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Anterior Eye > Corneal Diseases > Flashcards

Corneal Diseases Flashcards

1
Q

Chronic corneal diseases

A 
Congenital 
Dystrophy
Ectasia 
Degeneration 
Dry eye 
Surgery
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2
Q

MICROCORNEA

A

corneal diameter less than 10mm
uni/bilateral
the eye can be normal- or have other stuff. e.g. cataract

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3
Q

MEGALOCORNEA

A

cornea bigger than 13mm
symmetrical
non progressive
DD- Congenital glaucoma

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4
Q

Congenital CORNEAL PROBELMS

A

microcornea
megalocornea
Posterior embryotoxon
Sclerocornea

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5
Q

POSTERIOR EMBRYOTOXON

A

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

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6
Q

SCLEROCORNEA

A

limbus is not defined
90%BILATERAL
non-progressive
central cornea is usually normal

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7
Q

Types of dystrophy-

DYSTROPHY

A

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

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8
Q

MAP-DOt fingerprint

A

Dots- microcyts …..
Map-Geogrophic opacities c v d
Fingerprint-subepithelial ridges&raquo_space; «< LL&raquo_space; // \ LL

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9
Q

MEESMANS dystrophy

A

Dominant
FB sensation
mild vision reduction
small grey-white punctuate opacities

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10
Q

VORTEX dystrophy

A

Corneal deposits distributed in the Whorls like pattern
look for - Amiodarone intake
- Indomathacin intake
- Fabry’s disease

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11
Q

GRANULAR DYSTROPHY

snowflakes

A

Axial, greyish opaque granules
vision good until middle age- when it gets bigger- va reduces
minimal symptoms
BILATERAL- no inflammatory

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12
Q

LATTICE DYSTROPHY

A

greyish, linear, branching oacities- central cornea

severe recurrent erosions- early reduction in vision

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13
Q

macular dystrpohy

A

LEAST COMMON-
greyish opaque spots- indistinct borders affecting entire cornea
reduced VA- erosive sx

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14
Q

Schnyder’s dystrophy

A 
bilteral
opacity
accumulation of lipids and cholesterol
slow progression
need corneal transplant
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15
Q

congenital heredity endotheial dystrophy

A 
infancy 
cloudy cornea
photophobia
tearing
nystagmus?
DD- congenital conrea
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16
Q

Congenital clouding of the cornea

A 
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
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17
Q

corneal dystrophy

A

primary bilateral disorder
young px?
check which layers of the cornea is involved
pattern sx

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18
Q

keratoconus- irregular k values

A 
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

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19
Q

Keratoglobus

A

rare- thinning
protrusion of entire cornea
non progressive
may result in corneal rupture!!!!!!!!!!!!

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20
Q

Pellucid marginal degeneration

A

bilateral
slow progressive crescent shaped area of interior corneal thinning
protrusion is above the are of thinning
DD with keratoconus

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21
Q

Iridocorneal endothelial syndrome

A

chandlers syndrome- only silver appearance

cogan-reese syndrome- pigmnted noduules of iris

essential iris atrophy- striate an melt holes, posterio
angle pysniki

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22
Q

Corneal degeneration occur later in life. Not born with these

A

Lipid keratopathy
Band keratopathy
Salzmann nodular degeneration

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23
Q

Arcus senilis

A

white circle around periphery of iris- deposits of fatty material i cornea

24
Q

Band keratopathy

A

calcium deposits in a band across the cornea
caused by: chronic uveitis, glaucoma, hypercalcimia, phtisis bulbi

need surgical debridment

25
Q

Dellen

A

tear film instability- corneal instbaility

caused by strabismus, surgery, glaucoma, RGP

26
Q

corneal abrasions - most common

A

History of trauma
intense pain/photphobia
red eye
epithelial loss with Fl

27
Q

small abrasion- usualy manages out patent

A 
cylopegia
antibiotics
double pad
could have complications- recurrent/ infection
not generally referred
28
Q

persistent epithelial defect

A

corneas affected by other diseases
lubrication needed
treat infection
bandage cl? graft?

29
Q

recurrent corneal erosion

A 
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
30
Q

MK- marginal keratitis

A

staphylocoi exotoxin- hypersensitivty reaction
subepithleila infiltrate near limbus/ ulcer
treat with antibiotics, good lid hygiene, cyclopegia, steroids

31
Q

Terrien’s marginal degeneration\

peripheral thinning- in med

A

bilateral thinning of peripheral cornea
neovas?
treatment- lamella kp
painless blurred vision

32
Q

mooreens ulcer

A

idiopathic peripheral ulcer
caused by ischeamic necrosis
progresses centrally, centrifugally and posteriotlu
complains of ExtrEME pain
responds to agressive steroid/ immunoresponsice chemotherapy

33
Q

Peripheral corneal melt

A

caused by rheumatoid arthritis, lupus and other systemic disease
resorption of peripheral cornea
treatment with steroids and kerotoplasty

34
Q

corneal infections- bacterial/viral

A

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

35
Q

sx of

A

Rapidly reducing vision Pain

Photophobia Conjunctival injection Discharge

36
Q

examination

A

Epithelial ulceration
Stromal suppuration/ abscess Diffuse epithelial oedema Stromal infiltrate
Endothelial plaque
Hypopyon

37
Q

diagnosis of keratits based on H+S

A 
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

38
Q

how do u know if antibiotic therapy is working in bacterial keratits

A 
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
39
Q

adeno virus
herpes simplex
herpes zoster

A

viral keratitis

40
Q

adeno virus

A 
follicular conductiva
pain/ photophobia
glands/ unwell/va loss
no treatment
steroids?
41
Q

herpes simplex

A

pain
photophobia
lacrimation

42
Q

HERPES SIMPLEX

Dendridic ulcer

A

single/multiple linear branches- ed in beadlike extensions
stromal infiltrate
diminished corneal sensitivity

43
Q

HERPES SIMPLEX

Geographic ulcer

A

HSV treated by steroids

44
Q

how do u treat herpes simplex

with dendritrs/ geographical ulcer

A
  • Debridement
  • Topicalantivirals
  • Cycloplegia
  • OralAcyclovir
45
Q

Metaherpetic ulceration with herpes simplex

A 
recurrent episodes of heretic keratitis
recurrent corneal ersions
persistent ulceration
eluting of the aroma
stromal scarring
lubrication, antibiotic, antiviral drops
46
Q

Stromal keratitis

and herpes simplex

A 
hyspersensitivity
srtomal odeama
KP
irits
scarring
treat with topical steroids??
47
Q

herpes zoster

A 
5th cranial nerve
previous influence?
dermatol pain?
skin changes, respecting midline
involving tip of nose- hutchinsons sign
blepharitis and conjunctivitis
48
Q

stromal keratitis-

A

in herpes zoster

49
Q

ocular manifestations of herpes zoster

A 
Ophthalmoplegia
Uveitis
Episcleritis and scleritis
Retinal necrosis
Postherpetic neuralgia and other neurologic complications
50
Q

treatment of HZO

A

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

51
Q

fungal keratitis

A

ocualr consequences
anti fungal therapys
fungi proliferate within corneal tissue and to resis host defence
fungal corneal infections spread- to stroma- to ac

52
Q

what does fungal keratits look like

A

yellow-white or greyish- white ulcer with indistinct margins Dense suppuration Satellite lesions, ring infiltrate, hypopyon

53
Q

how would u manage fungal keratits

A

Corneal scrapping and biopsy
Topical and systemic antifungal agents Daily scrapping
Penetrating keratoplasty
No steroids

54
Q

Acanthamoeba Keratitisamoeba from

A

water, soil, sludge, dust
use of cl?
dendriform lesions
unlcerations/ infiltrates an opacification of cornea???

55
Q

characteristics of acanthomeabe keratitis

A

Elevated epithelial lesions Dendritiform lesions Sub-epithelial infiltrates Radial keratoneuritis Patchy stromal infiltrates Ring infiltrates Sclero-keratitis

56
Q

Diagnosis and management of fungal keratits

A

needs to be confirmed b lab
corneal biopsy?
multi frug therapy
painkillers

Anterior Eye (14 decks)

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