Exam 1 -- Corneal Disease

Question 1

Phlyctenular Keratoconjunctivitis

Etiology/Causes

Answer 1

• Hypersensitivity response
• More common in poor areas (sanitation, health care)
• Women > men
• Children, young adults
• Major causes: staph and TB

Question 2

Phlyctenular Keratoconjunctivitis

Subjective findings

Answer 2

• Conjunctival symptoms
   - FB sensation, irritation
   - Itching
   - Occasional discharge
   - Tearing
• Corneal symptoms: same as conjunctiva plus:
   - Pain
   - Photophobia
   - Ciliary spasm
   - Blurry vision

Question 3

Phlyctenular Keratoconjunctivitis

Objective findings

Answer 3

• Nodular inflammation of perilimbal tissue
• Small pink lesions on conj, limbus, or cornea
• Conj signs
- Injection
- Lesions on conj
• Corneal signs
- More common?
- Wedge shaped white lesion
- Begins at limbus (inferior)
- Radial vascularization
- May result in ulcer, scar, perforation

Question 4

Phlyctenular Keratoconjunctivitis

Treatment

Answer 4

• Rule out or treat TB
• Treat staph bleph
• Steroids (Pred Forte, Durezol, Lotemax)
• Cycloplegic
• Antibiotic/steroid combo (Zylet, Tobradex)
• Oral antibiotic (tetracycline, doxycycline)

Question 5

Filamentary Keratitis (Corneal Mucous Plaques)
Causes

Answer 5

• Aqueous deficient dry eyes cause corneal irregularities and increased mucin
• Sjogren’s, SLK, RCE, neurotropic keratopathy, chronic bullous keratopathy, patching
• Contact lens wear
• Cataract / corneal graft surgery
• Cronic use of medications

Question 6

Filamentary Keratitis (Corneal Mucous Plaques)
Subjective findings

Answer 6

• Red eye
• Pain
• FB sensation
• Photophobia

Question 7

Filamentary Keratitis (Corneal Mucous Plaques)
Objective findings

Answer 7

• Mucus strands attached to cornea, grey subepithelial opacities, stain with Rose Bengal
• Conjunctival injection
• Poor tear film
• PEE

Question 8

Filamentary Keratitis (Corneal Mucous Plaques)
Treatment

Answer 8

• Lubrication (long term)
• Punctal plugs
• Mycomyst (acetylcystine) to dissolve mucus
• Hypertonic solution
• Bandage CL
• Filaments resolve in 1-4 weeks
• Treat underlying condition
• Debridement of filaments
• Steroids (Lotemax)
• NSAIDs (Voltaren/diclofenac)

Question 9

Thygeson’s Superficial Punctate Keratitis

Etiology/Cause

Answer 9

• Immune or inflammatory process

* assoication with HLA-DR3

Question 10

Thygeson’s Superficial Punctate Keratitis

Subjective findings

Answer 10

• FB sensation, irritation
• Photophobia
• Slight decrease in VA
• Redness
• Dryness, burning, itching
• May be asymptomatic

Question 11

Thygeson’s Superficial Punctate Keratitis

Objective findings

Answer 11

• Bilateral
• Recurrent, exacerbations and remissions
• Multiple (average 20) epithelial lesions: round, grey/white, granular, raised, vary in size
• More numerous centrally
• Variable staining with NaFl
• No conjunctival involvement, no stromal inflammation (eye white and quiet)
• May have subepithelial opacities due to edema