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Flashcards in Cornea Degeneration (Cale) Deck (38):
1

anatomy and physio of cornea

epithelium: genesis, proliferation/migration, healing, cell junctions
stroma: generation, transparancy, hydrophilic
endothelium: energy, ion pumps

2

Degeneration

a process in which normal elements of corneal tissue are converted (involutional and metabolic disease)
represents a change in tissue (benign and detrimental to normal function)
family history or genetic predispositon

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corneal degenerations that are benign and non-sight threatening

crocodile shagreen
arcus senilis
limbal girdle of vogt
farinata

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crocodile shagreen

anterior: at level of bowmans layer
posterior: at the posterior corneal stroma and desemets
asymptomatic, age related

5

arcus

lucid interval- superficial lipid deposition ends at bowman's

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limble girdle of vogt

type 1: lucid interval-deposition ends at bowmans. swiss cheese holes. sharp edge centrally. early form of of band keratopathy
type II (true vogt): to limbus- elastoid degeneration of subepithelial collagen. extensions centrally

7

peripheral thinning disease

furrow degeneration, terrien's marginal degeneration, mooren's ulcer, peripheral ulcerative keratitis, pellucid marginal degeneration

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Terrien's Marginal Degeneration

typically asymptomatic and bilateral. can have pain, episcleritis, scleritis. epithelium is intact. thinning of peripheral corneal stroma, superior nasal then circumferential, marginal opacification with superficial vascularization, 75% males, young adult to elderly

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DiffDx to Terrien's marginal degeneration

mooren's ulcer

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Mooren's ulcer

painful, red eye, photophobia, NaFl staining ulcer (epithelium not intact), near limbus (progressive), thinning, stromal melting, potentially perforation

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Mooren's types

type 1: typically seen in older pt, unilateral, better response to treatment
type 2: younger (indian or african), 20-30yo, bilateral, poor response to treatment

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how is terrien's different from Mooren's?

epithelium intact, no NaFl, stain, rarely painful, inflammatory, rarely aggressive, rarely move centrally, rarely perforates

13

Systemic work up

mandatory referral to rheumatology for vasculitis or collagen vascular disease. autoimmune dz: ankylosing spondylitis, polyarteritis nodosa, psoriatic arthritis, rheumatoid arthritis, scleroderma, lupus, Sjogren syndrome, scleroderma, temporal arteritis, Wegener’s granulomatosis

14

Mooren's ulcer treatment

no well established treatment, mostly supportive to control inflammation, topical steroids, conj resection, radiation, bandage CL, topical steroid, cyclosporine or systemic immunosuppresion, perforation: tx with cyanoacrylate or lamellar keratoplasty

15

Peripheral ulcerative keratitis (PUK)

associated with autoimmune disease (rheumatoid arthritis, wegners granulomatosis), limbal crescent ulceration (epithelial defect, thinning, progresses circumferentially with extension in sclera), usually episcleritis or scleritis

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treatment for peripheral ulcerative keratitis

rheumatology referral: systemic immunosuppression, NO topical steroids

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miscellaneous degenerations

amyloid degeneration
spheroidal degeneration
salzmann's nodular degeneration
band keratopathy

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Salzmann's Nodular degeneration

>females, >50yo, may be inflammatory, hyaline nodules replace bowmans, elevated, bluish-white

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what is salzmann's nodular degeneration associated with

chronic ocular surface disease and/or previous inflammation, especially viral (phlyctenular keratoconj, interstitial keratitis, vernal keratitis, trachoma, rarely no clear history of preceding eye disease)

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Salzmann's symptoms

dry eye, VA if central or irregular astigmatism

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management for Salzmann's

lubricants, steroid if inflamed, bandage CL, in severe cases the nodules can be removed by corneal specialist, penetrating keratoplasty

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band keratopathy

interpalpebral Ca deposits in bowmans with clear zone separating the limbus. inflammatory dz, mercury. systemic conditions that cause increase Ca. chronic ocular pathology and degenerative conditions

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why does band keratopathy have the swiss cheese appearance

clear areas and small circular areas where nerve endings perforate the bowmans layer are seen within the band

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difference between Vogt's limbal girdle II and band keratopathy

no lucid interval, no swiss cheese, bilateral, does NOT spread across central cornea

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what is band keratopathy similar to

Vogt's I

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plan, treatment, management for band keratopathy

monitor, ocular lubricants for mild cases, refer for hypercalcemic workup, chelation using 2% EDTA for severe cases, PTK (phototherapeutic keratectomy)

27

phthsis bulbi

degenerative atrophic condition of chronic sick eye that may see band keratopathy involving all layers of cornea

28

corneal ectasias

keratoconus (anterior and posterior), keratoglobus, pellucid marginal degeneration

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keratoconus

bilateral (forme fruste), after puberty (progressive then stabilizes), greater association with down's, Ehler's Danlos, Marfan's, Oculodigital sign: Leber's, atopic disease

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pathology of keratoconus

irregular epithelium, breaks in bowman's, fibrosis beneath epithelium, stromal scarring, corneal thinning

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keratoconus pathophysiology uncertain

epithelial lysosomal enzyme expression increase, reduced inhibition of proteolytic enzymes, abnormal corneal collagen, lamellae, keratocyte populations

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diagnosis for keratoconus

keratometry >47.20, inferior steepening 1.2D>superior, skewing of axis astigmatism >21 degrees

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charleaux's sign

irregular red reflex from retinal retro-illumination (keratoconus)

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rizzutti's sign in keratoconus

triangle of light on distal iris

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keratoconus treatment

appropriate optical correction, specialty RGP, scleral RGP, hybrid CL, penetrating keratoplasty, NOT refractive surgery, intacs, collagen crosslinking

36

posterior keratoconus

posterior diffuse or localized curvature increase, normal anterior surface, sporadic (non-inherited), unilateral, non-progressive, more in females

37

keratoglobus

bilatera, congenital or acquired, diffuse corneal thinning>peripherally (1/3 to 1/5 normal thickness)

38

pellucid marginal degeneration

the thinned area is usually confined to an area of the cornea near inferior limbus most often seen from 4-8. Pot belly cornea, ATR astigmatism and irregular astigmatisim (kissing dove topography pattern)