Corneal Disorders

Question 1

Red Flags

Answer 1

Decreased Visual Acuity
Severe Deep Pain
Ciliary flush
Photophobia (in addition to these)
Severe foreign body sensation
corneal opacity
Fixed pupil
Severe HA w/ nea

Question 2

Subconjunctival Hemorrhage

Answer 2

Patients are generally asymptomatic.

May occur spontaneously or with coughing, sneezing, straining or vomiting.

Question 3

Subconjunctival Hemorrhage Tx

Answer 3

No specific therapy is indicated.
Blood will typically resorb in 1-2 weeks
May want to work up hematologic or coagulation abnormality

Question 4

Keratoconus

Answer 4

A degenerative disorder of the eye where the cornea assume a conical shape instead of spherical.

Question 5

Keratoconus S/S

Answer 5

• Substantial vision distortion
• Photophobia
• Typically diagnosed in adolescent years
• If bilateral, may have difficulty with daily activities

Question 6

Keratoconus Tx

Answer 6

Contacts, surgery

Question 7

Corneal Abrasion

Answer 7

• Term most often applied to any defect in the corneal surface epithelium.
• AKA corneal epithelial defect

Question 8

Recurrent (Spontaneous) foreign body

Answer 8

• No immediate antecedent injury or foreign body

- Basement membrane disturbance resulting in recurrent breakdowns of the epithelium.

Question 9

Pain + Foreign Body Sensation = _________?

Answer 9

Presumed corneal abrasion

Question 10

Regardless of intervention, corneal abrasions usually heal within ____ to ___ hrs

Answer 10

24-72 hours. This is because the eye is the most vascular part of the body

Question 11

Should I use an eye patch for a corneal abrasion?!

Answer 11

No. Don’t be dumb. dumbface.

Question 12

Why is Abx ointment better than drops for corneal abrasion?

Answer 12

Because it lubricates as well.

Question 13

What are 2 good options for topical Abx for corneal abrasion from fireign body/trauma w/o contacts?

Answer 13

Erythromycin and Sulfacetamide

Question 14

What is the best Abx for contact lens related abrasion?

Answer 14

Ciproflaxacin for the suspected pseudomonas infxn.

Question 15

Are topical anesthetics a good option for pain management in corneal abrasions?

Answer 15

NO, they inhibit corneal epithelial healing

Question 16

Infectious pseudomonas keratitis can result in corneal _____ and ______ within _____ hrs.

Answer 16

Melting and perforation within 24 hours. Do NOT patch

Question 17

How often should corneal abrasion patients follow up?

Answer 17

Every 24 hours until abrasion is fully healed.

Question 18

Foreign Body Removal

Answer 18

1st: Irrigation
2nd: Try the swab
3rd: Refer to someone who knows what the hell they are doing
In the meantime: Treat w/ topical abx (erythro)

Question 19

Corneal ulcers are most commonly due to ______.

Answer 19

Infection

• Bacteria
• Virus
• Fungi
• Severe allergic eye disease

Question 20

Karatitis

Answer 20

Inflammation of the cornea

Question 21

Keratitis S/S

Answer 21

Photophobia
Tearing
Reduced vision
Red eye
Ciliary flush
Purulent or watery discharge

Question 22

Bacterial Keratitis

Answer 22

Usually an aggressive course.
Cornea is hazy w/ central ulcer.
May be admitted for constant tx
Flouroquinolones are preferred

Question 23

Herpes Simplex Keratitis

Answer 23

• Dendritic, branching ulcer is most characteristic

- Refer these patients

Question 24

Fungal Keratitis

Answer 24

Tend to occur after injury from plant material.
More common in contact lens wearers
Multiple stromal abscesses

Question 25

Acanthamoeba Keratitis

Answer 25

• Caused by an ameba.
• One of the leading causes of suppurative keratitis in contact lens wearers (soft lenses)
• Diagnoses often missed by PCP
• Refer immediately to Optho