Slide Exam - AED cards (shortlist, summary) Flashcards
Name, define, causes (2), features (malignancy, feeder vessels, motility, corneal involvement), biopsy (2). Mx.
Conjunctival Papilloma - overgrowth of epithelial cells
Cause: Excess UV or HPV infection (HPV in 39% of cases)
Features: non-malignant, motile, doesn’t involve cornea, modest feeder vessels, pinkish (less red),
Biopsy: BM still intact, non-invasive of stroma
Mx: Px reassurance, optional sx cosmesis, general ddx (check FAT, feeder BVs, surrounding tissue invasion, biopsy)
Name, causes (2), features (malignancy, feeder vessels, motility, corneal involvement), biopsy (2). Mx.
CIN - conjunctival intraepithelial neoplasia
Cause: Excess UV or HPV (in 39%)
Features: Non-malignant, motile, more marked BV strawberry spots, more lush feeder vessels, invades corneal epithelium (but NOT stroma or substantia propria)
Biopsy: Non-invasive of stroma, plemorphism and metaplasia present
Mx: surgery for removal, general ddx
Name, features/biopsy (malignancy, feeder vessels, motility, corneal involvement), requirement for DDx. Mx.
SCN - squamous cell neoplasia
Features/biopsy: malignant, non-motile, broken through basement membrane and invading stroma/substantia propria, may see ulceration (with white plaques) and small haemorrhages
DDx: requires OCT or biopsy, b/c CIN-like appearance
(note: non-motile as anchored by stromal invasion)
Mx: surgery for removal, ddx
Name, characteristics (age group and skin colour, appearance, acquired/congenital, uni/bilateral, elevation, motility, malignancy). Biopsy when?
Primary Acquired Melanosis
Older + middle aged + fair skinned at risk.- Diffuse brown colour + acquired.- Unilateral.- Flat + Mobile over sclera.- Concerns for melanoma-
Biopsy indicated if: - diffuse lesion found at limbus + corneal involvement; - expansive/overgrowth of diffuse lesion in one eye (which shows its pleomorphic)
Name, features (growth rate, colour density, edges, boundary, feeder vessels). Biopsy. Mx.
Melanoma
- 75% come from PAM.- invasive.- Fast growth.- Dense Colour (may be Diffuse at edge).- Irregular boundary.- Feeders
biopsy: invasive lesion with pleomorphism and anaplasia
Mx: surgical removal
Name, define/features (malignancy, disease association, common site)
Kaposi’s sarcoma:
.- Malignant BV tumour. AIDS. Immunocompromised. Mx: Dx workup refer, or for therapy (HAART) if AIDS present.
Name, characteristics (3). Hallmark sign. Mx.
Sturge-Weber Syndrome
Effects seen along trigeminal nerve- Episcleral/conj involvement in 70%.- Congenital conjunctival or Episcleral haemangioma. Portwine stain along CNV hallmark
Mx: consider referral for ax of neurological status; follow up appt. in 3-12 months to check for glaucoma; if choroidal hemangioma present = check for signs of retinal detachment. If choroidal hemangioma grows into central vision, leaks or causes detachment: tx it by laser or radiation
Name, define, Mx (2).
Cavernous sinus fistula:
.- Break in the cavernous sinus- i.e. “fistula” = break in wall of an artery –> causing higher arterial blood to enter venous space—-
Mx: refer for closure of fistula + mx of IOP
Name, describe (1), causes (2), a symptom (1).
Stye/Hordeolum
Blockage of duct.- due to bacterial infection (external) or complication of chalazion (internal)- discomfort
Name, describe, symptoms (3), features (gland, cause)
Chalazion
Blockage of MG.- Inflammation- symptoms: cosmesis, generally painless, does not affect V.A (only lower lid)
Name, describe (5), risk group (age/gender, skin type)
Sebaceous gland carcinoma
elderly females (chronic bleph)-yellow and hard - madarosis with thickened, red lid margins (UL) - >2mm 60% mortality—
Careful reviews 6-12 mo. Refer suspicious cases
Epithelial Basement Membrane Dystrophy (EBMD): what is it also known as? How common is it? Describe it’s appearance. Mx.
Also known as map-dot fingerprint dystrophy.
***Most common corneal dystrophy***** but often misdiagnosed due to variable appearance
Lubricants; Mx of any co-existing surface disease if there are any symptoms; mx of any pre-existing erosion; any co-existing surface disease will increase the risk of recurrent corneal erosions.
Describe the appearance of Reis-Buckler’s Dystrophy
- Characteristic appearance where sheet-like connective tissue replaces bowman’s membrane—–
Thiel-Behnke corneal dystrophy (2). What is it similar to and what pattern does it have?
- Similar to Reis-Buckler’s dystrophy but later onset.- Same honeycomb appearance/layers affects so often indistinguishable—-
Name, desribe (5)
What is the severity of this disease? What appearance does it have?
Macular Dystrophy
- Exceptions to “dystrophy” rule (autosomal recessive, extends to cornea periphery).- Most severe and least common dystrophy- Diffuse “ground-glass” haze lesions, corneal haze between lesions, gray/milky white opacities throughout stroma, and limbus to limbus—
Fuchs Endothelial Dystrophy: describe (2)
[is the most common endothelial dystrophy!]
.- Loss of endothelial cells and the resulting oedema and thickening of the stroma- Diffuse thickening and lamination of Descemet’s membrane—-
Name, describe (3)
Filamentary Keratopathy
.- Abnormal areas of corneal epithelium + excess mucous in tears . These filaments form and form tails which stick—
Name, describe (2)
Superficial punctate keratopathy (SPK)
- Corneal condition consisting of multiple pinpoint epithelial defects; non-specific sign indicating corneal problem, e.g. dry eye syndrome(refer to lecture for different types!)- —
What’s this? How common is it? What causes it?
Subepithelial Infiltrates
- Relatively common, due to inflammatory response within the anterior corneal stroma—–
Name, causes (8), characteristics (4)
Neurotrophic keratopathy
Causes: *HSV/HZV, DM, LASIK, CL*, recurrent erosions/dystrophies, tumors, strokes, topical drug therapy
Description: Occurs in eyes with decreased corneal sensitivity .- SPK.- Large ulcers (sometimes).- Longest axis horizontal-
Name, describe, how does this affect vision?
Bullous Keratopathy:
- Degenerative process characterized by small blister-like pockets that form in swollen corneal epithelial layers; markedly reduces vision.—–
Name, describe what happens and what it leads to
Interstitial Keratitis
- Opaqueness on cornea that spreads to pupil -> leads to blindness.-Inflammation of the corneal stroma without primary involvement of the corneal epithelium or Endothelium—-
Name, how common? unilateral or bilateral? where/location? any associations? how often?
Marginal Keratitis
- Common, unilateral, peripheral corneal lesion .- CL-associated sometimes—-
Name, appearance, cause (2.5)
Phlyctenulosis
.- small vesicle at lateral limbus caused by Staph or M. tuberculosis.- Type IV reaction
Name, describe, what is unique about it?
Mooren’s ulcer
.- Peripheral corneal ulcer. MUST be independent of any underlying systemic disorder Unique: overhanging edge of corneal defect—-
Thygeson’s Superficial Punctate Keratitis (4)
- *Bilateral gray-white, slightly elevated lesions in white and quiet eye* .-minimal to no staining with NaFl-unknown etiology, but possible viral—
Name, describe
Fleischer’s Ring
- due to iron deposition in basal epithelial cells at the base of keratoconus cone which have degenerated
(note: image on right is a Kayser-Fleisher ring, which is slightly different, arising from copper deficits in descemet’s)
Name, where affected? unilateral or bilateral? appearance?
Polymorphic Amyloid Degeneration
- Deep stroma, bilateral.-Appears Similar to Lattice dystrophy.- SL . small Refractile punctate deposits.- Comma-shaped and filamentous Amyloid deposits- -
Name, describe. What is this condition characterized by? (4)
Lipid Keratopathy
- Type of degenerative corneal disease characterized by accumulations of lipid within the corneal stroma, corneal epithelium, keratocytes, and/or histiocytes infiltrating the cornea—–
What’s this? Describe it. Mx. [very common in px > 45yo]
Vogt’s Limbal Girdle
.- Chalky white deposits along the nasal and temporal limbus in the inter-palpebral fissure (crescent shaped)—– Mx: no tx required, its totally benign.
What is this? How does it occur? How would you describe how it looks?
Corneal Guttata.
- endothelial cell abnormalities.- Beaten metal appearance—-
What is this condition? What is it’s defining feature?
Pingueculum
.- Base to limbus-
What is this condition called? What is its defining feature?
Pterygium
.- Base to conj–
What’s this? Describe it? What happens if you peel it?
Pseudomembrane
- A loose membranous layer of exudate containing organisms, precipitated fibrin, necrotic cells, and inflammatory cells produced during an inflammatory reaction on the surface of a tissue..- Can be peeled without bleeding.- Leaves conjunctival epithelium intact—
What’s this? Describe. How easy is it to peel?
True membrane
.- Coagulated fibrinous exudate anchored to the inflamed conjunctival epithelium (Rare).- Peeling More difficult.- Rips conjunctival epithelium—
What’s this? How common? Acute or chronic? prognosis? unilateral or bilateral?
Bacterial conjunctivitis
- Very common, acute, self limiting, bilateral (start in one and transfer)—–
What’s this? How common? How usually transmitted? What pathogen is to blame?
Bacterial Conjunctivitis (gonococcal)
- Uncommon, often sexually transmitted .- e.g. Neisseria gonorrhoeae—-
What’s this? What pathogen causes it? What age group most common? Describe symptoms (1), transmissability (1) and prognosis (1)
Pharynogoconjunctival fever (PCF)
- Adenovirus serotypes 3/7.- More common in kids.- URTI.- Low grade fever.- Highly contagious- Resolution in 7-14 days
What’s all this? Acute or chronic? What is the main sign? Mx.
Trachoma: Chronic, contagious form of conjunctivitis that typically leads to blindness (chlamydiaaa).
- Main sign = Superior bulbar and palpebral conjunctival follicular response
Mx: Try and find source of exposure to help confirm diagnosis; Refer for lab test for diagnosis; Treat active infection with oral macrolides (e.g. azithromycin), tetracyclines (e.g. doxycycline); Refer for surgery; Corneal grafts rarely succesful; Inactive scarring requires topical lubrication; Improve hygeine + education for prevention
Name, how transmitted (1), in whom most common
Adult inclusion conjunctivitis (AIC)
.- seen in economically developed countries.- High risk of concurrent chlamydial.- Sexually transmitted.- Most common in young Sexually active adults.- Genital infections (make sure to get tests done)-
What is this called? What is the classic sign of this? Mx
Ocular rosacea
.- Classic butterfly rash across nose and cheeks—–
Mx: Topical antibiotic (microbial assoc.); Metronidazole gel for skin rash; Oral tetracyclines (doxcycline) or macrolides = mainstay; Lid therapy (for bleph); Tear supplements; Mild topical steroids
What are the main signs of seasonal/perennial allergic conjunctivitis? (7)
Common, seasonal or perennial depending on allergen; Type 1 hypersensitivity (IgE mediated); Usually bilateral, can have conjunctival papillae, hyperaemia, and oedema; lid may be oedematous; Serous + mucoid discharge; Cornea unaffected
What condition is this? Describe the features seen here (2)
Limbal form of VKC
Limbitis is present with limbal papillae and Horner-Trantas’ dots (mainly eosinophils); There is also psedogerontoxon (cupids bow) which occurs in an area of previously inflamed limbus
(note: horner’s trantas dots can also appear in atopic keratoconjunctivitis)
