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OPT 631 > Exam 1 -- Corneal Endothelial Dystrophies and Other Conditions > Flashcards

Exam 1 -- Corneal Endothelial Dystrophies and Other Conditions Flashcards

1
Q

Fuch’s dystrophy

Subjective findings

A
  • Symptomatic age 50-60
  • Decreased VA, fluctuating due to edema
  • Photophobia and glare
  • Bullae cause painful erosion
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2
Q

Fuch’s dystrophy

Objective findings

A
  • Females > males
  • Glutata formation
  • Disrupts endothelial pump
  • Stromal edema (striae, thickening)
  • Epithelial edema (microcysts, bullae)
  • Central corneal thickness > 600 um
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3
Q

Fuch’s dystrophy

Treatment

A
  • Hypertonic solution and ointment
  • Hot air (hair dryer)
  • Bandage CL
  • Dilation
  • Keratoplasty
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4
Q

Congenital hereditary dystrophy

Subjective findings

A
  • Decreased VA

* Can lead to blindness (epithelial caused)

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5
Q

Congenital hereditary dystrophy

Objective findings

A
  • Recessive: has nystagmus, congenital
  • Dominant: no nystagmus, onset 1st-2nd decade
  • Rare/absent endothelial cells
  • Increased corneal thickness
  • Edema
  • Thickening of Descemet’s
  • Bullae and erosions
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6
Q

Congenital hereditary dystrophy

Treatment

A
  • Hypertonic solution
  • Keratoplasty
  • Often poor results
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7
Q

Posterior Polymorphous dystrophy

Subjective findings

A
  • Can be asymptomatic
  • Photophobia
  • Foreign body sensation
  • Decreased VA
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8
Q

Posterior Polymorphous dystrophy

Objective findings

A
  • Endothelium displays characteristics of epithelium
  • Vesicular, band-like, geographic pattern of opacities on posterior cornea
  • Asymmetric
  • May also have iris membranes, posterior synechiae, corectopia, glaucoma
  • Can lead to edema, bullae
  • Usually autosomal dominant
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9
Q

Posterior Polymorphous dystrophy

Treatment

A
  • Lubrication
  • Hypertonic solution or ointment
  • Bandage CL
  • Treat erosions
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10
Q

Pannus

Causes

A
  • Rosacea, staph hypersensitivity
  • CL tight / overwear
  • Phlyctenule
  • Chlamydia
  • SLK
  • Vernal/allergic
  • Herpes simplex
  • Chemical burn / trauma
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11
Q

Pannus

Subjective findings

A
  • Asymptomatic

* Decreased VA if central

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12
Q

Pannus

Objective findings

A
  • Superficial vascular invasion, fibrous tissue bed
  • Chronic result of inflammatory response
  • At Bowman’s membrane
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13
Q

Pannus

Treatment

A
  • Treat underlying cause
  • Discontinue / reduce CL wear
  • Vasoconstrictors to reduce redness
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14
Q

Pterygium

Causes

A
  • Pinguecula
  • Sun, wind, dust exposure
  • Higher prevalence in populations near equator (Latino)
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15
Q

Pterygium

Subjective findings

A
  • Possible reduced VA

* Irritation (dry gritty eyes)

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16
Q

Pterygium

Objective findings

A
  • “Wing” of elevated conjunctival tissue
  • Becomes inflammed (red)
  • Irregular astigmatism
  • Corneal distortion
17
Q

Pterygium

Treatment

A
  • Protect eyes (sunglasses, goggles, hat)
  • Lubricants / ointments
  • Vasoconstrictor
  • NSAID
  • Mild steroid
  • Surgical removal if near visual axis (can recur)
18
Q

Interstitial keratitis

Causes

A

• 90% caused by syphillis (congenital [bilateral] or acquired [unilateral])
- Acute form 5-15 years after systemic infection
- Congenital form can present at age 15
• TB (unilateral, sectoral)
•Cogan’s syndrome
•Leprosy
• Herpes simplex
• Lyme disease

19
Q

Interstitial keratitis

Subjective findings

A
  • Redness
  • Pain
  • Decreased VA
20
Q

Interstitial keratitis

Objective findings

A 
• Unilateral, may become bilateral
• Triad: 
   - Stromal infiltration, haze and edema
   - Stromal thinning
   - Neovascularization
• Beaded corneal nerves
• Nodules on iris
• Iritis
• Conjunctivitis / episcleritis
• Salt-and-pepper retinopathy
• Hutchinson's triad for congenital form:
   - Notched incisor teeth
   - Deafness (Cogan's)
   - interstitial keratitis
21
Q

Interstitial keratitis

Treatment

A 
• Acute
   - Cycloplegic
  - Steroid
   - Glaucoma meds if elevated IOP
   - Treat underlying disease
• Chronic
   - Corneal transplant
   - Refer to ENT or rheumatologist
22
Q

Recurrent Corneal Erosion

Causes

A
  • Injury, iatrogenic, corneal dystrophies, diabetes
  • Damage to epi BM or Bowman’s layer causes weakening or loss of epithelium-stroma adhesions
  • BM repair requires 2-3 months
23
Q

Recurrent Corneal Erosion

Subjective findings

A
  • Pain waking up or rubbing eyes
  • Sandy gritty irritation
  • FB sensation
  • Lid spasms
  • Photophobia
  • Decreased VA
24
Q

Recurrent Corneal Erosion

Objective findings

A
  • Loose rough epithelium
  • NaFl lightly outlines area, stains brightly if epithelial defect
  • Dots, fingerprint, map patterns suggest EBMD or Fuchs
  • Stromal edema
  • Anterior chamber reaction
25
Q

Recurrent Corneal Erosion

Treatment

A
  • Cycloplegic
  • Bandage CL
  • Antibiotic
  • Steroid
  • Sunglasses / hat
  • Hypertonic solution
  • Lubrication
  • Corneal epi debridement
  • Anterior stromal puncture
  • Phototherapeutic keratectomy

OPT 631 (5 decks)

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