Flashcards in Cornea Deck (155):
Whats Avelino dys?
Gran + lattice
LGA airport (lattice granular avellino all same family)
Whats meretoja sx
Lattice and systemic amyloid
Masked facies and cranial n palsies
What % of peters will be bilateral?
Which dystrophies are tgfb1?
Large (5 letters = chrom. 5)
What does a pt w schnyders k dysrophy c/o?
Decr vision during day when pupil small bc cant get thru central cholest plaquea
Whats the eye finding in goldenhars
Preaur skin tag
Name 8 causes of spontaineous hyphema
2. Von willinbrand
4. Juv xanthogran (tuton)
7. Iris melanoma
8. Zoster uveitis
Refractive power of the cornea
What syndrome is keratoglobus ass w?
Can have deafness
short stature, short stubby fingers, microspherophakia, extopia lentis
whats the surgical risk in a pt w nanophthalmos?
spontaneous choroidal hemorrhage
small screwed up eye
what causes keratoglobus?
high IOP pushes against ectatic cornea causing thinning and K readings in the 60s
name 3 syndrome associated with keratoglobus
3) Rubenstein-Taybi syndrome
what syndrome is limbal dermoid associated with?
Name the 3 indications for corneal surgery
1) center of K has opacity and cant see through it
2) opacity NEAR visual axis causing astigmatism that cant be corrected with glasses
3) pain/redness failed medical treatment
name 2 causes of massive telangiectasias of the conj
1) ataxia-telangiectasia (aka Louis bar- AR)
2) osler-weber-rendu syndrome (plt disorder w renal compromise)
name 5 causes of follicular conjunctivitis
adeno hardly happens to careful nuns
hemorrhagic conjunctivitis (picornavirus)
newcastles disease (a bird virus)
what causes ligneous conjunctivitis?
type 1 plasminogen deficiency
whats the finding in CIN
"fimbriated blood vessels" grows rapidly in immunocompromise
how do you treat CIN?
Excisional biopsy with surrounding cryo
where does SCC of conj usually appear?
by limbus and may be white bc its growing faster than the eye can lubricate it so it keratinizes itself
when do you biopsy PAM?
>1 cm in diameter
whats the w/u for conj malignant melanoma?
full body scan and LFTs
whats the surgical management of sebaceous cell ca
full-thickness lid biopsy--send fresh for oil red o staining
don't forget its pagetoid spread (spreads from deep to superficial)
what causes episcleritis and how do you treat it?
its just irritation, lubricate
whats the symptoms of scleritis?
whats the workup for scleritis?
infectious, collagen vascular dz
rf, ana, anca,lyme, syphilis, tb
how do you treat scleritis?
Whats posterior embryotoxon?
anteriorly displaced prominent schwalbes line
whats the abnormality in peters?
no K endo or decemets
Whats the abnormal finding in chandlers syndrome
clinically iris looks normal but there is "reversal" on the specular microscopy- cells look black w white borders
how do you treat acanthomeba?
biguanide (PHMB) or chlorhexadine
what was the variable in HEDS1?
Everyone on viroptic but...did steroid help treat stroma keratitis?
2 findings of heds1
1) use steroid for stromal keratitis
2) use oral acyclovir 400tid for iridocyclitits
finding of heds2
acyclovir 400bid x 1 yr reduced recurrence by 41%
whats the ring you see in herpes?
Wesley immune ring
post-lasik pt with stroma keratitis..cause?
atypical mycobacteria- had an outbreak bc of reusable blades. Treat with amikacin
which mucopolysaccaride does not involve the cornea?
sanfillipo and hunters
"sam the hunter must see to shoot"
whats the finding in thygessons
bilateral in boys white eyes, white deposits, negative staining
interstitial keratitis with defness
whats the treatment of fungal keratitis?
topical natamycin 5%
ddx of enlarged K nerve MARKING L cornea
Riley day/refsums dz
4 drugs that cause K verticilata
corneal graft rejection sign
khohodust line (inflammatory cells on K endo)
how could prostate cancer cause blepharitis?
anti-androgen treatment causes decr meibomian gland fxn
how does early acanthomeba present
PERINEURITIS in the cornea with pain- culture on non-nutrient agar w e coli overlay
which herpes are associated with cin?
HHV 16 AND 18 (HHV 6 and 11 is conj papilloma)
how do you manage terriens marginal degeneration
rx for glasses to account for any astigmatism and counsel the pt that the astig may get worse with time
what are salzmanns nodules (looks like clear lump on surface)?
post-inflammatory thing when bowmans get replaced by fibrillar material. Treat with superficial keratectomy
what is type 2 lattice dystrophy?
meretoja syndrome- get recur erosions from lattice and systemic amyloid deposition, can have cn7 palsy
terriens marginal degen
1) bilat v unilat
2) red eye or white eye?
3) location of thinning?
4) young or old?
limbus, esp sup-temp, with lipid bc of bridging blood vessels
rx for astigmatism caused by the thinning- usually steep at 180 bc thins at 90
1) unilat v bilt
2) red eye or white eye?
3) old or young pts?
4) epi defect or no epi defect?
steroids!!!! bc its an immunologic resp possibly to hepatitis
1) unilater or bilat?
infectious or autoimmune
cbc, ana, anca, syphilis, ace, ppd
doxy or conj recession to move inflammatory mediators away from cornea
whats the difference between moorens and PUK?
look the same but in PUK theres a known autoimmune or inflammatory cause
what causes phlectunule? where in cornea occur? how to treat?
type-4 t cell mediated inflammation
fleshy nodule at limbus
rx with steroids
what serotypes of chlamydia causes trachoma
Whats the treatment of trachoma?
1) topical erythro
2) oral erythro x2 weeks for concomitant pneumonitis
what causes SLK?
mechanical rubbing of lid on conj eg in thyroid. can rx by trimming conj
1) kids or older pple?
2) whats the usual pmhx include?
1) kids or older pple?
2) name 2 findings
horner trantas dots/GPC/eosinophilia
whats the histologic finding in band K?
calcium hydroxyapetite in bowmans
where is keyser Fleischer ring located?
Hudson stahli line
Hudson stahli line- bleb
what hereditary dz is associated with K verticilatta?
Fabrys disease (alpha galactosidase deficiency)
what does salzmanns look like?
1) whats the cause of salzmanns
2) how to treat salzmanns?
1) post inflammatory fibrillar material at level of bowmans
2) lubricate or superficial keratectomy
whats inside the dots in meesmans dystrophy and what stains it?
"peculiar substance" PAS+
What the electron microscopy finding in reiss bucklers?
rod-shaped (R for Reiss buckler)
whats the electron microscopy finding in theil benke?
has honey-comb appearance in central K only
recurrent erosions due to path at level of bowmans
which is the only AR corneal dystrophy?
whats the typical CCT in Fuchs?
what CCT foreshadows bad outcome in CE?
What type of abnormal collagen is found in fuchs?
fetal banded type 8 collagen
is PPMD visually signif?
whats the clinical finding?
which dystrophy recurs the most in PK?
whats "irregular astigmatism?
no bowtie pattern!
who gets keratoglobus?
how steep is the k?
1)ehlers-danlos or collagen disorders
2) >50 also thin all over
what ideal cell count in a donor cornea
whats the wavelength of the excimer laser?
whats an epikeratoplasty? and who gets it?
sew an extra K on top of your K. Used for aphakic pts
whats an abnormal TBUT?
how do you do a schirmers I?
no anesthetic- measure tears with paper- <10mm is abnormal
how is rose Bengal and lissamine green different from fluorescein?
rose Bengal and lissamine stain dead/sick cells
fluorescein stains erosion
whats the optical principle behind keratometry?
name 3 causes of mucin deficiency
3) linear IgA deficiency
what are 2 drugs you can use for MGD?
2) Azasite (topical azithromycin)
whats the ddx for any inflammation in the eye?
OCP and SJS what type of hypersens rxn?
type 2 (direct ab vs. tissue)
what do you do immunofluorescence for (3 things)?
Linear IgA deficiency
how do you treat OCP systemically?
dapsone- but not if have G6PD deficiency
what meds can cause symblepharon?
How does muro help EBMD?
Helps create adhesions between epithelial cells
staph- clusters or chains?
("the staff clusters around the water cooler")
who gets filamentary dry eye?
severe dry eye (mucus adheres to eroded area)
whats the potassium content of the lens?
HIGH! pumps K INTO lens
whats the metabolism pathway in the lens?
anaerobic unless high glucose then shifts to HMP shunt
whats the direction of subluxation in homocystinurea?
down and in
atopic dermatitis- what type of cataract?
3 risk factors for psc cataracts?
3) steroid use
when do you get "oil droplet cataract" that you see on retroillumination
what's the minimum ecc for a k donor graft
how long after CE does CME tend to appear?
what type of hpv casues
- sessile squam papilloma
- peduculated squam papilloma
sessile- hpv 16, 18 (sex-ile- teenage yrs 16, 18)
peduculated hpv 6, 16
what do you see in bietti corneal dystrophy?
AR (dirty dozen type thing)
crystals in k periphery
nyctalopia from retinal degenration
what does the schimflug (pentacam) measure?
anterior and posterior K curvature, CCT and ACD
Besides hep c, what else can moorans be associated with?
whats the mutation in meesmans
recurrence in grafts of dystrophies
Really? Lets graft more
age of presentation of stromal dystrophies
"might like to grow"
what are shield ulcers ass with?
whats GPC associated with?
how does doxy effect the cornea?
inhibits martix metalloproteinase
does scleromalacia perforans have inflammation?
What alpha hemolytic strep?
at what CCT does epi edema typically appear
what are cowdry bodies associated with?
hsv and vzv
how does the K get neurtrophils and lysozyme?
tears (NOT limbal blood vessels)
snow blindness and welding injury can damage what layer of the K?
PUK involves the sclera but ....... does not
moorens (K only)
what bugs can invade intact epitelium? CHANLS
what type of crystallins are the most in the lens
which are largest
Beta is the most common
alpha are the largest w highest molecular weight
what contributes to anterior capsular phimosis?
any dz with loose zonules--> the capsule can contract more
which type of icthyosis has K changes?
What bug causes chronic angular blepharoconjunctivitis?
which map measures central corneal power?
which map measures peripheral corneal power?
what kind of K changes do you see with aniridia?
what causes thygessons? how do you treat?
dry eye and mgd, occurs in boys usually bilateral
lubricate +/- lotemax or fml
whats lisch epithelial dystrophy?
x-linked epi dystrophy
similar to meesmans
has clear intervening spaces between the cysts
what finding on exam indicates that post-op K edema may resolve
clear cornea periphery
what contributes the refractive power of the K. The air/tear interface or the tear/cornea interface?
in which case would you consider doing a running suture in a pk?
kids, thin K, vasc K- do interupteds
what part of the K is effected wit "fleck" dystrophy?
what are filaments made of and how do you treat?
epi with mucus core
at what ECC will you start getting K edema?
which mucopolysaccaridoses actually causes clouded corneas?
what can you look for on an ELISA in macular K dystrophy
sulfated keratin sulate
how do you treat hydrops?
or possible muro +bcl
UBIAD1 gene causes which dystrophy?
besides apple green birefringence, lattice can stain with what?
crystal violet metachromasia
you see a "wavelike" K epi irregularity, what dz are you thinking?
limbal stem cell deficieny staining pattern is 2/2 conjunctivization of the K
which drop is ineffective for ice?
drugs of choice are aq suppressants like b-block and cai
In the hav recurrence trial, what was found to cause recurrences?
Stress, sunlight, menatruation and cl wear were not proven to be triggers for outbreaks
Which type of adenovirus causes ekc?
what level of the K does crocodile shagreen effect?
is crocodile shagreen visually significant?
whats the biggest difference between crocodile shagreen and central cloudy dystrophy of francois?
crocodile- 2/2 old age
francois- AD inherited disorder
TGFB1 - LARGE dystrophies- what locus is fucked up
whats the thinnest part of the cornea?
temporal to center