Non-infectious Corneal Disorders: Filamentary Keratopathy/Keratitis, Recurrent Corneal Epithelial Erosion

Question 1

loose area of epithelium attracts deposit of mucus & cellular debris from dead epithelial cells that are shed into tear film

Answer 1

filamentary keratopathy/keratitis

Question 2

what disorder do these cause?

• *severe dry eye (aq. deficient — keratoconjunctivitis sicca)
• *neurotrophic keratopathy (decreased corneal sensation)

CL overwear, post-surgical, prolonged eye closure/patching, chronic ocular surface toxicity (topical meds), superior limbic keratoconjunctivitis

Answer 2

filamentary keratopathy/keratitis

Question 3

• strands of degenerate epithelial cells & mucus move when blinking
• strands are attached to cornea at one end
• filament stains w/ rose bengal & NaFl
• small epithelial defect may be present at base of filament

what condition are these signs for?

Answer 3

filamentary keratopathy/keratitis

Question 4

what are these symptoms of filamentary indicative of?

foreign body sensation, discomfort, redness, photophobia

Answer 4

filamentaty keratopathy/keratitis

Question 5

these treatments are for what disorder?

frequent lubrication, bandage CLs, debridement (pluck filament at base of filament),

10% N-Acetylcysteine (mucomyst) TID-QID), topical steroid,

Answer 5

filamentary keratopathy/keratitis

Question 6

what is used as oral inhalant for pts w/ bronchial disease such as asthma & cystic fibrosis?

Answer 6

10% N-acetylcysteine

Question 7

abnormally weak attachment b/w basal cells of the epithelium & their basement membrane (anchors epithelium to underlying Bowman’s layer/anterior stroma)

Answer 7

recurrent corneal epithelial erosion

Question 8

these cause what disorder?

prior minor corneal trauma, epithelial basement membrane dystrophy

Answer 8

recurrent corneal epithelial erosion

Question 9

what are signs indicative of?

epithelial defect that stains w/ NaFl, absence of stromal infiltrates

Answer 9

recurrent corneal epithelial erosion

Question 10

these symptoms are indicative of?

severe pain, photophobia, redness, blepharospasm*, tearing

when do they occur?

Answer 10

recurrent corneal epithelial erosion

usually occurs after waking up from sleep

Question 11

• prophylactic topical antibiotic (erythromycin ointment QID), sodium chloride (Muro 128) QID: may improve epithelial adhesion
• frequent lubrication, bandage soft CLs, topical cycloplegic for pain management (cyclopentolate 1%/homatropine 5%)
• oral doxycycline: inhibits metalloproteinases (50mg BID x 4-6 wks)
• topical steroid: inhibits metalloproteinases (promotes intercellular adhesion)

-surgical: anterior stromal puncture, phototherapeutic, keratectomy, superficial keratectomy w/ diamond burr polishing.

do NOT patch eye → will slow down epithelial healing

what condition is this management for?

Answer 11

recurrent corneal epithelial erosion

Question 12

which surgical procedure improves corneal epithelial adhesion by producing scar tissue b/w the epithelium & anterior stroma?

-used for RCES that are AWAY from visual axis

Answer 12

anterior stromal puncture

Question 13

minor surgical procedure that uses an excimer taser
removes abnormal areas of thickened basement membrane to provide a more solid & even base for epithelial adhesion & healing

which surgical procedure is this?

Answer 13

phototherapeutic keratectomy (PTK)

Question 14

epithelium is removed down to Bowman’s layer & up to 1.5mm from the limbus (where stem cells are)

diamond burr is used to polish Bowman’s layer

bandage soft CL is placed on eye

which surgical procedure is this?

Answer 14

superficial keratectomy w/ diamond burr polishing