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Advanced Ocular Disease > Cornea Disease > Flashcards

Cornea Disease Flashcards

1
Q

Where does Terrian’s Marginal Degeneration typically occur?

A

Superiorly

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2
Q

What are the two type of TMD?

A

Quiescent

Inflammatory: 10% - 30% of cases

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3
Q

What condition is associated with the development of Pseudopterygium?

A

TMD

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4
Q

How do you distinguish TMD from Mooren’s Ulcer?

A

Mooren’s ulcer is super painful and inflammatory w/ stromal necrosis

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5
Q

What is Pellucid Marginal Degeneration?

A

Bilateral inferior corneal thinning. Associated with Keratoconus and Keratoglobus.

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6
Q

How does Pellucid Marginal Degeneration affect corneal refractive error?

A

Superior cornea flattens out while the inferior cornea gets steeper. Creates against the rule astigmatism.

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7
Q

What surgical procedure can allegedly cause Pellucid Marginal Degeneration?

A

Hyperopic LASIK surgery (because it removes peripheral corneal epithelium)

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8
Q

How is Pellucid Marginal Degeneration managed?

A

Early - RGP lenses
Severe - Penetrating Keratoplasty (old method), crescentic lamellar keratoplasty, lamellar crescentic resection, corneal wedge excisions/resection, and thermokeratoplasty

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9
Q

What is Senile Furrow Degeneration?

A

Thinning of the peripheral cornea in the lucid interval between arcus senilis and the limbus. Noninflammatory.

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10
Q

How is Senile Furrow Degeneration managed?

A

Artificial Tears

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11
Q

What is the cause of Terrien’s Marginal Degeneration?

A

TMD is “non-inflammatory” as in there are totally inflammatory cells present (sometimes) along with vascularization along a thinned out peripheral cornea

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12
Q

What is the definition of Megalocornea in adults? Infants?

A

Adults - Greater than 13 mm

Infants - Greater than 12 mm

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13
Q

What conditions have been associated with Megalopthalmos? (4)

A

Pigment Dispersion
Zonular Stretching leading to Phakodenesis
Iridodeness
Iris Stromal Hyperplasia

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14
Q

What is the definition of Microcornea?

A

Cornea less than 10 mm

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15
Q

What conditions have been associated with Microcornea?

A

Glaucoma
Aniridia
Peter’s Anomaly
MCRS Syndrome

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16
Q

What is MCRS Syndrome?

A

Bilateral Microcornea
Rod-Cone Dystrophy
Congenital Cataracts
Posterior Staphyloma associated w/ High Myopia

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17
Q

What is the definition of a Staphyloma?

A

Bulging of the globe lined with uveal tissue

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18
Q

What is sclerocornea associated with?

A

Anterior Chamber Dysgenesis

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19
Q

Band Keratopathy is a calcification of what layer?

A

Bowman’s Layer

Begins in the BM but progresses to Bowman’s

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20
Q

What are the predominant findings in Chandler’s Syndrome v Essential Iris Atrophy v Cogan Reese Iris Nevus Syndrome

A

Chandler’s Syndrome: “beaten metal” corneal endothelial atrophy w/ corneal edema
Essential Iris Atrophy: iris atrophy (shockingly) and corectopia / pseudopolycoria
CRINS: iris stroma hypoplasia with nubs (nodules) poking through

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21
Q

What may disrupt Bowman’s Membrane in advanced cases of Band Keratopathy?

A

Degenerative Pannus

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22
Q

What is the difference between Type 1, Type 2, and Type 3 Spheroidal Degeneration?

A

Type 1 - Wind, Dust, UV light
Type 2 - Inflammation, Trauma, Dystrophy
Type 3 - Conjunctiva, Pinguecula

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23
Q

What is the pathogenesis of Spheroidal Degeneration?

A

UV, Wind, Dust, Toxins, etc fuck with the eye -> Hyalin Deposits and Elastotic Degeneration occurs in Bowman’s Membrane and the Anterior Stroma

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24
Q

What is the difference between Grade 1, Grade 2, and Grade 3 in Type 1 Spheroidal Degeneration?

A

Grade 1 - Peripheral
Grade 2 - Paracentral, starting to affect VA
Grade 3 - Central, VA is shit

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25
Q

How is Spheroidal Degeneration managed?

A

Scraping / Amoil’s Brush, followed by PTK

Lamellar / Penetrating Keratoplasty

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26
Q

When it comes right down to it, what is really the difference between Spheroidal Degeneration and Band Keratopathy?

A

Spheroidal Degeneration is not calcified. Spheroidal Degeneration also has “spheres” of hyalin droplets as opposed to a “band” of degenerated tissue

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27
Q

What type of people typically get Salzmann’s Nodular Dystrophy?

A

Females over 50 years old

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28
Q

What type of people typically get Spheroidal Degeneration?

A

Men who work outside near the equator (but only because big strong shirtless men work outside more with their spheres… balls… penis)

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29
Q

What is the pathogenesis of Salzmann’s Nodular Dystrophy?

A

Chronic inflammation and irritation keep disrupting the cornea, and the cornea gets lazy and starts to repair itself poorly, so the fibroblasts start to take over and lay out too much collagen which decompose into clumps of hyalin, which disrupt bowman’s and build up in the anterior stroma

30
Q

What typically deposits at the base of the nodules of Salzmann’s?

A

Iron

31
Q

How can Salzmann’s Nodular Dystrophy be managed medically?

A

Aggressive Artificial Tears (all the time)
Topical Steroids (Lotemax QID x 30 days, BID x 30 days)
Doxycycline (100 mg x 7 days, 50 mg x 60 days)
Restasis (Long Term management of DES)
Mitomycin C

32
Q

How can Salzmann’s Nodular Dystrophy be managed surgically?

A

Old way: Scrape off epithelium, then treat with PTK

New way: Create flap, treat with PTK, replace flap

33
Q

How old would a patient have to be in order for you to be suspicious that his or her arcus was due to an underlying lipid disorder?

A

Under 50 years old

34
Q

Vogt’s Limbal Girdle Type 1 is really a form of what disease?

A

Band Keratopathy

35
Q

What is a major distinguishing feature of Type 1 v. Type 2 Vogt’s Limbal Girdle?

A

Type 2 does NOT have a lucid interval

36
Q

Why does Mosaic Shagreen of Vogt have a similar presentation to ocular hypotony?

A

They’re both a result of relaxation of normal tension on Bowman’s

37
Q

What distinguishes Mosaic Shagreen of Vogt from Central Cloudy Dystrophy of Francois?

A

Central Cloudy Dystrophy of Francois is located more posteriorly and shows AD inheritance

38
Q

What is the difference between Primary and Secondary Lipid Deposition?

A

Primary - No sign of corneal insult or vascularization

Secondary - Corneal vascularization leaks out lipid from blood serum

39
Q

Which is more common: Primary or Secondary Amyloid Corneal Deposition?

A

Secondary. Systemic amyloidosis rarely involves the cornea.

40
Q

What condition is a result of a corneal healing response to a rust ring?

A

Coat’s white ring

41
Q

Define Keratoconus

A

Bilateral, non-inflammatory corneal ectasia

42
Q

Keratoconus typically has an onset at what age? When does it typically stabilize?

A

Onset: 10 - 20 years of age
Stabilizes: By 30 years of age

43
Q

Is Iridocorneal Endothelium Syndrome unilateral or bilateral?

A

Unilateral

44
Q

Name some characteristic signs of Keratoconus (4)

A

Fleischer Ring
Thickened corneal nerves
Vogt’s Striae
Apical Scarring

45
Q

What is Descmetocele?

A

Herniation of Descement’s Membrane because so much of the cornea has gotten fucked up and degraded that DM has become exposed, creating a “bubble of Descement’s Membrane”

46
Q

What is Urrets-Zavalia Sydrome?

A

Permanent mydriasis after anterior segment surgery

47
Q

How can an optometrist manage patients with Anterior Keratoconus?

A

Glasses
Piggyback Lens
Hybrid Lens
Scleral Lens

48
Q

How could a surgeon manage patients with Anterior Keratoconus?

A

Corneal Cross-Linking
Penetrating Keratoplasty
Epikeratophakia (Lamellar Keratoplasty)

49
Q

What is the Dresden Protocol?

A

Corneal Cross-Linking procedure that involves:
pre-operative Pilocarpine
scraping off the epithelium
instilling riboflavin every 2-3 minutes x half an hour
blast with UV-A + riboflavin every 2-3 minutes x half an hour
instill antibiotic with bandage contact lens

50
Q

What type of Anterior Keratoconus patients make good candidates for corneal cross-linking?

A

Low to Moderate cases with THICK ass corneas

51
Q

How could an optometrist medically manage corneal hydrops?

A

5% NaCl drop 4-6 QID with 5% Nacl Qhs
Topical steroid QID
Cycloplegics (note… miotics with gas bubble)
Antibiotics

52
Q

How could a surgeon manage corneal hydrops?

A

Miotics (note… cycloplegics with medical therapy)
Gas bubble, pt remains supine for 1 - 2 days
Follow normal medical therapy after (no cycloplegics)

53
Q

Define Keratoglobus

A

Bilateral diffuse corneal thinning

54
Q

What conditions are associated with Keratoglobus?

A

Ehlers-Danlos, Leber’s Congenital Amaurosis, Osteogenesis Imperfecta

55
Q

How is Keratoglobus managed? Why can’t you perform PK?

A

Epikeratophakia

Can’t do PK because cornea is thin everywhere. Would mostly likely just poke a hole right through

56
Q

What is the general rule for all types of Anterior Chamber Dysgenesis? (4)

A

Congenital
Bilateral (but asymmetric)
No gender predilection
AD inheritance (“ACD is AD”)

57
Q

Name all the ocular tissues that are derived from Surface Ectoderm

A

Corneal epithelium
Conjunctival epithelium
Len

58
Q

Name all the ocular tissues that are derived from True Mesoderm

A

THERE CAN BE ONLY ONE:

Temporal portion of the Sclera

59
Q

Name all the ocular tissues that are derived from Mesectoderm

A 
Basically all the structures that make up the angle:
Corneal Stroma / Endothelium
Iris stroma
Chamber Angle (TM, SC)
Ciliary muscles and stroma
Uveal and epithelial melanocytes
Sclera (except temporal portion)
60
Q

What is descement’s membrane like in posterior keratoconus?

A

Thin but NOT absent or broken

61
Q

Explain the pathogenesis of Anterior Chamber Dysgenesis

A

The corneal endothelium and pigmented epithelium of the iris are supposed to split so the angle is properly formed, but in ACD the two layers stick together and the angle gets all fucked up due to an anteriorly placed shwalbe’s line, shit ton of iris processes covering up the TM, along with other abnormalities like iris atrophy, corectopia, and iris hypoplasia

62
Q

Define Posterior Embryotoxon

A

Toxon = greek word for “bow-like”. Membrane of residual tissue is hanging on the endothelium of the cornea which looks like a super prominent schwalbe’s line, and when other tissue naturally migrate, complications may form. Best seen inferotemporally in 15% of adults

63
Q

Differentiate Axenfeld Anomaly v Axenfeld Sydrome

A

Not to be confused with Axenfeld Loops:
Axenfeld Anomaly - Posterior Embryotoxon with iris processes over the TM into Schwalbe’s Line / Scleral Spur
Axenfeld Syndrome - Axenfeld Anomaly with Glaucoma

64
Q

When does Axenfeld Anomaly become Axenfeld-Rieger’s Anomaly?

A

Axenfeld-Rieger’s - when there is iris stromal hypoplasia

65
Q

When doe Rieger’s Anomaly become Rieger’s Syndrome?

A 
When there are systemic complications:
Small teeth
Flat nasal bridge
Zygomatic bone hypoplasia
Mental retardation
Prominent supraorbital ridges
66
Q

What are the two types of Peter’s Anomaly?

A

Type 1: Iridocorneal adhesions

Type 2: Iridocornel / Iridolenticular adhesions (more serious)

67
Q

What is Peter’s Plus Syndrome? (AKA Krause-Kivlin Disorder)

A

Peter’s Anomaly PLUS developmental defects of the ear, spinal cord, heart, and urinary tract

68
Q

How do you manage Axenfeld-Riegers or Peter’s medically? Surgically?

A

Medically: IOP lowering drops except for cholindergics
Surgically: PK, remove cataracts

69
Q

100% of all patients with ICE develop ______

A

glaucoma

70
Q

Define Pellucid Marginal Degeneration

A

Inferior bilateral thinning

Advanced Ocular Disease (8 decks)

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