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OPT 631 > Exam 1 -- Corneal Degenerations, ICE, and Corneal Pigmentations > Flashcards

Exam 1 -- Corneal Degenerations, ICE, and Corneal Pigmentations Flashcards

1
Q

Arcus (Senilis)

Etiology/Cause

A 
• Very common
- 50% by age 50
- 100% by age 80
• More common in African-Americans
• Hyperlipidemia
• High cholesterol
• If under 40, possible CV disease
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2
Q

Arcus (Senilis)

Location

A
  • Bowman’s

* Limbus

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3
Q

Arcus (Senilis)

Objective findings

A 
• Bilateral
• 1-2mm white band mid-periphery
• Cholesterol / lipid deposition 
• Gradual onset
   - Starts superior and inferior
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4
Q

Arcus (Senilis)

Subjective findings

A

Asymptomatic

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5
Q

Arcus (Senilis)

Diagnosis/Treatment

A
  • Refer if under 40 / haven’t been to PCP in 2 years

* Annual follow up if no risk factors

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6
Q

Limbal Girdle of Vogt

Etiology/Cause

A
  • Degeneration of collagen fibers
  • Type 1 associated with band keratopathy
  • Age 45+
  • Women > men
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7
Q

Limbal Girdle of Vogt

Location

A

• Nasal and temporal limbus

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8
Q

Limbal Girdle of Vogt

Objective findings

A
  • Bilateral
  • White line at limbus
  • Avascular
  • Type 1: see clear zone between limbus and line
  • Type 2: no clear zone
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9
Q

Limbal Girdle of Vogt

Subjective findings

A

• Asymptomatic

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10
Q

Limbal Girdle of Vogt

Diagnosis/Treatment

A
  • Type 1: treatment for band keratopathy

* Type 2: nothing

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11
Q

Dellen

Etiology/Cause

A

• Dryness

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12
Q

Dellen

Location

A
  • Often adjacent to pinguecula / conjunctival mass
  • Up to 1/2 corneal thickness
  • Epithelium intact
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13
Q

Dellen

Objective findings

A
  • Focal peripheral thinning near limbus
  • 0.5-1mm, edges sloped or steeply defined
  • Surrounding tissue may be hazy
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14
Q

Dellen

Subjective findings

A
  • Asymptomatic

* Any age

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15
Q

Dellen

Diagnosis/Treatment

A
  • Lubrication

* Bandage CL

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16
Q

Hassall-Henle Bodies

Etiology/Cause

A

• Age

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17
Q

Hassall-Henle Bodies

Location

A

• Descemet’s

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18
Q

Hassall-Henle Bodies

Objective findings

A
  • Small round thickenings in Descemet’s membrane, endothelial displacement
  • Maybe corneal edema
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19
Q

Hassall-Henle Bodies

Subjective findings

A

• Asymptomatic

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20
Q

Hassall-Henle Bodies

Diagnosis/Treatment

A
  • Peripheral gluttata if in periphery
  • DDx Fuch’s if central
  • No treatment
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21
Q

Pellucid Marginal Degeneration

Location

A

• Inferior cornea

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22
Q

Pellucid Marginal Degeneration

Objective findings

A
  • Bilateral inferior corneal thinning
  • Central cornea buldges out
  • Irregular ATR astigmatism
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23
Q

Pellucid Marginal Degeneration

Subjective findings

A
  • Usually asymptomatic

* Decreased VA

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24
Q

Pellucid Marginal Degeneration

Diagnosis/Treatment

A
  • Topography shows kissing birds or crab claw
  • Correct astigmatism with gas permeable CL
  • Keratoplasty
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25
Q

Terrien’s Marginal Degeneration

Etiology/Cause

A

• Rare, 75% males, any age

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26
Q

Terrien’s Marginal Degeneration

Location

A
  • Stroma

* Begins superior nasal

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27
Q

Terrien’s Marginal Degeneration

Objective findings

A
  • Bilateral but asymmetric
  • Marginal stromal thinning
  • Opacification, neovascularization
  • Irregular astigmatism
  • Minor trauma may cause rupture
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28
Q

Terrien’s Marginal Degeneration

Subjective findings

A
  • Maybe pain

* Decreased VA

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29
Q

Terrien’s Marginal Degeneration

Diagnosis/Treatment

A
  • Steroids

* Keratoplasty

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30
Q

(Marginal) Furrow Degeneration

Etiology/Cause

A
  • Idiopathic

* Systemic disease (RA, SLE, leukemia, PAN, TB)

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31
Q

(Marginal) Furrow Degeneration

Location

A

• Stroma

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32
Q

(Marginal) Furrow Degeneration

Objective findings

A 
• Idiopathic
   - Bilateral thinning with Arcus
   - Epithelium intact
   - No neovascularization
• With systemic disease
   - Ring ulcer
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33
Q

(Marginal) Furrow Degeneration

Subjective findings

A

• VA not affected

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34
Q

(Marginal) Furrow Degeneration

Diagnosis/Treatment

A
  • None

* Treat systemic cause

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35
Q

Mooren’s Ulcer

Etiology/Cause

A
  • Males > females
  • Severe form in Nigerians
  • Possible autoimmune reaction
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36
Q

Mooren’s Ulcer

Location

A

• Epithelium and stroma

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37
Q

Mooren’s Ulcer

Objective findings

A
  • Older pts: unilateral
  • Young pts: bilateral 25%
  • Begins with marginal infiltrate, progresses to limbal ulceration
  • 3-12 month course with remissions
  • Minor trauma may cause perforation
  • Adjacent conjunctiva injection and neovascularization
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38
Q

Mooren’s Ulcer

Subjective findings

A

•Pain, photophobia

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39
Q

Mooren’s Ulcer

Diagnosis/Treatment

A
  • An infectious ulcer would not cause thinning
  • Old patients usually respond to treatment
  • Young patients difficult to manage
  • Steroids may speed perforation
  • Refer to corneal specialist for conjunctiva excision and corneal reconstruction
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40
Q

Posterior Crocodile Shagreen

Location

A

• Descemet’s membrane

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41
Q

Posterior Crocodile Shagreen

Objective findings

A
  • Bilateral

* Small grey polygonal “crocodile skin” patches of various sizes

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42
Q

Posterior Crocodile Shagreen

Subjective findings

A

• Asymptomatic

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43
Q

Posterior Crocodile Shagreen

Diagnosis/Treatment

A

• None

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44
Q

Amyloid Degeneration

Etiology/Cause

A

• Secondary to long term disease (trachoma, glaucoma, uveitis, bullous keratopathy)

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45
Q

Amyloid Degeneration

Location

A

• Epithelium and Bowman’s

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46
Q

Amyloid Degeneration

Objective findings

A
  • Fleshy mass, nodular surface
  • Pink/yellow/white
  • Neovascularization
47
Q

Amyloid Degeneration

Diagnosis/Treatment

A
  • Primary cause prevention (usually too late)
  • Keratectomy
  • Corneal transplant
48
Q

Coats White Ring

Etiology/Cause

A

• Foreign body

49
Q

Coats White Ring

Location

A

• Epiethlium, but left intact

50
Q

Coats White Ring

Objective findings

A
  • Granular whitish oval ring in cornea (possibly lipid in nature)
  • May contain iron
51
Q

Coats White Ring

Subjective findings

A

• Asymptomatic

52
Q

Coats White Ring

Diagnosis/Treatment

A

• None

53
Q

Band Keratopathy

Etiology/Cause

A 
• Calcium deposits
• Secondary to ocular inflammation 
   - Chronic anterior uveitis, prolonged glaucoma, phthisis bulbi
• Secondary to systemic disease
   - Hypercalcemia conditions
   - Autoimmune
54
Q

Band Keratopathy

Location

A

• Bowman’s, anterior stroma

55
Q

Band Keratopathy

Objective findings

A

• White/yellow deposits

56
Q

Band Keratopathy

Subjective findings

A
  • Early stages asymptomatic
  • Later decreased VA
  • Pain with recurrent corneal erosion in late stages
57
Q

Band Keratopathy

Diagnosis/Treatment

A
  • Refer if systemic
  • Lubrication
  • Chelating agents (EDTA), scrape off
58
Q

Bullous Keratopathy

Etiology/Cause

A

• Long term prolonged corneal edema

59
Q

Bullous Keratopathy

Objective findings

A

• Bubbling of cornea, break down and reform, eventually scar

60
Q

Bullous Keratopathy

Subjective findings

A

• Acute, painful

61
Q

Bullous Keratopathy

Diagnosis/Treatment

A
  • Antiedema treatment
  • Early: bandage CL
  • Late: treat symptoms, poor prognosis
62
Q

Salzmann’s Nodular Degeneration

Etiology/Cause

A
  • Females > males

* Related to previous inflammations, especially phlyctenular disease

63
Q

Salzmann’s Nodular Degeneration

Location

A

• Mid-periphery

64
Q

Salzmann’s Nodular Degeneration

Objective findings

A
  • Not inflammatory
  • Multiple bluish-white nodules, usually mid periphery
  • Bilateral
65
Q

Salzmann’s Nodular Degeneration

Subjective findings

A
  • Asymptomatic

* VA depends on location

66
Q

Salzmann’s Nodular Degeneration

Diagnosis/Treatment

A
  • Asymptomatic: monitor 3-6 months
  • With epithelial breakdown: bandage CL, antibiotic qid
  • Keratoplasty
67
Q

Xeropthalmia / Keratomalacia

Etiology/Cause

A

• Vitamin A deficiency

68
Q

Xeropthalmia / Keratomalacia

Objective findings

A 
• Xeropthalmia
   - Keratinization of epithelium
   - Atrophy of conj goblet cells
   - Corneal edema
   - Neovascularization
• Keratomalacia
   - Corneal tissue liquefaction
• Both can have Bitot spots
69
Q

Xeropthalmia / Keratomalacia

Diagnosis/Treatment

A

• Vitamin A supplement, ocular changes may reverse

70
Q 
Iridocorneal Endothelial (ICE) Syndrome
Etiology/Cause
A 
• Females > males
• Unilateral
• Abnormal endothelium
   - Endothelium proliferates, migrates into angle and onto iris
   - Causes angle closure glaucoma
71
Q 
Iridocorneal Endothelial (ICE) Syndrome
General objective findings
A

• Corectopia
• Pseudopolycoria in a previously normal iris
• Iris atrophy
• Corneal endothelial abnormalities
- Hammered appearance similar to Fuch’s
- Corneal edema due to endothelial defects

72
Q

Iridocorneal Endothelial (ICE) Syndrome
Chandler’s Syndrome
IOP, Corneal Edema, Corectopia, Glaucoma Prevalence

A

IOP: Normal to high
Corneal Edema: Moderate to severe
Corectopia: Mild to moderate
Glaucoma Prevalence: ~5%

73
Q

Iridocorneal Endothelial (ICE) Syndrome
Cogan-Reese Syndrome
IOP, Corneal Edema, Corectopia, Glaucoma Prevalence

A

IOP: Usually high
Corneal Edema: Mild to moderate
Corectopia: Moderate to severe
Glaucoma Prevalence: ~50%

74
Q

Iridocorneal Endothelial (ICE) Syndrome
Progressive Iris Atrophy
IOP, Corneal Edema, Corectopia, Glaucoma Prevalence

A

IOP: Usually high
Corneal Edema: Mild to moderate
Corectopia: Moderate to severe
Glaucoma Prevalence: ~37%

75
Q

Kruckenberg’s Spindle

Causes

A

•Old uveitis or pigment dispersion syndrome

76
Q

Kruckenberg’s Spindle

Location

A
  • Inferior 1/3 to 1/2

* Posterior cornea

77
Q

Kruckenberg’s Spindle

Appearance

A
  • Brown

* Vertical spindle shaped

78
Q

Vortex Keratopathy

Causes

A
  • Fabry Disease

* Drugs: amiodarone, hyrdoxychloroquine, indomethacin, tamoxifen

79
Q

Vortex Keratopathy

Location

A
  • Epithelium

* Below pupil

80
Q

Vortex Keratopathy

Appearance

A
  • Grey/gold

* Swirl pattern

81
Q

Arlt’s Triangle

Causes

A

• Old uveitis

82
Q

Arlt’s Triangle

Location

A
  • 6:00 position

* Posterior cornea

83
Q

Arlt’s Triangle

Appearance

A
  • Brown

* Triangular shaped

84
Q

Brawny Cornea

Causes

A
  • EBMD

* RCE

85
Q

Brawny Cornea

Location

A

• Epithelium

86
Q

Brawny Cornea

Appearance

A
  • Brown

* Edematous haze

87
Q

Ferry’s Ring

Causes

A

• Glaucoma surgery

88
Q

Ferry’s Ring

Appearance

A
  • Orange/brown

* Iron deposition around surgical filtration bleb

89
Q

Fleisher’s Ring

Causes

A

• Keratoconus

90
Q

Fleisher’s Ring

Appearance

A
  • Orange

* Iron deposition at base of cone

91
Q

Goar’s line

Causes

A

•Pigmentary glaucoma

92
Q

Goar’s line

Location

A

•Inferior cornea

93
Q

Goar’s line

Appearance

A
  • Brown

* Horizontal line

94
Q

Hemosiderosis

Causes

A
  • Hyphemia

* Intracorneal bleeding, neovascularization

95
Q

Hemosiderosis

Location

A

• Intracorneal or posterior corneal surface

96
Q

Hemosiderosis

Appearance

A
  • Red/brown

* Blood stain

97
Q

Hudson-Stahli line

Causes

A
  • Males > females

* Frequency increases with age

98
Q

Hudson-Stahli line

Location

A
  • Upper and lower lid junction

* Bowman’s

99
Q

Hudson-Stahli line

Appearance

A
  • Orange/brown
  • Segmented or continuous line
  • May be surrounding opacity
  • Frequent site of RCE
100
Q

Kaiser-Fleisher Ring

Causes

A

• Wilson’s disease

101
Q

Kaiser-Fleisher Ring

Location

A
  • Posterior cornea

* Anterior angle

102
Q

Kaiser-Fleisher Ring

Appearance

A
  • Orange
  • Copper deposition
  • Best seen with gonioscopy
103
Q

Keratic Precipitates

Causes

A
  • Uveitis

* Trauma

104
Q

Keratic Precipitates

Location

A

• Endothelial surface

105
Q

Keratic Precipitates

Appearance

A

•White or pigmented

106
Q

Keratomelanocytosis (Striate Melanokeratosis)

Causes

A
  • Trauma
  • Infection
  • Staph
  • Most in patients with high pigment
107
Q

Keratomelanocytosis (Striate Melanokeratosis)

Location

A
  • Limbus

* Most at 4:00 and 8:00

108
Q

Keratomelanocytosis (Striate Melanokeratosis)

Appearance

A

• Pigmented spokes radiating out into cornea from limbus

109
Q

Salmon Patch

Causes

A

• Syphilitic keratitis

110
Q

Salmon Patch

Location

A

• Mid-stroma

111
Q

Salmon Patch

Appearance

A
  • Orange

* Discoloration of mid-stroma, interstitial keratitis

112
Q

Stocker’s line

Causes

A

• Pterygium

113
Q

Stocker’s line

Location

A

• Leading edge of pterygium

114
Q

Stocker’s line

Appearance

A
  • Orange

* Iron deposition

OPT 631 (5 decks)

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