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OD2 - Applied Clinical Training & Research Studies in Vision and Optometry > AED - Conjunctival Degeneration - Week 4 > Flashcards

AED - Conjunctival Degeneration - Week 4 Flashcards

1
Q

Describe the SOAP mnemonic.

A

Subjective (symptoms
Objective (signs)
Assessment (DDx)
Plan (Mx)

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2
Q

Where are goblet cells located?

A

Just inferior to the forniceal conjunctiva on the bulbar conjunctiva

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3
Q

List three structures that secrete mucin.

A

Goblet cells
Crypts of henle
Glands of menz

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4
Q

List two basal lacrimal secretors.

A

Glands of krause

Glands of wolfring

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5
Q

Where are glands of krause located?

A

At the forniceal conjunctiva

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6
Q

Where are glands of manz located?

A

Inferior to goblet cells on the bulbar conjunctiva

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7
Q

Where are crpyts of henle found?

A

Inferior to the glands of wolfring, on the palpebral conjunctiva close to the tarsal plate

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8
Q

What is a sign of pingueculum? What does it look like?

A

A triangle with the base at the limbus, yellowish mass. Looks like a gelatinous deposit

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9
Q

Are pingueculae raised or flat?

A

Slightly raised

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10
Q

Are pingueculae common or rare? Are they uni- or bilateral?

A

Very common and generally bilateral

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11
Q

List 3 symptoms of pingueculae.

A

Usually asymptomatic
Foreign body sensation if inflammed
Cosmetically unappealing

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12
Q

List the three components for a pingueculum workup.

A

Slit lamp
Fluorescein staining
Tear workup if symptomatic

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13
Q

Do pingueculae affect visiond?

A

No

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14
Q

Are pingueculae vascularised? Explain (2).

A

Not vascular but can be hyperaemic if inflammed.

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15
Q 
Which of the following are thought to be a possible cause of pingueculae?
Family history
Sun exposure
Age
Racial background
A

Family history only

The rest are not significant

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16
Q

What is the histopathology of pingueculae (4)?

A

Elastotic degeneration of collagen
Hyalinisation of the conjunctival stroma
Collection of elastotic fibres
Granular deposits

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17
Q

List 4 differential diagnoses for pingueculae.

A

Pterygium
Conjunctival intraepithelial neoplasia
Other tumours (papilloma)
Limbal dermoid

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18
Q

List 3 treatment options for pingueculae (no severe inflammation).

A

Vasoconstrictors to reduce redness [note: “vasoconstrictors useless in chronic patients” - Darryl
Ocular lubricants and cold compresses if foreign body sensation is felt

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19
Q

List two treatment options for pingueculae with severe inflammation.

A

NSAIDs or topical steroids

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20
Q

What should be done if dellen persists in pingueculae?

A

Refer for cosmetic surgery

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21
Q

What are two ways pingueculae can be removed?

A

Excision surgery - excision with the conjunctiva

Argon laser - photocoagulation

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22
Q

List1 3 signs of pterygium.

A

A vascular triangular mass ith the base to the conjunctiva
Slowly advancing to the central cornea
Increasing astigmatism

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23
Q

Are pterygia vascular?

A

Yesd

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24
Q

Are pterygia uni- or bilateral?

A

Often bilateral

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25
Q

Are pterygia generally nasal or temporal?

A

Generally nasal

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26
Q

What is Stocker’s line? What is it caused by?

A

An orange-brown line at the leading edge of pterygia caused by iron deposits

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27
Q

Aside from Stocker’s line, what can be seen at the leading edge of pterygia?

A

An opaque epithelium

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28
Q

List three symptoms of pterygia.

A

Foreign body sensation
Dryness
Reduction in vision if encroaching on the visual axes/increasing cyl

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29
Q

What can pterygia rarely cause?

A

Diplopia

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30
Q

List 4 differential diagnoses for pterygia.

A

Pingueculum
Pannus
Conjunctival intraepithelial neoplasm
Other tumours

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31
Q

List the 5 components for pterygia assessment.

A 
Slit lamp
Keratometry/topography
Fluorescein staining
Tear workup if indicated
Grading scale (efron)
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32
Q

List 3 treatment options for pterygium (no severe inflammation).

A

Vasoconstrictors to reduce redness? (not if chronic)

Ocular lubricants for ocular irritation and corneal signs

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33
Q

List two treatment options for pterygium with severe inflammation.

A

NSAIDs or topical steroids

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34
Q

In what 5 cases would pterygia be referred for surgery?

A 
Rapid advancement
Chronic irritation
Diplopia
Marked effect on vision
Cosmesis concern
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35
Q

What is the histopathology of pterygia (3)?

A

Activated fibroblasts in the leading edge invade and fragment bowman’s layer as well as a variable amount of the superficial corneal stroma

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36
Q

What does pterygium development resemble histologically?

A

Actinic degeneration of the skin

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37
Q

What does the follow-up of pterygium depend on (3)?

A

Rate of progression
If stable, review in 1-2 years
If progressive or new patient, review in 3-6 months

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38
Q

What should be advised for patients with pterygium?

A

UV protection

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39
Q

Can pterygium recur following surgical removal?

A

Yesd

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40
Q

What is the standard surgical removal for pterygia?

A

Bare scleral resection

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41
Q

What is the recurrence rate for standard surgical removal of pterygia? What about adjunctive treatments?

A

Bare scleral resection - up to 80%

Adjuncts - <10%

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42
Q

What colour are concretions?

A

Yellow-white

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43
Q

How big are concretions?

A

<1mm but up to 4mm

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44
Q

What are concretions?

A

Deposits in the palpebral conjunctival epithelium

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45
Q

In which age group are concretions common in?

A

The elderly

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46
Q

What are concretions composed of (3)?

A

Mucin
Necrotic cells
Eosinophilic proteins

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47
Q

What may concretions be associated with (2)?

A

Chronic conjunctivitis

Contact lens wear

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48
Q

What additional cyst may be seen with concretions?

A

A clear cyst

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49
Q

List 2 symptoms of concretions.

A

Generally asymptomatic

May have a gritty foreign body sensation

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50
Q

List the to components for a concretion assessment.

A

Slit lamp

Fluorescein staining for erosion

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51
Q

List 3 differential diagnoses for concretions.

A

Other foreign bodies
Conjunctival cysts
Conjunctival trauma

52
Q

What is the treatment for concretions if asymptomatic?

A

Monitor

53
Q

What are 3 general treatment options for concretions?

A

Review contact lens care
Ocular lubricants
Remove using topical anaesthesia and a needle
Prophylactic antibiotic after removal

54
Q

How should concretions be followed up (if removed and not removed)?

A

If removed - 3-5 days after removal

If not removed - follow-up at patient’s request

55
Q

What colour is an amyloidosis?

A

Yellowish

56
Q

Is an amyloidosis vascular or avascular?

A

Avascular

57
Q

What is an amyloidosis and where can it be found?

A

A waxy deposit within the bulbar or forniceal conjunctiva

58
Q

What can an amyloidosis be associated with?

A

Recurrent bleeding

59
Q

What are amyloidoses composed of?

A

Amyloid

60
Q

Are amyloidoses usually uni- or bilateral?

A

Unilateral

61
Q

Are amyloidoses localised or a systemic disorder?

A

Can be either

62
Q

List 3 symptoms of amyloidoses.

A

Usually asymptomatic

Not tender unless large enough to affect lid function or give a foreign body sensation

63
Q

List three differential diagnoses for amyloidoses.

A

Pingueculae
Conjunctival papilloma
Other conjunctival tumours

64
Q

What are the to components to an amyloidosis assessment?

A

Slit lamp

Fluorescein staining

65
Q

hat is the treatment option for amyloidosis (3)?

A

Check if amyloid is present elsewhere in the eye
Removal required if foreign body sensation is felt or for cosmesis
Refer for biopsy to rule out systemic amyloidosis

66
Q

How should amyloidosis be followed up (3)?

A

Early if doubt over diagnosis, change in size, or symptoms

67
Q

What is lymphaniectasia?

A

Conjunctival cysts

68
Q

Are lymphangiectasia opaque or clear?

A

Small clear cysts like a bubble

69
Q

Where can lymphangiectasia be found?

A

Bulbar or forniceal or palpebral conjunctiva

70
Q

Are lymphangiectasia always bubble shaped or can they be other shapes? Explain.

A

Can also be a tube-like swelling, which is more transparent than a cyst (this occurs in the bulbar region)

71
Q

Are lymphangiectasia mobile to touch/blinking?

A

Yesd

72
Q

Are lymphangiectasia typically uni- or bilateral?

A

Unilateral

73
Q

List two symptoms of lymphangiectasia.

A

Typically asymptomatic

May have a foreign body sensation

74
Q

List 4 differential diagnoses for lymphangiectasia.

A

Conjunctival intraepithelial neoplasm
Conjunctivochalasis
Chemosis
Phlyctenule

75
Q

What is the treatment option for lymphangiectasia if asymptomatic?

A

Usually monitor

76
Q

What is the general treatment option for lymphangiectasia if removal is required (2)?

A

Lance the cyst under local anaesthesia, massage closed lids to drain
Prophylactic antibiotic required
Refer for surgical removal from base if required

77
Q

Do lymphangiectasia that have been lanced and drained typically re-occur?

A

Yes

78
Q

How should lymphangiectasia be followed up (2)?

A

Monitor if lanced

At patient’s request

79
Q

What is ecchymosis?

A

Sub-conjunctival blood anywhere under the bulbar conjunctiva

80
Q

What is notable in ecchymosis?

A

A distinct white border at the limbus and conjunctival fornix

81
Q

Are echhymosis common or rare?

A

Very common

82
Q

Are ecchymosis uni- or bilateral?

A

Unilateral

83
Q

What are ecchymosis also known as?

A

Sub-conjunctival haemorrhage

84
Q

Are ecchymosis painful? Does it affect vision?

A

Painless and has no effect on vision

85
Q

List the six components for an assessment of ecchymosis.

A 
History for any precipitating event
Slit lamp
Pupils
Eye movements
IOP
Blood pressure
86
Q

List 4 differential diagnoses for ecchymosis.

A

Conjunctival Kaposi’s sarcoma
Haemorrphagic conjunctivitis
Breakthrough bleed from behind the globe
Other ocular neoplasia with secondary haemorrhage

87
Q

What is the treatment option foe ecchymosis?

A

Reassure the patient

Cold packs to stop bleeding for 1-2 days followed by hot packs to assist haemolysis

88
Q

How long may ecchymosis take to resolve?

A

1-3 weeks

89
Q

How should ecchymosis be followed up? What about if there are more than 2 recurrences in a year?

A

Review after one week if concerned or no other resolution

If more than 2 recurrences - refer to determine if its systematic or for cauteristation

90
Q

What are bitot’s spot? How do they look? Are they raised or flat? Where on the eye can they be found?

A

Foamy, slightly raised patches on the bulbar conjunctiva

91
Q

What is bitot’s spot due to (2)?

A

Metaplastic keratinisation of the conjunctival epithelium and loss of goblet cells

92
Q

Are bitot’s spots usually temporal or nasal?

A

Usually temporal, less frequently nasal

93
Q

Bitot’s spot is associated with the colonisation of what bacteria? What aspect of bitot’s spot exactly?

A

Hyperkeratinisation of the local area is associated with colonisation by crynebacterium

94
Q

What is bitots spot characteristic of?

A

Late stage vitamin A deficiency

95
Q

List 3 symptoms of bitot’s spot.

A

Ocular surface irritation
Reduced vision
Nightblindness

96
Q

List two components for the assessment of bitot’s spot.

A

Slit lamp

Dry eye workup

97
Q

List three differential diagnoses for bitot’s spot.

A

Pingueculum
Amyloidosis
Conjunctival intraepithelial neoplasm

98
Q

What is the treatment option for bitot’s spot (3)?

A

Refer to GP for a vitamin A deficiency
Will normally disappear with high dose vitamin A theraphy
Manage dry eye symptoms as appropriate

99
Q

What may happen if bitot’s spot is longstanding?

A

May have permanent epithelial metaplasia

100
Q

How should bitot’s spots be followed up (2)?

A

Over the period of vitamin A therapy

If there is a change in size or symptoms

101
Q

List 3 signs of superior limbic keratoconjunctivitis.

A

Papillary hypertrophy of the superior tarsus (papillae)
Hyperaemia of the superior bulbar conjunctiva
SPK of the superior cornea

102
Q

Is superior limbic keratoconjunctivitis usually uni- or bilateral?

A

Bilateral

103
Q

In what percentage of superior limbic keratoconjunctivitis cases can corneal filaments be found?

A

30%

104
Q

In what age population and gender does superior limbic keratoconjunctivitis usually occur?

A

Middle-aged women

105
Q

In what percentage of superior limbic keratoconjunctivitis cases is there associated dry eye? What about thyroid dysfunction?

A

25% for dry eye

50% for thyroid dysfunction

106
Q

What happens with superior limbic keratoconjunctivitis over time?

A

It is recurrent, but usually disappears with time

107
Q

What kind of other response is similar to superior limbic keratoconjunctivitis?

A

Contact lens wearers develop an identical condition

108
Q

List 5 symptoms of superior limbic keratoconjunctivitis.

A 
Burning
Foreign body sensation
Slightly blurred vision
Photophobia
Lacrimation/mucoid discharge
109
Q

List 3 components for the assessment of superior limbic keratoconjunctivitis.

A

History
Slit lamp with lid eversion
Dry eye workup

110
Q

List 3 differential diagnoses for superior limbic keratoconjunctivitis.

A

Terriens marginal degeneration
Trachoma
Adult inclusion conjunctivitis

111
Q

Should superior limbic keratoconjunctivitis be referred? Explain.

A

Yes, for evaluation of thyroid function

112
Q

List 6 possible treatment options for superior limbic keratoconjunctivitis.

A 
Evaluate contact lens fit and material
Topical steroids
Topical vasoconstrictors
Ocular lubrication
Soft contact lens bandage
Surgery
113
Q

What is the treatment of superior limbic keratoconjunctivitis aimed at (4)?

A

Managing inflammation
Reducing friction
Reducing interaction of the upper eyelid with the limbus
Reducing subconjunctival space

114
Q

How should superior limbic keratoconjunctivitis be followed up?

A

Every 1-2 weeks during the attack, more if management requires it

115
Q

What is floppy eyelid syndrome?

A

Loose upper eyelids

116
Q

What kind of conjunctivitis occurs with floppy eyelid syndrome and why?

A

Papillary conjunctivitis of the tarsal conjunctiva - the upper eyelid everts during sleep resulting in exposure

117
Q

What kind of discharge occurs in floppy eyelid syndrome?

A

Slight mucous discharge

118
Q

Is the cornea exposed in floppy eyelid syndrome?

A

Yes (SPK, SLK etc)

119
Q

Is floppy eyelid syndrome common or rare? Which population is it found in (gender too)?

A

Rare, found in obese men

120
Q

What is floppy eye syndrome associated with?

A

Sleep apnoea

121
Q

List 4 symptoms of floppy eye syndrome.

A

Gritty sore eyes
Blurred vision
Increased lacrimation
Lids require uneversion on waking

122
Q

List four components for the assessment of floppy eyelid syndrome.

A

History of bad snoring
Slit lamp
Observe lash position
Feel for lid laxity

123
Q

List four differential diagnoses for floppy eyelid syndrome.

A

Dry eye syndrome
Superior limbic keratoconjunctivitis
Rosacea keratitis
Range of chronic keratitis/conjunctivitis/canaliculitis

124
Q

What are 5 treatment options for floppy eyelid syndrome?

A

Refer for sleep apnoea investigation - management of sleep apnoea will improve condition
Weight loss program
Ocular lubricant before sleep
Taping lids shut during sleep
Surgical horizontal tightening of the upper lid

125
Q

How should floppy eyelid syndrome be followed?

A

Up to weekly as appropriate until resolved

OD2 - Applied Clinical Training & Research Studies in Vision and Optometry (174 decks)

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