Corneal Diseases Flashcards
Chronic corneal diseases
Congenital Dystrophy Ectasia Degeneration Dry eye Surgery
MICROCORNEA
corneal diameter less than 10mm
uni/bilateral
the eye can be normal- or have other stuff. e.g. cataract
MEGALOCORNEA
cornea bigger than 13mm
symmetrical
non progressive
DD- Congenital glaucoma
Congenital CORNEAL PROBELMS
microcornea
megalocornea
Posterior embryotoxon
Sclerocornea
POSTERIOR EMBRYOTOXON
Prominent irregular ridge which lies cereal to the limbus
caused by anterior placed schwalbes ring
can be seen with gonioscopy- in about 30% of population
SCLEROCORNEA
limbus is not defined
90%BILATERAL
non-progressive
central cornea is usually normal
Types of dystrophy-
DYSTROPHY
Primary bilateral inherited disorders.- they have distinct clinical pathological findings. -stationary/slow progression, occurs in the absence of inflammation
Epithelial- Dot-Map-FIngerprints/Meesmans
Stromal-Granular/Lattice/Macular
Endothelial-CHED/Fuchs
MAP-DOt fingerprint
Dots- microcyts …..
Map-Geogrophic opacities c v d
Fingerprint-subepithelial ridges»_space; «< LL»_space; // \ LL
MEESMANS dystrophy
Dominant
FB sensation
mild vision reduction
small grey-white punctuate opacities
VORTEX dystrophy
Corneal deposits distributed in the Whorls like pattern
look for - Amiodarone intake
- Indomathacin intake
- Fabry’s disease
GRANULAR DYSTROPHY
snowflakes
Axial, greyish opaque granules
vision good until middle age- when it gets bigger- va reduces
minimal symptoms
BILATERAL- no inflammatory
LATTICE DYSTROPHY
greyish, linear, branching oacities- central cornea
severe recurrent erosions- early reduction in vision
macular dystrpohy
LEAST COMMON-
greyish opaque spots- indistinct borders affecting entire cornea
reduced VA- erosive sx
Schnyder’s dystrophy
bilteral opacity accumulation of lipids and cholesterol slow progression need corneal transplant
congenital heredity endotheial dystrophy
infancy cloudy cornea photophobia tearing nystagmus? DD- congenital conrea
Congenital clouding of the cornea
STUMPED you stumped? S - Sclerocornea T - Tears in the Descemet membrane secondary to birth trauma or congenital glaucoma U - Ulcers M - Metabolic P - Peters anomaly E - Edema (CHED) D – Dermoid
corneal dystrophy
primary bilateral disorder
young px?
check which layers of the cornea is involved
pattern sx
keratoconus- irregular k values
non-inflammatory stromal thinning- distortion cornea thins and protrudes progresses slowly over 10-20 years sx- frequent changes of glasses/cl blurring/ distortion glare monocular diplopia photophobia eye rubbing FLEICHERS ring- iris position vogts stress striae line munsons sign- when u look down- v shape
TREAT WITH - RGP
cornela rings
corneal transplant
Keratoglobus
rare- thinning
protrusion of entire cornea
non progressive
may result in corneal rupture!!!!!!!!!!!!
Pellucid marginal degeneration
bilateral
slow progressive crescent shaped area of interior corneal thinning
protrusion is above the are of thinning
DD with keratoconus
Iridocorneal endothelial syndrome
chandlers syndrome- only silver appearance
cogan-reese syndrome- pigmnted noduules of iris
essential iris atrophy- striate an melt holes, posterio
angle pysniki
Corneal degeneration occur later in life. Not born with these
Lipid keratopathy
Band keratopathy
Salzmann nodular degeneration
Arcus senilis
white circle around periphery of iris- deposits of fatty material i cornea
Band keratopathy
calcium deposits in a band across the cornea
caused by: chronic uveitis, glaucoma, hypercalcimia, phtisis bulbi
need surgical debridment
Dellen
tear film instability- corneal instbaility
caused by strabismus, surgery, glaucoma, RGP
corneal abrasions - most common
History of trauma
intense pain/photphobia
red eye
epithelial loss with Fl
small abrasion- usualy manages out patent
cylopegia antibiotics double pad could have complications- recurrent/ infection not generally referred
persistent epithelial defect
corneas affected by other diseases
lubrication needed
treat infection
bandage cl? graft?
recurrent corneal erosion
disturbance of epithelial membrane pain on waking, UNILATERAL lacrimation/ photophobia central cornreal abrasion with large epithelial flaps bownish odeama in anterior stroma secondary to corneal injury/ spontaneous?? in diabetics
MANAGEMENT_ repair epithelium resolve spontaneously? lubrication for 6 weeks pressure patch bandage cl phototheraputic keratectomy
MK- marginal keratitis
staphylocoi exotoxin- hypersensitivty reaction
subepithleila infiltrate near limbus/ ulcer
treat with antibiotics, good lid hygiene, cyclopegia, steroids
Terrien’s marginal degeneration\
peripheral thinning- in med
bilateral thinning of peripheral cornea
neovas?
treatment- lamella kp
painless blurred vision
mooreens ulcer
idiopathic peripheral ulcer
caused by ischeamic necrosis
progresses centrally, centrifugally and posteriotlu
complains of ExtrEME pain
responds to agressive steroid/ immunoresponsice chemotherapy
Peripheral corneal melt
caused by rheumatoid arthritis, lupus and other systemic disease
resorption of peripheral cornea
treatment with steroids and kerotoplasty
corneal infections- bacterial/viral
risk factors:
Mechanical or chemical damage of the epithelium
Extended-wear soft C/L
Other ocular infections and dry eye
Debilitation and nutritional deficiency
Cancer, AIDS
Administration of topical and systemic immunosuppressive agents
sx of
Rapidly reducing vision Pain
Photophobia Conjunctival injection Discharge
examination
Epithelial ulceration
Stromal suppuration/ abscess Diffuse epithelial oedema Stromal infiltrate
Endothelial plaque
Hypopyon
diagnosis of keratits based on H+S
istory Contact lens Trauma Previous surgery Pre-existing ocular diseases Urban/ rural Topical and systemic medication Examination
we need to identify pathogen and its sensitivity to antibiotics
we need corneal scrapings- Green needle
Surgical blade Sterile spatula
admit to hosp- if no bacteria iddentified- then give broad spectrum antibody
how do u know if antibiotic therapy is working in bacterial keratits
Blunting of the perimeter of the stromal infiltrate – ↓ density of the stromal infiltrate – ↓ stromal oedema and endothelial inflammatory plaque – ↓ anterior chamber inflammation – Reepithelialization of defect – Improvement in painful symptoms   No response to therapy Compliance/????? What did the lab grow- is he treatment effecting this Is the diagnosis correct- Stop the treatment Re-scrape Biopsy Toxicity from drops
adeno virus
herpes simplex
herpes zoster
viral keratitis
adeno virus
follicular conductiva pain/ photophobia glands/ unwell/va loss no treatment steroids?
herpes simplex
pain
photophobia
lacrimation
HERPES SIMPLEX
Dendridic ulcer
single/multiple linear branches- ed in beadlike extensions
stromal infiltrate
diminished corneal sensitivity
HERPES SIMPLEX
Geographic ulcer
HSV treated by steroids
how do u treat herpes simplex
with dendritrs/ geographical ulcer
- Debridement
- Topicalantivirals
- Cycloplegia
- OralAcyclovir
Metaherpetic ulceration with herpes simplex
recurrent episodes of heretic keratitis recurrent corneal ersions persistent ulceration eluting of the aroma stromal scarring lubrication, antibiotic, antiviral drops
Stromal keratitis
and herpes simplex
hyspersensitivity srtomal odeama KP irits scarring treat with topical steroids??
herpes zoster
5th cranial nerve previous influence? dermatol pain? skin changes, respecting midline involving tip of nose- hutchinsons sign blepharitis and conjunctivitis
stromal keratitis-
in herpes zoster
ocular manifestations of herpes zoster
Ophthalmoplegia Uveitis Episcleritis and scleritis Retinal necrosis Postherpetic neuralgia and other neurologic complications
treatment of HZO
Oral Acyclovir
Topical lubrication and antibiotics for blepharitis and conjunctivitis
Epithelial keratitis: debridement, topical antibiotics
Stromal & intraocular disease: steroids Local and systemic analgesics for pain Antidepressants for post herpetic neuralgia
fungal keratitis
ocualr consequences
anti fungal therapys
fungi proliferate within corneal tissue and to resis host defence
fungal corneal infections spread- to stroma- to ac
what does fungal keratits look like
yellow-white or greyish- white ulcer with indistinct margins Dense suppuration Satellite lesions, ring infiltrate, hypopyon
how would u manage fungal keratits
Corneal scrapping and biopsy
Topical and systemic antifungal agents Daily scrapping
Penetrating keratoplasty
No steroids
Acanthamoeba Keratitisamoeba from
water, soil, sludge, dust
use of cl?
dendriform lesions
unlcerations/ infiltrates an opacification of cornea???
characteristics of acanthomeabe keratitis
Elevated epithelial lesions Dendritiform lesions Sub-epithelial infiltrates Radial keratoneuritis Patchy stromal infiltrates Ring infiltrates Sclero-keratitis
Diagnosis and management of fungal keratits
needs to be confirmed b lab
corneal biopsy?
multi frug therapy
painkillers
