cornea pt 1: Corneal anomalies, dysgenesis, and degenerations

Question 1

Recurrent Corneal Erosion is a problem with which layer of the cornea

Answer 1

basement membrane

Question 2

it is called recurrent because …

Answer 2

its recurrent breakdowns of the epithelium due to the defective adhesions in the basement membrane

Question 3

what causes RCE?

Answer 3

trauma like a clean slice to the cornea or its spontaneous

Question 4

How long does it take a wound that caused RCE to heal?

Answer 4

8-12 weks. The epithelial cells undergo mitosis.

Question 5

RCE symptons occur most often ____ (am or pm)

Answer 5

pain, FBS occurs most often in AM

Question 6

recurrentces of RCE is how often?

Answer 6

every monthy or every year

Question 7

name the preventative txts for RCE

Answer 7

plently of fluids, avoid dry environments, wake up with eyes closed, protective glasses

Question 8

Someone has RCE. Their slit lamp findings were normal. But on second look you say microsysts (that didn’t staing) , surface irregularity, nafl staining. How are you going to txt?

Answer 8

genteal every night until tube is gone, Freshkote, Muro 128 5%(solution and/or ung)

Question 9

you decide to employ a bandage cl on your patient with RCE. What else should you add to this bandage cl? What are you going to be careful of with bandage cl? In terms of withdrawl.

Answer 9

Ofloxacin (prophylatic antibiotic ) , not to withdraw too soon. Need about 4 weeks.

Question 10

What is the rx for doxycycline? And why is it used in RCE management?

Answer 10

50-100mg, once or twice a day . Its used to inhibit the MMP9s with rce

Question 11

an anomaly is

Answer 11

Something different, abnormal, peculiar, or not easily classified; a deviation from the common rule, type, arrangement, or form

Question 12

normal adult cornea diameter:

Answer 12

12

Question 13

Microcornea defined:

Answer 13

10; can be bilateral or unilateral

Question 14

pts with microcornea are more prone to

Answer 14

angle closure glaucoma

Question 15

Megalocornea is more common in F or M

Answer 15

M

Question 16

t/f. Patients with Megalocornea are not prone to glaucoma.

Answer 16

true. They have nomal iop

Question 17

Megalocornea is defined as

Answer 17

bilateral anterior segment enlargement

Question 18

greater than 13 mm after 2 years is

Answer 18

megalocornea

Question 19

Anteriorly displaced, prominent Schwalbe’s line

Answer 19

Posterior Embryotoxon

Question 20

management of posterior embryotoxon

Answer 20

no txt necessary

Question 21

what is schwalbe line

Answer 21

is the termination of decemats membrane marks transition between cornea to sclera

Question 22

Axenfeld- Rieger’s Anomaly

Answer 22

posterior embryotoxon,iris stromal hypoplasia,iris strands that attach to posterior embryotoxon

Question 23

What would make Axenfeld-reiger’s anomaly a syndrome?

Answer 23

Glaucoma

Question 24

what is the least appropiate option for Axenfeld reigers

Answer 24

trabeculoplasty

Question 25

The best option for axenfeld reiger is aqueous suppressants. Beta blockers or CI

Answer 25

true

Question 26

Peters’ Anomaly description

Answer 26

central corneal opacity; focal absence of Descemet’s membrane and endothelium, iridocorneal adhesions, shallow AC

Question 27

Peters’ Syndrome involves

Answer 27

Glaucoma and pt starts to develop systemic problems.

Question 28

patients may also have ______ with peter's . tip: another ocular diagnosis.

Answer 28

cataract especially if lens adhering to cornea

Question 29

txt for peter's anomaly

Answer 29

treat glaucoma, penetrating keratoplasty

Question 30

yellow-white hazy ring of stromal deposits, cholesterol, has a lucid interval between ring and limbus

Answer 30

Arcus Senilis (aka Gerontoxon)

Question 31

arcus senilis starts inferior to superior and encircles cornea

Answer 31

TRUE

Question 32

posterior embroytoxin starts inferior to superior and encircles cornea

Answer 32

FALSE. It starts in perphiery

Question 33

arcus senilis is common in which race?

Answer 33

African americans.

Question 34

incidence of arcus senilis ?

Answer 34

50-60 y.o; and older than 80 nearly everyone

Question 35

management of arcus senilis ?

Answer 35

lipid panal

Question 36

main worry of unilateral arcus sensilis?

Answer 36

the cartoid artery could be blocked. Listening to bruit here

Question 37

small, irregular chalk-like opacities – subepithelial, irregularly shaped but collectively have a crescent

Answer 37

White Limbal Girdle of Vogt

Question 38

white limbal girdle of vogt is located at the limbus more in the termporal .

Answer 38

false. Nasal more than termporal

Question 39

whats the difference btwn type I and type II White Limbal Girdle of Vogt

Answer 39

Type I – separated by limbus by narrow lucid area; no lucid area between limbus and opacities

Question 40

most common corneal degeneration

Answer 40

White Limbal Girdle of Vogt

Question 41

txt for white limbal girdle of vogt

Answer 41

none. It has no clinical significance. Just a finding.

Question 42

grayish-white polygonal stromal opacities separated by clear spaces

Answer 42

Mosaic (Crocodile) Shagreen

Question 43

which layer of cornea is Mosaic (Crocodile) Shagreen located?

Answer 43

stroma. Most noticeably centrally , rarely impacts vision. Involutional

Question 44

dust-like gray dots and flecks in the deep corneal stroma

Answer 44

Cornea Farinata

Question 45

cornea farinata's degenerative pigment must be differentiated from

Answer 45

guttata. Guttata is in the endothelium. Cornea farinata is in the stroma.

Question 46

refractile, punctate, comma-shaped and filamentous amyloid deposits most common centrally and posteriorly in stroma

Answer 46

Polymorphic Amyloid Degeneration

Question 47

DDX: cornea farinata and lattice dystrophy

Answer 47

Polymorphic Amyloid Degeneration

Question 48

Polymorphic Amyloid Degeneration is associated with systemic dz

Answer 48

false. Its not associated with disease. You thinking of lattice corneal dystrophy type II with FAP.

Question 49

progressive non-inflammatory conical-shaped corneal thinning (ectasia), usually inferior to center of cornea

Answer 49

Keratoconus

Question 50

easy way to remember cornea farinata

Answer 50

it has a flower like appearance

Question 51

keratoconus is non progressive

Answer 51

false. Its progressive. Onset is young adulthood and progresses throughout life

Question 52

which of the following is not a late change of keratoconus? A. visible fleischer's ring, vogt's lines (vertical stress lines in desments membrane, increased thing of interior stroma, munsons sign, steep mires on keratometry

Answer 52

steep mires on keratometry. That’s an early change not a late change. Other early changes involve refraction too.

Question 53

corneal scarring, prominent nerves, and acuity 20/60 or worse are late changes in

Answer 53

Keratoconus

Question 54

a pertinent negative in keratoconus

Answer 54

fletchers sign

Question 55

acute corneal hydrops is an additional complication keratoconus. What are acute corneal hydrops?

Answer 55

Ruptures in Descemet’s membrane which allows aqueous fluid to invade the cornea. Management with bandage cl, pressure patch, cycloplegic and nacl 5%

Question 56

this condition has been associated with marfan syndrome, down syn, ehlers danols syndr, atic disease. Atopic kertoconjunctivies VKC, RP, and FLOPPY eyelid syndrome

Answer 56

Keratoconus

Question 57

management of keratoconus

Answer 57

spx, rgp cl, corneal intacs, corneal cross linkin, penetrating keratoplasty

Question 58

limbus to limbus corneal thinning

Answer 58

Keratoglobus

Question 59

Keratoglobus may be associated with what systemic syndrome?

Answer 59

Ehlers-Danlos syndrome

Question 60

what is true about keratoglobus?

Answer 60

treatment options are limited and not very successful

Question 61

t/f kertoglobus pts are more prone to trauma.

Answer 61

ture. They have a ectasia (cornela thining)

Question 62

narrow arcuate band of inferior corneal thinning (4-8 o clock); peripheral band of normal cornea, stoma clear

Answer 62

Pellucid Marginal Degeneration

Question 63

area of protrusion of normal cornea occurs superior to the thinning band

Answer 63

Pellucid Marginal Degeneration

Question 64

DDX for pellucid marginal degeneration

Answer 64

Keratoconus. The pellucid doesn’t have a Fletchers ring, and theing of pellucid is 4-8 o clock postion

Question 65

what type of surgery do you want to avoid in pellucid marginal degen pts?

Answer 65

refractive

Question 66

noninflammatory and asymptomatic and non progressive corneal degeneration. Is pellucid.

Answer 66

false. Marginal furrow degen is noninflamm and asymptomic. ITS also nonprogressive.

Question 67

thinning of cornea in area adjacent to limbus

Answer 67

Marginal Furrow Degeneration aka Senile Corneal Furrow degen

Question 68

Terrien’s Marginal Degeneration is more common in

Answer 68

males .

Question 69

marginal thinning of cornea with opacification and superficial vasculariation; yellow-white line (lipid deposit) noted central to thinned edge

Answer 69

Terrien’s Marginal Degeneration

Question 70

easy way to remember prllucid degener appearance

Answer 70

kissing claws

Question 71

t/f epi is intact in terriens marginal degen.

Answer 71

true . Theres no inflammation so its intact.

Question 72

what is the least appropiate option for terriens marginal

Answer 72

lamellar or pentrationg kertoplase.

Question 73

there is treatment to slow the progression of terriens marginal

Answer 73

fasle . Theres no txt for to slow its progression.

Question 74

terriens marginal degen are often asymptomatic unless astigma occurs

Answer 74

true

Question 75

elevated gray-white (or sometimes light blue) corneal nodules; single or multiple separated by clear cornea

Answer 75

Salzmann’s Nodular Degeneration

Question 76

Often found in eyes with chronic dryness or inflammation, more common in women than males

Answer 76

Salzmann’s Nodular Degeneration

Question 77

most common association of alzmann’s Nodular Degeneration (other than dryness

Answer 77

phlyctenular keratitis

Question 78

salzmanns can be asymtomatic or sympatheic. For symptomatic txt :

Answer 78

txt is lubricants, rgp cl, nodule removal (PTK, PK, LAMERLLAR, SUPERFICIAL

Question 79

band keratopathy is associated with ____ _____

Answer 79

chronic inflammation

Question 80

calcium deposits in the subepithelial space, Bowman’s layer and anterior stroma Swiss cheese appearance

Answer 80

Band Keratopathy

Question 81

band keratopathy is associated with hyerpcalceimia, hyperparathyoidism, excissive vitamin d intack, renal failure, sarcoidosis, juvenile idiopatch arthris.

Answer 81

true and there are many others.

Question 82

txt for band kertophaty

Answer 82

Ocular lubricants, Manage RCE, EDTA, Surgical

Question 83

Deposition of iron, yellowish-brown line in the corneal epithelium, Causes no symptoms. Often in the junction between middle and lower third, No clinical significance

Answer 83

Hudson Stähli Line

Question 84

chronic progressive, painful peripheral ulceration of the cornea,

Answer 84

Mooren’s Degeneration (Mooren’s Ulcer)

Question 85

Unilateral, older patients, responds well to medical treatment

Answer 85

Mooren’s Degeneration (Mooren’s Ulcer) Type 1

Question 86

Bilateral, usually younger individuals, progressive destruction of cornea despite treatment

Answer 86

Mooren’s Degeneration (Mooren’s Ulcer) Type 2

Question 87

Mooren’s Degeneration (Mooren’s Ulcer) Type 2 responds well to topical steriods and conjunctival resection.

Answer 87

FALSE. Type 1 responds well to topical steroids, type 2 of moorens ulcer has poor prognosis, reduce likilihood of perferation is all we can do.