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Duke Elder > External Eye and Cornea > Flashcards

External Eye and Cornea Flashcards

1
Q

What is the refractive power of the cornea?

A

43D

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2
Q

What is the diameter of the cornea in a) an adult b) a newborn?

A

a) 10-13mm

b) 9.5-10.5mm

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3
Q

What is the thickness of the cornea a) centrally b) peripherally?

A

a) 535mcm b) 660mcm

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4
Q

Is the cornea vascular?

A

no

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5
Q

Where does the cornea get nutrition from?

A

aqueous humour and tear film

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6
Q

Which nerves supply the cornea?

A

Long ciliary nerves - from V1

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7
Q

How many layers does the cornea have?

A

5

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8
Q

Name the layers of the cornea from outermost to innermost.

A 
epithelium
Bowman's layer
Stroma
Descemet's membrane
endothelium
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9
Q

Which corneal layer is the principal barrier to topical eye drops?

A

Epithelium

Lipid soluble drugs pass easily

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10
Q

Does the epithelium have regenerative potential?

A

yes- contains limbal stem cells

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11
Q

Which layer of the cornea is this:
thickest layer
contains keratinocytes and collagen fibrils
no regenerative power
increased pH increases absorption across this layer

A

stroma

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12
Q

Do acids or alkaline chemicals cause more damage to the eye?

A

alkaline- increasing pH causes increased absorption of chemicals across the stroma

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13
Q

Which elastic layer of the cornea contains type 4 collagen fibres?

A

Descemet’s membrane

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14
Q

What is the function of the corneal endothelium?

A

pumps fluid out of the stroma to maintain its transparency

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15
Q

contact lens wearer, unilateral acute pain, redness, photophobia and decreased VA with circumcorneal injection and discharge

A

bacterial keratitis

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16
Q

which bugs most commonly cause bacterial keratitis?

A

pseudomonas, staph aureus

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17
Q

which organisms cause a bacterial keratitis that is more likely to spread and infect the whole globe?

A

Neisseria gonorrhoea

Haemophilus influenzae

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18
Q

Which class of abx should be used in bacterial keratitis?

A

fluoroquinolones (-floxacin)

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19
Q

patient ran into a tree branch, feathery branching infiltrate on cornea, aspergillus cultured

A

filamentous fungal keratitis

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20
Q

immunocompromised patient,small ulcer with expanding infiltrate in collar stud formation

A

candida fungal keratitis

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21
Q

What treatment is given for filamentous fungal keratitis?

A

natamycin drops

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22
Q

What treatment is given for candida keratitis?

A

amphotericin B or voriconazole

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23
Q

Patient been swimming with contact lenses in. Eye pain out of proportion with clinical signs, photophobia and blurred vision. Ring shaped stromal infiltrates and perineural infiltrates.

A

Acathamoeba keratitis

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24
Q

What is the management for acanthamoeba keratitis?

A

stop contact lens wear

topical polyhexamethylene biguanide or chlorhexadine

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25
Q

Blepharo conjunctivitis, pain, blurred vision, lacrimation, foreign body sensation, photophobia. Dendritic ulcer seen with fluorescein. Dendrite margins stain well with rose Bengal.

A

Herpes simplex keratitis

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26
Q

Which HSV is the most common cause of viral keratitis?

A

HSV 1

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27
Q

What is the treatment for herpes simplex keratitis?

A

topical acyclovir

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28
Q

Dermatomal rash, Hutchinson’s sign. Keratitis with psuedodendrites- stain well with rose Bengal.

A

herpes zoster ophthalmicus

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29
Q

What is the treatment for herpes zoster ophthalmicus?

A

oral acyclovir 800mg 5 times/day

topical lubricants

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30
Q

Pain, photophobia, decreased VA, feathery midstromal scarring and neovascularisation.

A

interstitial keratitis

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31
Q

Causes of interstitial keratitis?

A 
syphilis 
lyme disease
HSV
HZV
Cogan syndrome
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32
Q

Interstitial keratitis, notched teeth and sensorineural deafness

A

Hutchinson’s triad of congenital syphilis

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33
Q

interstitial keratitis, sensorineural hearing loss, vertigo and tinnitus

A

Cogan Syndrome

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34
Q

degeneration of corneal epithelium, foreign body sensation, mobile comma shaped epithelial strands

A

filamentory keratitis

due to tear film changes

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35
Q

conditions associated with filamentary keratitis

A

sicca syndrome
Sjogren’s syndrome
contact lenses

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36
Q

Peripheral corneal inflammation. Subepithelial infiltrates separated from the limbus by the clear zone. Staph infection

A

marginal keratitis

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37
Q

what type of hypersensitivity reaction is seen in marginal keratitis?

A

type III

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38
Q

Patient with RA. Peripheral corneal thinning and epithelial defect. Episcleritis and scleritis

A

peripheral ulcerative keratitis

39
Q

Older patient with hypercalcaemia. Calcium deposition in Bowman’s area. Band like chalky plaques containing haloes.

A

band keratopathy

40
Q

What is the treatment for band keratopathy?

A

chelation with EDTA

41
Q

Which layer of the cornea is thinned in keratoconus?

A

stroma

42
Q

Patient with Down’s syndrome. Irregular astigmatism, Munson’s sign (lower eyelid protrusion on downward gaze), cone shaped protrusion of central cornea. Acute hydrops.
Vogt’s striae and fleischer ring. Oil drop and scissoring reflexes. Corneal topography shows bow tie pattern progressing to steep central cone.

A

Keratoconus

43
Q

Which layer of the cornea tears in acute hydrops, leading to corneal oedema?

A

Descemet’s membrane

44
Q

what is the treatment for keratoconus?

A

mild- glasses
mod- contact lenses or corneal collagen crosslinking using riboflavin and UVA
sev- penetrating or deep anterior lamellar keratoplasty

45
Q

Autsomal recessive disorder. Copper deposits in Descemet’s membrane (Kayser-Fleischer ring). Anterior subcapsular sunflower cataract.

A

Wilson’s disease

46
Q

Drug causing vortex keratopathy

A

amiodarone

47
Q

vortex keratopathy, burning pain in extremities, angiokeratomas and renal failure

A

Fabry’s disease

48
Q

Small eye by at least two standard deviations

A

microphthalmia

49
Q

Older lady. Blurry vision worse in the morning. Corneal guttata (beaten metal appearance)

A

Fuchs endothelial dystrophy

descemet’s membrane affected

50
Q

what sort of cells make up the conjunctiva?

A

stratified columnar epithelium

51
Q

Which nerves supply the conjunctiva?

A 
mainly CNV1
inferiorly CNV2 (infraorbital nerve)
52
Q

lymphatic drainage of medial conunctiva

A

preauricular nodes

53
Q

lymphatic drainage of lateral conjunctiva

A

submandibular nodes

54
Q

what is the main function of the conjunctiva?

A

secrete mucin

55
Q

Which bugs commonly cause bacterial conjunctivitis?

A

strep pneumo,
staph aureus
haemophillus influenzae

56
Q

Redness, grittiness and mucopurulent discharge with conjunctival injection. Starts unilateral then spreads to both eyes.

A

Acute bacterial conjunctivitis

57
Q

what is the treatment for acute bacterial conjunctivitis?

A

topical chloramphenicol

58
Q

Unilateral red eye with mucopurulent discharge. Preauricular lymphadenopathy. Follicles in inferior fornix. Giemsa stain shows basophilic intracytoplasmic inclusion bodies. Immunofluorescent staining shows free elementary bodies.

A

Adult inclusion (chlamydial) conjunctivitis

59
Q

Which serological variants of chlamydia trachomatis cause inclusion conjunctivitis?

A

D-K

60
Q

Conjunctival inflammation developing in the first 30 days of life. Most commonly caused by chlamydia.

A

ophthalmia neonatorum

61
Q

Baby aged 1-3 weeks, mucopurulent discharge. Organism and management?

A

chlamydia trachomatis

oral erythromycin

62
Q

Baby aged 1-2 weeks. Watery discharge, periauricular skin vesicles, dendritic corneal ulcer. Organism and management

A

HSV

High dose IV acyclovir

63
Q

Baby first week of life. Purulent discharge with sticky eyes. Organism and management.

A

Staphylococcus

topical chloramphenicol

64
Q

Watery discharge in first few days of life. Chemical cause and management

A

silver nitrate

artificial tears

65
Q

Baby first week of life. Hyperpurulent discharge, swollen eyelids, rapidly progressing corneal ulcer. Organism and management

A

gonococcus

systemic ceftriaxone and chloramphenicol

66
Q

Unilateral red, itchy gritty eye with watery discharge, spreads to other eye. Pre-auricular lymph adenopathy.

A

Acute non-specific follicular conjunctivitis

67
Q

Fever, pharyngitis, conjunctivitis and lymphadenopathy.

A

pharyngoconjunctival fever

68
Q

Which serotypes of adenovirus cause pharyngoconjunctival fever?

A

3, 4 and 7

69
Q

Red, itchy gritty eye with watery discharge and keratitis.

A

epidemic keratoconjunctivitis

70
Q

Which serotypes of adenovirus cause epidemic keratoconjunctivitis?

A

8, 19 and 37

71
Q

Which virus is the most common causative agent in viral conjunctivitis?

A

adenovirus

72
Q

Red, watery, itchy eye with rhinitis. Conjunctival hyperaemia and papillary conjunctivitis.

A

Allergic conjunctivitis

73
Q

What type of hypersensitivity reaction seen in allergic conjunctivitis?

A

Type 1

74
Q

Contact lens wearer. Increased ocular tiredness while wearing lenses. Pruritis, red eye and mucous secretion worse after removing lenses. Superior tarsal hyperaemia and papillae.

A

giant papillary conjunctivitis

75
Q

what sort of hypersensitivity is seen in giant papillary conjunctivitis?

A

Type 4

76
Q

Elderly female. Bilateral conjunctivitis with conjunctival hyperaemia, swelling and subepithelial fibrosis. Dry eyes, trichiasis and chronic blepharitis. Symblepharon. Subepidermal oral mucosal involvement.
Direct conjunctival immunofluoresence shows linear bands of IgG and IgA deposits at the basement membrane.

A

Ocular mucous membrane pemphigoid

77
Q

What sort of hypersensitivity is seen in ocular mucous membrane pemphigoid?

A

Type 2- autoantibodies attack basement membrane

78
Q

What is the treatment of ocular mucous membrane pemphigoid?

A

mild- dapsone

sev- systemic steroids

79
Q

Female with deranged TFTs. Gradual onset foreign body sensation with itching and photophobia. Localised conjunctival hyperaemia and papillary reaction superiorly. Cornea has superior punctate epithelia

A

Superior limbic keratoconjunctivitis

80
Q

Patient scratched by cat. Granulomatous unilateral conjunctivitis with ipsilateral pre-auicular lymphadenopathy and low grade fever.

A

Parinaud Oculoglandular syndrome

81
Q

Which organism causes cat scratch disease?

A

bartonella henselae

82
Q

Pink fleshy triangle shaped fibrovascular wedge arising on nasal limbus and growing over the cornea. Stocker’s line (iron deposits). Fuch’s islets. Ocular dryness, astigmatism and reduced vision.

A

pterygium

83
Q

What is the management for pterygium?

A

conservative

84
Q

Yellow white raised lesion at the nasal limbus. Doesn’t extend over cornea. Associated with UV light exposure and increasing age.

A

pinguecula

85
Q

Acute onset red eye with discomfort. Peaks at 12-24 hours and slowly fades over a few days.

A

simple episcleritis

86
Q

Insidious onset red eye and discomfort. Tender vascular nodule at interpalpebral fissure.

A

Nodular episcleritis

87
Q

Which chemical can aid diagnosis of episcleritis by blanching the episclera?

A

phenylephrine

88
Q

Dull pain radiating to forehead or jaw. Gradual onset of localised or diffuse redness. Oedematous sclera resolves leaving a blue hue. Associated with joint pain

A

Diffuse anterior scleritis

89
Q

Gradual onset pain followed by a red eye with erythematous tender nodules.

A

Nodular anterior scleritis

90
Q

Severe pain radiating to forehead or jaw, redness and lacrimation. Scleral necrosis and blue/purple hue. Loss of vision.

A

Necrotising scleritis with inflammation

91
Q

Elderly patient with advanced rheumatoid. Necrosis of sclera without inflammation. Asymptomatic gradual onset of necrotic patches and exposure of underlying uvea.

A

Scleromalacia perforans

92
Q

Severe pain not correlating to appearance of eye. Diplopia, mild proptosis, optic disc swelling, vision loss, choroidal folds. USS shows increased scleral thickness and T sign. Can lead to retinal detachment.

A

posterior scleritis

93
Q

What is the treatment for posterior scleritis?

A

topical steroids

oral NSAIDs

Duke Elder (8 decks)

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