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Optho > Diseases Of The Cornea > Flashcards

Diseases Of The Cornea Flashcards

1
Q

Purpose of cornea

A

Clear medium for vision
Gross focus
Protection
Refraction

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2
Q

What are the layers of the cornea

A

Outer epithelium
Stroma
Descemet’s membrane
Innermost endothelium

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3
Q

Where does the cornea get its blood supply

A

Aqueous humor

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4
Q

Why is the cornea clear

A

Avascular
Anhydrous
Regular arrangement of collagen fibers

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5
Q

What can make the cornea opaque

A 
Cellular infiltrate 
Fibrosis
Pigment
Neovascularization
Edema
Mineralization
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6
Q

What is the difference in location of abscess and white blood cell in cornea

A

White blood cell behind.

Abscess in the middle of it

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7
Q

Infiltrate color

A

Creamy

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8
Q

Fibrosis color

A

Grey
A scar
Response to healing

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9
Q

Fibrosis characteristics

A

End result of healing

No fluid

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10
Q

What causes Pigment problems

A

Secondary to chronic irritation
Caused by trichiasis
Chronic dry eye
Pannus

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11
Q

What causes vascularization

A

Inflammatory stimulus

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12
Q

Characteristics of vascularization

A

Can be deep or superficial
Leak into cornea
Usually see with edema

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13
Q

Superficial vascularization

A

Single ‘Tree’

Dry eye

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14
Q

Deep vascularization

A

Many ‘Bushes’
Glaucoma
Uvitis

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15
Q

Edema

A

Fluid in corneal stroma

Occurs at different levels

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16
Q

What color is edema

A

blue with indistinct border

Can have white blisters which can pop causing ulcer

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17
Q

Mineralization

A

Dystrophic along with a degenerative disease
Underneath epithelium
Difficult to treat

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18
Q

Color of mineralization

A

Chalky white

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19
Q

Corneal ulcers

A

Most common ophthalmic condition seen in practice

Loss of corneal tissue

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20
Q

What takes up stain

A

Stroma if it’s exposed

Not endothelial cells

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21
Q

Are blood vessels good with ulcers

A

Yes

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22
Q

What do you base your treatment plan on with ulcers

A

Depth

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23
Q

Superficial ulcers

A

Epithelium is the only structure missing

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24
Q

What has to happen for superficial ulcer to heal

A

Epithelial cells around ulcer will migrate in and cover the wound
Stem cells supply epithelial cells

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25
Q

How fast does an epithelial injury heal

A

.6-1mm/day

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26
Q

How long does it take for a superficial ulcer to completely heal

A

6 weeks

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27
Q

Stromal ulcer

A

Varying degrees of stromal collagen lost in addition to epithelium

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28
Q

What happens if you see white blood cell around the stromal ulcer

A

Infection

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29
Q

stroma response to injury

A

Re-synthesis and cross linking of collagen
PMN appear around edge
Transform into fibroblasts and produce collagen

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30
Q

Cillary flush

A

Vessels engorge

Endothelial budding of blood vessels

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31
Q

How long does cillary flush take

A

5ish days

Endothelial cells of blood vessels bud off into the stroma

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32
Q

What happens to the blood vessels after they are done doing their job

A

Ghost vessel

Vessel walls are there, but no blood

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33
Q

How fast do WBC move in the cornea

A

9mm/day

34
Q

Haw fast do corneal blood vessels and epithelial cells move

A

1mm/day

35
Q

Importance of ghost vessels with reoccurring ulcer

A

The vessels will re profuse faster than if new ones had to be grown

36
Q

Dermoid

A

Normal tissue in an abnormal location

37
Q

Diagnosis of corneal ulcer

A

Treat aggressively
Recheck often
Assume it will get worse

38
Q

Clinical signs of corneal ulcer

A 
Blepharospasm (squinting)
Epiphora (tearing)
discharge
Secondary anterior uvitis 
Miosis
Corneal edema
Corneal vascularization
39
Q

Corneal ulcer diagnostics

A

Fluorescein every painful eye
Schirmer tear test (if recurrent)
Culture

40
Q

What should your STT be in an ulcerated eye

A

Increased tearing

41
Q

Corneal cytology

A

Topical anesthesia
Back of scalpel blade
Diff-quick and gram stain

42
Q

Descemetoceles

A

Epithelium and stroma lost
Very thin
Only DM remains

43
Q

Iris prolapse

A

DM ruptures

Iris passively flows AqH and plugs hole

44
Q

Melting ulcers

A

Proteases destroy
Look soft
Infection

45
Q

How do distinguish melting ulcers from corneal edema

A

Melting ulcers are soft

46
Q

Do you use corticosteroids topically on a corneal ulcer

A

NEVER

47
Q

How do you tell if ulcer is infected

A 
Cellular infiltrate 
Melting
Degree of uveitis
Delayed healing
Positive culture
48
Q

What species is herpies most common

A

Cats

49
Q

How does the corneal ulcer appear with herpies

A

Branching ulcer

50
Q

Therapy of corneal ulcer

A

Support wound healing

Body will heal itself

51
Q

What determines the treatment for ulcer

A 
Primary etiology
Infected
Depth
Melting
Extent of uveitis
52
Q

Goals of therapy

A

Sterilize the wound
Control 2nd anterior uveitis
Slow collagen breakdown
Provide structural support

53
Q

Medical treatment of ulcers

A

Treat etiology
Broad spectrum topical antibiotics
Reduce tear protease activity
Treat Uveitis

54
Q

Hypopians are most often…

A

Sterile

55
Q

Treatment of reflex uveitis

A

Atropine

Systemic NSAID

56
Q

Superficial ulcer treatment

A

antibiotic
Atropine
E collar

57
Q

Stromal/complicated ulcer

A 
Antibiotics
Antifungals if needed
Serum, EDTA, 
Atropine
Systemic NSAID
Maybe surgery
58
Q

Melting ulcer treatment

A

Very aggressive medical/surgical treatment

Do everything…..except topical steroids

59
Q

Anti-melting therapy

A

Serum/plasma
EDTA
N-acetylcysteine

60
Q

Deep ulcers, descemetoceles, and perforated ulcer treatment

A

Aggressive medical therapy
antibiotics
Surgery

61
Q

Iris prolapse treatment

A

Emergency
Systemic antibiotics
No oitments

62
Q

Corneal foreign body ulcer. Treatment

A

Remove and treat as ulcer

63
Q

Non-healing ulcer causes

A

Look at eyelid/lashes
Tear production
Foreign bodies

64
Q

Refractory ulcers

A

Superficial corneal erosion with epithelial ‘lips’

Epithelial roll back, mitosis, but cannot adhere

65
Q

indolent ulcer

A

Defect in hemidesmosomes of basal corneal epithelial cells

66
Q

Treatment for indolent ulcer

A

Remove with a q-tip

67
Q

Why can’t grid horses

A

Horses: usually have fungal issues that can get dragged deeper

68
Q

Keratitis

A

Non-specific inflammation of the cornea

69
Q

Pannus

A

AKA chronic superficial keratitis
Immune mediated
German shepherds

70
Q

Pannus treatment

A

Topical steroids
No cure
Topical cyclosporine

71
Q

Pannus looks like

A

Pigment and vessels coming from lateral

72
Q

Immune mediated process where the body is reacting to a virus. Chronic.

A

Hermetic stromal keratitis

73
Q

Hermetic stromal keratitis managment

A

Steroids, CsA, antiviral

74
Q

Proliferative keratitis
Non-healing ulcer
Caused by tumor

A

Eosinophilic keratitis

75
Q

How to diagnose eosinophilic keratitis

A

Cytology

76
Q

Inherited, breed related disease.
Affects both eyes
No corneal inflammation

A

Corneal dystrophies in dog

77
Q

Endothelium response to injury

A

Limited capacity for regeneration

78
Q

What happens when endothelium is damaged

A

Fluid isn’t pumped out

79
Q

Hallmark of corneal endothelial disease

A

Corneal edema

80
Q

Treatment of endothelial disease

A

Topical hyperosmotics
Thin permanent grafts
Thermal keratotomy

Optho (13 decks)

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