Disorders of the Cornea

Question 1

Corneal Abrasion Etiology

Answer 1

• Probably the most common eye injury seen in practice
• Ill fitting or over worn contact lens
• Foreign body
• Chronic dry eye
• Trauma – fingernail, animal paw, paper, cardboard, make-up applicators, branches or leaves

Question 2

Corneal Abrasion Symptoms

Answer 2

foreign body sensation
pain
difficulty opening eye photophobia
excessive tearing

Question 3

Corneal Abrasion Signs

Answer 3

Conjunctival injection (red eye) blepharospasm 
excessive tearing

Question 4

Corneal Abrasion Diagnosis/Work up

Answer 4

• Slit lamp exam w/ fluorescein dye usually confirms abrasion
• If abrasion is result of high speed penetration (i.e., lawnmower, string trimmer, hammer, power tool etc) then ocular CT or MRI (if non ferromagnetic) get to Ophtho consult stat

Question 5

Corneal Abrasion Tx

Answer 5

• Topical local anesthetic drops (facilitate exam & relieve pain)
• oral analgesics for large abrasions
• abx gtts (drops) w/contact lens abrasion
• otherwise abx is controversial
• patching generally not used any longer
• F/U PRN
• if retained FB – Eye MD

Question 6

Herpes Simplex Keratitis Etiology

Answer 6

HSV 1

Question 7

Herpes Simplex Keratitis Symptoms

Answer 7

Irritation
photophobia
redness
pain is mild if at all

Question 8

Herpes Simplex Keratitis Signs

Answer 8

Most cases are unilateral
mild conjunctival injection
epithelial dendrites seen with fluorescein staining
stromal scarring can occur with advanced disease.

Question 9

Herpes Simplex Keratitis Tx

Answer 9

Urgent referral to eye doctor, topical antiviral meds

Question 10

Herpes Zoster Ophthalmicus Etiology

Answer 10

Latent Varicella (Chickenpox) Virus – still unclear whether pts vaccinated against VARICELLA CAN get HZ (live vaccine) – but reported cases of children w/Varicella vaccination HAVE gotten HZ

Question 11

Herpes Zoster Ophthalmicus Symptoms

Answer 11

Pain
H/A
photophobia

Question 12

Herpes Zoster Ophthalmicus Signs

Answer 12

vesicular rash seen in V1 distribution of the trigeminal nerve
conjunctivitis
can also include uveitis
even glaucoma

Question 13

Herpes Zoster Ophthalmicus possible DDX

Answer 13

Herpes simplex – but rash does not follow dermatomal pattern of zoster

Question 14

Herpes Zoster Ophthalmicus Tx

Answer 14

Oral acyclovir for 7 – 10 days

Question 15

Corneal ulcer affects what part of eye?

Answer 15

Ulceration of the cornea

Question 16

Corneal ulcer etiology

Answer 16

often associated with bacterial
viral or fungal infection of  the eye,
a hx of trauma
contact lens wearers are more susceptible
entropion (more rare)
corneal abrasion

Question 17

Corneal ulcer symptoms

Answer 17

Pain
redness
photophobia
decreased vision

Question 18

Corneal ulcer signs

Answer 18

dense corneal infiltrate
layering of WBC’s in the anterior chamber (hypopyon)
severe infections can lead to rapid corneal destruction and perforation

Question 19

Corneal ulcer Tx

Answer 19

Emergent referral to an ophthalmologist

Question 20

What is Pterygium

Answer 20

Fibrovascular growth extending from the conjunctiva onto the cornea

(pinguecula does not overgrow the cornea, but pterygia may overgrow the cornea)

Question 21

Pterygium Etiology

Answer 21

(sometimes referred to as surfers eye)
*overexposure to UV light* (more common closer to the equator or sunny climates)
outdoor workers or sporting enthusiasts
windy conditions
chronic dry eye

Question 22

Pterygium Symptoms

Answer 22

Usually symptom free or may have occasional mild irritation or gritty/itchy feeling
FB sensation
if extensive enough decrease vision

Question 23

Pterygium Signs

Answer 23

Overgrowth of fibrovascular material over the cornea, maybe decreased VA

Question 24

Pterygium Tx

Answer 24

lubricating drops

surgical resection if problem persists