Cornea Flashcards
(175 cards)
1
Q
Name 3 stains for amyloid?
A
Congo red, thioflavin T, crystal violet
2
Q
A
3
Q
Name of Iron line at head of pterygium?
A
Stocker’s line
5
Q
Does pterygium usually cause ATR or WTR? Astigmatism?
A
Usually WTR (flattens in meridian of pterygium/horizontal)
7
Q
What causes adenochrome deposits?
A
topical epinephrine is metabolized to melanin
9
Q
How large is a giant papillae?
A
>1.0mm
11
Q
What type of hypersensitivity is AKC? What age?
A
Type IV > Type I, onset 30-50yo
13
Q
What type of cataract is associated with AKC?
A
Subcapsular Maltese Cross
15
Q
What systemic disease is associated with SLK?
A
Thyroid disease
17
Q
Imagine patient with SLK, What are typical exam findings of SLK?
A
Velvety papillary hypertrophy, with superior cornela and conjunctival punctate staining, micropannus, redundant superior conj, +/- filamentary keratitis
19
Q
What is treatment for SLK?
A
Steroids of little use; usually requires conj scarring (cautery or silver nitrate) or recession/resection of superior conj; can try large diameter CL
21
Q
Is parinaud’s oculoglandular syndrome papillary or follicular conjunctivitis?
A
Follicular
23
Q
Most common eye finding in Reactive arthritis?
A
COnjunctivitis (30%)
25
Q
Common bugs for Reactive Arthritis?
A
Chlamydia, Shigella, Salmonella
27
Q
What is the lining of inclusion cyst?
A
normal epithelium (non-keratinized stratified squamous)
29
Q
Treatment for squamous conj papilloma?
A
Excisional biopsy with cryotherapy
31
Q
Most common malignant epithelial tumor of conj?
A
SCC
33
Q
Width of margin for conj SCC?
A
4mm
35
Q
Path buzzword for SCC?
A
Keratin pearls
37
Q
% of conj nevi that are amelanotic?
A
20-30%
39
Q
Location of junctional nevus?
A
confined to epithelial/subepithelial junction (anterior to basement membrane)
41
Q
Location of compound nevus?
A
cells in epithelial and subjepithelial locations
43
Q
Which nevus type is most common?
A
Compound nevus
45
Q
Cause of PAM (cellular level)?
A
Proliferation of intraepithelial melanocytes
47
Causes of secondary acquired conj melanosis (4)?
Addision's, radiation, pregnancy, topical epinephrine
48
Stains for conj melanoma (2)?
S-100 and HMB-45
50
SCC or melanoma more likely to invade sclera?
melanoma
52
melanoma thickness with increased risk of mets?
2mm
54
Better prognosis with cutaneous or conj melanoma?
Conj melanoma
56
What is path for cavernous hemangioma?
endothelial lined canals with RBCs
58
Most common conj location for lymphoid tumors?
Fornix
60
What percent of conj lymphoid tumor associated with systemic disease?
20%
62
which medium is used for Immunofluorescent stain?
Michel's medium
64
Pathology for fibrous histiocytoma?
Storiform pattern?
66
What does BHID stand for?
Benign hereditary intraepithelial Dyskeratosis
68
What is BHID inheritance\>
AD
70
Where is BHID found?
Halifax County, NC with Haliwa Indians
72
What is BHID presentation
Itching, burning, photophobia in 1st decade of life with bilateral dyskeratotoic lesions (plaques with gelatinous base and keratinized surface) on bulbar conj
74
where is oncotytoma commonly found?
Caruncle
76
why do alkali burns penetrate deeply?
Alkalis saponifies fat
78
which alkali is associated with Firework injuries?
MgOH
80
normal tear meniscus in mm?
0.5mm
82
normal TBUT?
10sec
84
normal Tear Osmolality?
\<311mosm
86
Normal Phenol red thread test?
\>9mm in 15 seconds
88
What is Mikulicz syndrome?
Lacrimal and parotid gland swelling and dry eye from sarcoid, TB, lymphoma or leukemia
90
What is Heerfordt syndrome?
CN7 palsy, parotid gland enlargment, fever and uveitis from sarcoid
92
How do you measure the number of goblet cells?
impression cytology
94
What topical drops are associated with OCP?
Pilocarpine, Phospholine iodide, timolol, epinephrine, idoxuridine
97
What is pathology of OCP?
IgA in conj basement membrane zone with antigen-antibodies below epidemis; occurs at level of BM
99
Most common cause of bilateral interstitial keratitis?
syphilis (congenital)
101
WHat is Cogan syndrome?
vertigo, tinnitus, hearing loss, interstitial keratitis (also conjunctivitis, iritis, scleritis, episcleritis
103
Differential for Cornea and vestibuloauditory symptoms?
Cogan, Syphilis, PAN, Wegeners, Sarcoid, VKH, Sympathetic ophthalmiaa, cerebellopontine angle tumore
105
Treatment of Cogan syndrome?
Systemic steroids
107
Thygeson's HLA type?
DR3
109
Natural course ofThygeson without treatment?
1-2months then with recurrences in as little as 2 months
111
What are filaments made of?
Mucus and desquamated epithelial cells adherent to cornea at one in
113
Treatment of filaments?
Mucomyst, lubricatione, removal, BCL
115
what is limbal girdle of vogt?
small, white, fleck and needle deposits at temporal and nasal limbus
117
What causes salzmann's nodules?
chronic inflammation (old phlyctenulosis, trachoma, staph hypersensitivity, IK)
119
What is pathology of Salzmann's nodules?
replacement of Bowman's membrane by hyaline and fibrillar material
121
Spheroidal degeneration types?
1- peripheral cornea/horizonal meridian, 2- other cornea pathology/involves center, 3- Involve conj also
123
What are Cornea Farinata?
Tiny, dot- and comma shaped flour like" deep stromal opacities with lipofuscin (an AD involutional change)
125
What is Hassall-Henle Body?
Gutatta in Periphery, normal with age
127
When does Coat's white ring occur?
Following metallic foreign body
129
Dyslipoproteinemias are associated with which chromosome?
16
131
What is Tangier's disease?
AR, HDL deficiency, relapsing polyneuropathy, small deep stromal opacities
133
Alkaptonuria Chromosome/inheritance pattern?
AR, Chr 3
135
Tyrosinemia enzyme deficit/inheritance/chromosome?
Tyrosine aminotransferase, Chr 16, AR;
137
Tyrosenemia findings?
corneal dendrites, retardation, skin lesions
139
Which quadrant does Kayser-Fleischer ring start?
Superior
141
In wilson Dz, increase or decrease in ceruloplasmin?
Decrease
143
Does Kayser Fleischer ring resolve or not?
Resolves with treatment
145
What is chalcosis?
Deposition of CU in descemets from FB
147
What is siderosis?
Accumulation of iron in stroma
149
What is iron ring in keratokonus?
Fleischer ring
151
What is iron line at head of pterygium?
Stocker line
153
What is iron line at filtering bleb?
Ferrys line
155
What is iron line at lower 1/3 of cornea?
Hudson-Stahli line
157
What is argyrosis?
Silver in deep stroma
159
What is Chrysiasis?
Gold in deep stroma
161
What is Krukenberg spindle made of?
Melanin
163
Corneal crstals can come from which plant?
Dieffenbachia
165
What type of hypersensitivity is moorens?
Type 2
167
Is moorens painful?
Yes
169
Is sclera involved in Moorens?
No, but can have adjacent conj injection
171
Which type of astigmatism is caused by Terriens?
Against the rule
173
is Terriens painful?
No
175
What demographic is Terriens most common?
Young middle age men (75%)
177
What are common findings in Terriens?
Leading edge of lipid, steep centrally/sloping peripheally with no epi defect
179
What enzyme is elevated in PUK to cause melting?
Collagenase
181
What is Fuch's superficial marginal keratitis?
marginal infiltrates initially then pseudopterygium with severe corneal thinning underneath; like kids version of terriens
183
Bugs that can penetrate intact epithelium?
CHANLS-\> Corynebacterium diphtheriae, Haemophilus aegyptus, Neisseria, listeria, Shigella
185
What is bug most commonly associated with ICK (infectious crystalline keratopathy) ?
Strep Viridans
187
What does ICK look like?
Branching, Cracked-glass appearance without epi defect
189
Can HSV have granulomatous AC reaction?
Yes
191
Can HSV have hypopyon?
Yes
193
What type of inclusions are seen with HSV
Lipshutz and Cowdry A
195
HEDS findings for stromal disease?
Steroids(8x/d)+ Viroptic (QID then 10 week taper) better than just Viroptic by 68%; no beenfit to adding oral acyclovir
197
Heds fidnings for HSV Iritis?
Acyclovir (400 5x/d) + viroptic + steroid si better than viroptic + steroids alone
199
HEDS findings for prophy?
Acyclovir BID for 1 year decreases recurrent HSV keratitis by 50%
201
In HEDS, did oral acyclovir reduce risk of stromal keratitis in patheients with epithelial disease?
No
203
Did oral Acyclovir reduces risk of recurrent ocular disease in HEDS?
Yes 19% vs 32%
205
Describes VZV dendrites?
Blunt ends, no terminal bulbs, no ulceration, minimal staining, self limited (4-6 days);
207
Describe iris atrophy in HSV
Patchy near pupillary border
209
Describe iris atrophy in VZV
Segmental due to vasculitis and ischemia
211
does chickenpox cause papillary or follicular conjunctivitis?
Papillary
213
What type of fungi are fusarium and aspergillus
Septate filamentous (molds) form hyphae
215
What type of fungi is Candida
Yeast/non-filatmentous
217
Best treatment for filamentous?
Natmycin
219
Best treatment for yeast/non-filamentous?
Amphotericin 0.15%
221
What are common findings in acanthamoeba?
PSeduodendrite, ring ulcer, perineural infiltrate, hypopyon, scleritis, epithelial cysts
223
Ways to culture acanthamoeba?
Calcocluor white, giemsa, non-nutrient agar with ecoli overlay, confocal microscopy
225
Acanthamoeba treatments?
neomycin, paromycin 1%, oral keotconazole or itraconazole, propamidine (brolene) 0.1%, hexamidine 0.1%, Pentamidine, PHMB/pool cleaner 0.02%, chlorhexidine 0.02%
227
Common cause of keratitis in HIV+ patient?
Microsporidia
229
Treatment for microsporidia
Fumagillin
231
Findings in EBV keratitis
Multifocal stromal keratitis, lymphocytosis, elevated liver enzymes;
233
What are vogt striae?
Fine deep stria anterior to descemets that dissapear with pressure in keratoconus
235
Pathology of KCN
breaks in bowmans membrane, stromal thinning
237
What type of astigmatism is seen with pellucid?
Irregular ATR
239
Name 3 corneal dystrophies that are Autosomal recessive?
Macular, Type 3 lattice, gelatinous
241
Path buzzword for Meesmann's
Peculiar substance " PAs posivite material in epithelial cells;
243
Chromosome/Gene/Inheritance for Gelatinous
Chr 1 , TACT2/AR
245
Path buzzword for Thiel Behnke
Honey Comb pattern
247
BEst stain for Reis Buckler
Masson trichrome
249
most common stromal dystrophy
granular
251
most severe/least common stromal dystrophy
Macular
253
macular gene/inheritance/chromosome
CHST6 for keratan sulfate, AR, 16
255
Most common recurrence?
Reis-buckler then lattice
257
Meretoja is seen in people of what descent?
FInnish
259
Type 3 lattice associated with people of what descent?
Japanese
261
Schnyder Chromosome/inheritance/gene?
1/AD/UBIAD1
263
Systemic findings in Schnyder?
Hyperlipdemia, short forearm, genu valgum
265
Does fleck dystrophy extend to periphery?
Yes
267
IS Fleck Congenital? Progressive?
Yes and No
269
WHat is central cloudy dystrophy of Francois?
Posterior stromal mosaic opacities, vision usually not affected
271
What inheritance is Fuchs endothelial dystrophy most commonly?
AD; early onset is Chr 1
273
Most common inheritance of PPMD?
AD
275
What is a delle?
focal thinning from dehydration due to adjacent area of elevation
277
What is brown-mclean syndrome?
Peripheral corneal decompensation in aphakic patiens, central cornea remains clear;
279
What is a Khodadoust line?
Sign of endothelial graft rejection
281
Treatment of graft rejection?
Epithelial and stromal can be treated with increased topical steroids and enodthelial can use oral or IV steroids.
283
Diagnosis of epithelial downgrowth?
Argon laser to surface of iris turns white
285
How to diagnosis limbal stem cell deficiency?
Impression cytology (presence of goblet cells on cornea); slow wave like uptake of fluorescein by epithelium
287
What are the eye findings possible in MEN2
prominent corneal nerves, cojunctival neuroma, eyelid neuroma, dry eye prominent perilimbal blood vessels
289
What is differential diagnosis of prominent corneal nerves:
leprosy, acanthamoeba, downs, NF\< KCN, congenital glaucoma, Refsum, Fuchs, ichthyosis, PPMD, trauma, advanced age
291
is episcleritis more often sectoral or diffuse?
sectoral 70%
293
When to perform systemic work-up in episcleritis?
if is persists for \>3 weeks
295
Most common cause of scleritits?
RA (20% of cases)
297
what are the findings in posterior scleritis?
chorioretinal folds, amelanotic fundus mass, ON edema, vitritis, macular edema, limited motility, ptosis/proptosis, exudative RD, choroidal detachment
299
Systemic sign in Takayasu?
Diminished pulse in upper xtremity; low BP but high in lower extremity
301
Wegeners and PAN more common in male or female?
Male
303
Recurrent episodes of inflammation i cartilaginous tissues seen in what disorder? treatment?
Relapsing polychondritis; steroids/dapsone
305
What enzyme is deficient in alkaptonuria?
homogentisic acid oxidase deficient
307
For PKP is HLA matching useful?
No, not cost effective or advantageous
309
PK donor contraindications:
Septicemia, lymphoma/leukemia, ocular metastasis, anterior segment tumor, Creutzfeldt Jakob disease, rabies, subacute sclerosis panencephalitis, PML, HIV, hep , Hep C
311
What is keratophakia?
Donor lenticule place between cornea after microkeratome has been used to make lamellar section
313
What is keratomileusis?
Lamellar stromal section is removed, frozed and shaped on cryolathe then replaced into stromal be to correctrefractive error
315
What is epikeratophakia?
epithelium is removed and a lather donor lenticule is placed on top to correct refractive error. Reversible
317
What is optical zone for AK?
7-8mm
319
What is optical zone for LRI?
10-12mm
321
what factors increase effect in RK?
Longer incision, deeper incision, smaller optical zone, male sex
323
Risk of hyperopic shift in PERK study at 10 years?
43 had at lead 1D of hyperopia
325
wavelength of eximer for PRK
193nm
327
what is munnerlyn equation?
depth = OZxOZ x (D of refractive error/3)
329
Does haze after PRK cause myopic or hyperopic shift?
hyperopic
331
Buttonhole more common with steep or flat cornea?
steep
333
Free cap more common with steep or flat cornea?
flat
335
What is DLK?
Inflammation within the flap interface
337
What is treatment for DLK?
Topical steroids in stage I and II; Lift the flap in III & IV
339
What is central toxic keratpathy?
Non-inflammatory central corneal opacity after LASIK with hyperopic shift; post op day 3-5; usually preceded by DLK; no treatment, spontaneously resolves in 2-18 months
341
Which hinge location has worse dry eye after lasik?
superior is worse than nasal
343
Most common infectious keratitis after lasik?
Gram positive cocci and atypical mycobacterium
345
what type of refractive error are Intacs used for?
low to moderte myopia
347
What type of refractive error is conductive keratoplasty used for ?
Low to moderate hyperopia
