19. Corneal Degenerations & Deposits Flashcards
Name the layers of the cornea from most anterior to most posterior structures (7 layers) .
• Tear film
• Epithelium
• Epithelial basement membrane
• Anterior limiting lamina
• Stroma
• Posterior limiting lamina
• Endothelium
Corneal degenerations are non-... and usually has a .... These diseases are often ..., ... and either ... or .... Changes to corneal tissue is often due to inflammation, ... or ... disease. It is characterised by a ..., and thinning of ... or ....
Corneal degenerations are non-familial and usually has a late onset. These diseases are often asymmetric, unilateral and either central or peripheral. Changes to corneal tissue is often due to inflammation, age or systemic disease. It is characterised by a deposition of material, and thinning of tissue or vascularisation.
Band keratopathy is ... (1/1000). It is characterised by ... deposits (sometimes ...) in the ... region, ... and/ or the .... This may be idiopathic, ... and rarely .... This may be related to systemic or ocular conditions: * Ocular conditions are ..., such as ... (e.g. ...), ... in the eye after ocular surgery, longstanding .... * Metabolic conditions are ..., including ..., ..., .... Band keratopathy is ... initially and may later develop ..., ... and .... Signs of band keratopathy includes ... in the anterior cornea, it begins inside the ... of ... or ... cornea and slowly .... Band keratopathy tends to be confined to the ... area and doesn’t reach the .... The opacity may contain ... that become ... and .... Treatment involves treating ..., use of ... or ... for comfort if necessary. If there is poor comfort or VA is affected, we should ... for superficial keratotomy or ... (PTK).
Band keratopathy is uncommon (1/1000). It is characterised by grey/ white calcium deposits (sometimes brown) in the sub-epithelial region, Bowmans layer and/ or the anterior stroma. This may be idiopathic, age-related and rarely hereditary. This may be related to systemic or ocular conditions: * Ocular conditions are common, such as chronic ocular inflammation (e.g. rheumatoid arthritis), silicone oil in the eye after ocular surgery, longstanding glaucoma. * Metabolic conditions are less common, including hypercalcaemia, gout, chronic renal failure. Band keratopathy is asymptomatic initially and may later develop surface irritation, blurred vision and glare. Signs of band keratopathy includes grey/ white opacities in the anterior cornea, it begins inside the limbus of nasal or temporal cornea and slowly extend centrally. Band keratopathy tends to be confined to the interpalpebral area and doesnt reach the limbus. The opacity may contain holes that become elevated and nodular. Treatment involves treating underlying cause, use of artificial tears or bandage CLs for comfort if necessary. If there is poor comfort or VA is affected, we should refer for superficial keratotomy or phototherpeutic kertectomy (PTK).
Phototherapeutic keratectomy (PTK) is a .... technique that remove the .... as a treatment for ... disorders (..., ..., ..., ...). This is an alternative to ... technique. PTK aims to achieve a ... to improve ... of the cornea; improve ...; and ... and facilitate subsequent ....
Phototherapeutic keratectomy (PTK) is a laser technique that remove the corneal epithelium as a treatment for superficial corneal disorders (degenerations, dystrophies, irregularities, scars). This is an alternative to manual superficial kertectomy technique. PTK aims to achieve a smooth stromal surface to improve surface quality of the cornea; improve post-operative corneal clarity; and decrease post-operative scarring and facilitate subsequent epithelial adhesion.
Salzmann’s Nodular Degeneration is a rare, non-..., ... progressive disease. It is usually ..., but can be .... This is most common with .... It forms smooth, ... , elevated .... These are sometimes described as .... They consist of irregularly arranged ... with ... between epithelium and Bowman’s layer, covered by .... They are rarely .... However, it is associated with chronic keratopathy, such as ..., ... and .... This degeneration can be ... but may also cause surface discomfort, ..., increased lacrimation, ... and blurred vision.
Signs of Salzmann’s Nodular Degeneratoin includes ... anywhere on the cornea. There may also be ... around the base.
For treatment, ... are usually given for comfort. Occasionally, ... or ... or ... may be needed.
Salzmann’s Nodular Degeneration is a rare, non-inflammatory, slowly progressive disease. It is usually bilateral, but can be unilateral. This is most common with middle aged women. It forms smooth, blue/ white , elevated nodules. These are sometimes described as avascular pannus. They consist of irregularly arranged collagen fibrils with hyalinisation between epithelium and Bowmans layer, covered by atrophied corneal epithelium. They are rarely hereditary. However, it is associated with chronic keratopathy, such as VKC, trachoma and interstitial keratits. This degeneration can be asymptomatic but may also cause surface discomfort, FB sensation, increased lacrimation, photophobia and blurred vision. Signs of Salzmanns Nodular Degeneratoin includes single or multiple grey-white elevated lesions anywhere on the cornea. There may also be iron deposits around the base. For treatment, tear supplements are usually given for comfort. Occasionally, manual removal or PTK or lamellar graft may be needed.
Terrien’s Marginal Degeneration is a rare, ... (can be ...) condition. It is ..., slowly progressive ... of the ... corneal .... This most commonly affect ... >... yo. Patients often have no symptoms initially and may develop ... and .... Corneal thinning can cause .... Signs that can be observed include ... (usually beginning ...), this might coalesce and progress to mild ... (pseudopterygium) with thinning. Degeneration can slowly progress in a ... pattern. The overlying epithelium is often ... and is also separated from the ... by clear zone. The leading edge often has ... deposits. This ultimately results in a peripheral corneal .... There is a potential for cornea to ... in response to relatively mild trauma. Astigmatic changes can develop from this of over ...D. This is often monitored using ... and .... Patient will require ... correction and may need ... if VA becomes very poor even with contact lenses.
Terrien’s Marginal Degeneration is a rare, bilateral (can be unilateral) condition. It is painless, slowly progressive thinning of the peripheral corneal stroma. This most commonly affect older males >40 yo. Patients often have no symptoms initially and may develop periodic irritation and decreasing vision. Corneal thinning can cause irregular astigmatism. Signs that can be observed include fine white punctate stromal lipid opacities (usually beginning superiorly), this might coalesce and progress to mild superficial vascularisation (pseudopterygium) with thinning. Degeneration can slowly progress in a circumferential pattern. The overlying epithelium is often intact and is also separated from the limbus by clear zone. The leading edge often has yellow lipid deposits. This ultimately results in a peripheral corneal gutter. There is a potential for cornea to perforate in response to relatively mild trauma. Astigmatic changes can develop from this of over 10D. This is often monitored using corneal topography and pachymetry. Patient will require astigmatic correction and may need keratoplasty if VA becomes very poor even with contact lenses.
... Degeneration is also known as Labrador’s keratopathy, chronic actinic keratopathy, climatic droplet keratopathy etc. This is characterised by ... globular ... droplets over the ..., within the ... layer and superficial .... This tend to begin ... and progress .... Advanced lesions can become ... and ....This is rare and can be ... or .... This typically affects people who work ... ∴ high exposure to ..., extreme ... & .... This occurs more frequently with .... This may also associate with .... Symptoms include ..., ... and .... Px should be advised on .... Px may be given ... for comfort. In severe cases, px may also need referral for ..., ... or ....
Spheroidal Degeneration is also known as Labrador’s keratopathy, chronic actinic keratopathy, climatic droplet keratopathy etc. This is characterised by small white/ yellow brown globular proteinaceous droplets over the cornea, within the Bowman's layer and superficial stroma. This tend to begin peripherally and progress centrally. Advanced lesions can become nodular and raised.This is rare and can be unilateral or bilateral. This typically affects people who work outdoors ∴ high exposure to UV, extreme temperature & dry atomsphere. This occurs more frequently with males than females. This may also associate with pterygium. Symptoms include surface irritation, burning and FB sensation. Px should be advised on UV protection. Px may be given ocular lubricants for comfort. In severe cases, px may also need referral for epithelial debridement, superficial keratectomy or penetrating keratoplasty.
Polymorphic Amyloid Degeneration is relatively ... and is .... This often arises after the age of .... Throughout the stroma, there are varying sizes of ..., ..., ...-shaped and ... amyloid deposits. This is best seen in ... under the slit lamp. Patients are often .... There are no ... associations and no ... is required.
Polymorphic Amyloid Degeneration is relatively uncommon and is bilateral. This often arises after the age of 50s. Throughout the stroma, there are varying sizes of refractive, punctate, comma-shaped and filamentous amyloid deposits. This is best seen in retroillumination under the slit lamp. Patients are often asymptomatic. There are no systemic associations and no treatment is required.
What are corneal deposits?
Corneal deposits are due to the abnormal accumulation of material in the cornea. They vary in depth and pigmentation.
Corneal ... is the lipid deposits in the cornea from the ... . These deposits are most prominently found near the ... membrane and the ... membrane. There are two types:
* Arcus ... - universal in those over 80 yo and rarely associates with ...
* Arcus ... - also known as anterior .... In px under 40yo, it may be due to .... It is also associated with .... If this is unilateral, may need to check for ... disease on the uninvolved side. Patients are often .... Lipid deposits begin ... and ... and later extend .... There are clear zones separates deposits from .... No treatments are needed unless ....
Corneal Arcus is the lipid deposits in the cornea from the Limbal vasculature . These deposits are most prominently found near the Bowman's membrane and the Descemet's membrane. There are two types:
* Arcus senilis - universal in those over 80 yo and rarely associates with abnormal blood lipids
* * Arcus juvenilis - also known as anterior embryotoxon. In px under 40yo, it may be due to hyperlipidaemia. It is also associated with Schnyder's crystalline dystrophy. If this is unilateral, may need to check for carotid disease on the uninvolved side. Patients are often asymptomatic. Lipid deposits begin inferiorly and superiorly and later extend laterally. There are clear zones separates deposits from limbus. No treatments are needed unless referral is warranted to check blood lipids.
Lipid Keratopathy is relatively .... This is unilateral and can be ..., ... or .... It’s primary form has features of corneal .... Whereas its secondary form has ... These deposits have ... and are separated by a ... from .... It may also be associated with previous ... or .... Vision may be affected if ... located. Treatment for lipid keratopathy involves topical ..., which helps reduce ....
Lipid Keratopathy is relatively uncommon. This is unilateral and can be central, peripheral or diffuse. It’s primary form has features of corneal dystrophy. Whereas its secondary form has white/ yellow corneal stromal lipid deposits. These deposits have feathery edges and are separated by a clear narrow zone from corneal stromal neovascularisation. It may also be associated with previous HSV or HSK. Vision may be affected if centrally located. Treatment for lipid keratopathy involves topical corticosteroids, which helps reduce neovascularisation.
Vogt’s Limbal Girdle is very common in patients >45 yo and is a bilateral condition. It is characterised by the chalky white deposits along the nasal and temporal limbus, in the inter-palpebral fissure (crescent-shaped). Histology suggest that they may be either elastoid or calcified deposits. Px are often asymptomatic and no treatment is needed as this condition is totally benign.
Vogt’s ... is very common in patients >... yo and is a ... condition. It is characterised by the ... deposits along the nasal and temporal limbus, in the ... (...-shaped). Histology suggest that they may be either ... or ... deposits. Px are often ... and no treatment is needed as this condition is totally ....
Vortex Keratopathy (corneal verticillata) is characterised by bilateral, symmetrical, golden brown deposits in the corneal epithelium. These deposits are arranged in a curvi-linear fashion. They begin below the pupil as punctate deposits, then extends and swirl outwards in a whorl shape. The limbus is spared from these deposits. This can be drug-induced by amiodarone, chloroquine/hydroxychloroquine, chlorpromazine or indomethacin; It may also be caused by Fabry’s disease, which is a X-linked lipid metabolism disorder, therefore males tend to have this keratopathy. Other ocular signs of Fabry’s include conjunctival aneurysums, lens opacities, papilloedema, optic atrophy, macular and retinal oedema. Systemic signs include hand and foot pain, skin blemishes and later may develop heart and kidney diseases. Px are often asymptomatic. The cause needs to be determined and may need to refer for opinion if drug related or for Fabry's diagnosis.
... Keratopathy (corneal verticillata) is characterised by bilateral, symmetrical, ... deposits in the corneal .... These deposits are arranged in a ... fashion. They begin below the pupil as ... deposits, then extends and .. in a ... shape. The ... is spared from these deposits. This can be drug-induced by ..., .../..., ... or ...; It may also be caused by Fabry’s disease, which is a ..., therefore ... tend to have this keratopathy. Other ocular signs of Fabry’s include conjunctival ..., ..., papilloedema, optic ..., macular and retinal .... Systemic signs include ..., skin blemishes and later may develop .... Px are often asymptomatic. The cause needs to be determined and may need to ....
What are the 7 types of corneal iron deposits?
• Rust ring
• Hudson-Stahli line
• Fleischer’s ring
• Stocker’s line
• Ferry’s line
• Siderosis
• Haemosiderosis
Rust ring
* Epithelial or stromal rust from ...
* May require further ...
Hudson-Stahli Line
* Idiopathic
* Epithelial ... just below the ...
* Occurs with ...
* No ... required
Fleischer’s ring
* Occurs at the base of the ...
* ... formation
* May assist in diagnosis of ... but does not alter ...
Stocker’s line
* Epithelial iron deposit at the ... edge of a ...
* May indicate ...
Ferry’s line
* Epithelial iron deposit at the ... of a ...
Siderosis
* Stromal iron deposits from ...
* May req grafts to ...
Haeomsiderosis
* Stromal iron deposits as a result of ... (hyphaema)
Rust ring
* Epithelial or stromal rust from corneal metal foreign bodies
* May require further debridement
Hudson-Stahli Line
* Idiopathic
* Epithelial iron deposits just below the mid-point of the interpalpebral fissure
* Occurs with advancing age
* No management required
Fleischer’s ring
* Occurs at the base of the cone in keratoconus
* Circular formation
* May assist in diagnosis of keratoconus but does not alter management
Stocker’s line
* Epithelial iron deposit at the leading edge of a pterygium
* May indicate slowed growth of the pterygium
Ferry’s line
* Epithelial iron deposit at the front edge of a filtering bleb
Siderosis
* Stromal iron deposits from intraocular FB
* May req grafts to restore vision
Haeomsiderosis
* Stromal iron deposits as a result of intraocular blood (hyphaema)
