - Endotoxins = ring shaped corneal infiltrates
29
What topical antibiotics are used?
Combined therapy with fortified aminoglycoside & fortified cephalosporin OR Monotherapy with fluoroquinolone
30
Other pharmaco treatment
- Subconjunctival injections - Systemic ciprofloxacin 750 mg BD - Cycloplegic - Steroid therapy
31
Treatment (procedures)
- Corneal biopsy - Excisional keratoplasty
32
Filamentous fungal keratitis
- Aspergillus - Fusarium
33
Vegetable matter injury (trauma caused by plant material)
- Greyish white ulcer with indistinct margins - surrounded by feathery infiltrates - ring infiltrates - endothelial plaque - hypopyon
34
Etiology of Candida keratitis
- pre-existing corneal disease - immunocompromised ptn
35
Candida keratitis findings
Yellow-white ulcer Dense suppuration
36
DD of fungal keratitis
Suppurative bacterial keratitis Herpetic stromal necrotic keratitis
37
Antifungal therapy
Initially - broad spectrum Econazole 1% topically Then (based on sensitivity) - Natamycin/imidazole for 6 weeks
38
Other treatments
Systemic ketoconazole Therapeutic penetrating keratoplasty
39
Diagnosis of fungal keratitis
Culture Biopsy
40
Acanthamoeba Keratitis
Protozoan - active = trophozoites - dormant = cystic
41
Acanthamoeba Keratitis common in
Swimmers Contact lens wearers
42
C/F of Acanthamoeba Keratitis
1. Blurred vision & disproportionate pain 2. Patchy ant stromal infiltrates 3. Perineural infiltrates (radial keratoneuritis) 4. Infiltrates coalesce = ring abscess, ulceration & hypopyon 5. White satellite lesions
43
Diagnosis of Acanthamoeba Keratitis
1. Corneal scrappings stained with calcoflour white 2. Corneal biopsy
44
Treatment for Acanthamoeba Keratitis
1. Chlorhexidine 2. Polyhexamethylenebiguanide drops 3. Dipropamidine 4. Propamidine 5. Therapeutic penetrating keratoplasty
45
Dendritic ulcer
- opaque cells arranged in course punctate/stellate pattern - central desquamation -> linear branching ulcer - anterior stromal infiltrates - geographical/amoeboid ulcer - fluorescein, rose bengal stain - diminished corneal sensitivity
46
DD for dendritic ulcer
1. Herpes zoster keratitis 2. Healing corneal abrasion 3. Pseudodendrites due to soft contact lens 4. Acanthamoeba keratitis 5. Drug toxicity
47
Antiviral therapy
- Acycloguanosine 3% ointment - Trifluorothymidine 1% drops - Adenine arabinoside 3% ointment - 0.1% drops Idoxuridine
48
Other procedures for dendritic ulcer
Debridement with sterile cotton-tipped bud 2mm beyond edge of ulcer
49
Etiology for Phlyctenulosis
- TB - Delayed hypersensitivity reaction to staphylococcal/other bacterial antigen
50
C/F for Phlyctenulosis
- Photophobia - Lacrimation - Blepharospasm
51
Conjunctival signs in Phlyctenulosis
Pinkish white nodule surrounded by hyperaemia
52
Corneal signs in Phlyctenulosis
- resolve spontaneously/extend radially to cornea - may cause severe ulceration/perforation
53
Treatment for Phlyctenulosis
Short course of topical steroids Topical antibiotics
54
Keratoconus
- onset at puberty - central/paracentral stromal thinning - apical protrusion - irregular astigmatism
55
Classification of Keratoconus (by keratometry)
- mild = <48 D - moderate = 48-54 D - severe = >54 D
56
Classification of Keratoconus (by morphology)
- nipples cones - oval cones - globes cones
57
Early signs of Keratoconus
1. Ophthalmoscopy = oil droplet reflex 2. Retinoscopy = irregular scissor reflex 3. Keratometry = irregular astigmatism 4. Placido disc = irregular reflected ring 5. Slit-limp = very fine deep stromal striae (Vogt lines)
58
Late signs of Keratoconus
1. Decreased visual acuity 2. Munson sign 3. Fleischer ring 4. Corneal scarring 5. Acute hydrops
59
Keratoglobus
Non-inflammatory corneal disorder characterized by diffuse corneal thinning & generalized protrusion -> globular shape
60
Management for keratoglobus
- spectacle correction - contact lenses - penetrating keratoplasty

Ophthal (18 decks)

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