Corneal Degeneration Flashcards Preview

Ocular Disease > Corneal Degeneration > Flashcards

Flashcards in Corneal Degeneration Deck (75)
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1
Q

What is represented in this picture?

A

Crocodile Shagreen with plaques of fibrous tissue

2
Q

Why does arcus occur?

A

There are lipid/cholesterol deposits in Bowman’s

3
Q

What does the lucid interval in arcus mean?

A

The superficial lipid deposition ends at Bowman’s layer so it won’t go into the limbus.

4
Q

What is Type I Limble Girdle of Vogt?

A

Lucid interval where deposition ends at Bowman’s, looks like swiss cheese holes with sharp edges centrally.

Early form of band keratopathy.

5
Q

What is type II Limble Girdle of Vogt?

A

True Vogt’s

Goes to limbus because of elastoid degeneration of subepithelial collagen

Extensions centrally

6
Q
A

Vogt I

7
Q
A
8
Q
A

Vogt I and Calcified Scleral Plaque

9
Q

What is Farinata?

A

White dust like particles pre-Descemet’s with aging

10
Q

What is Furrow Degeneration?

A

Non inflammatory mild thinning with occasional vessel extensions

11
Q

What disease is in this picture?

A

Terrien’s Marginal Deneration

12
Q

How does Terrien’s Marginal Degeneration present?

A

Asymtomatic

Bilateral

Epithelium Intact

Marginal opacification with superficial vascularization

Young adult to elderly

13
Q

How does the peripheral thinning of the cornea progress in Terrien’s Marginal Degeneration and what other complications occur with it?

A

Starts in the peripheral corneal stroma superior-nasal then goes circumferential

Astigmatism and rarely perforation

14
Q

What percent of terrien’s patients are male?

A

75%

15
Q

At what age does Terrien’s Marginal Degeneration onset?

A

Young adult to elderly

16
Q

What is a differential diagnosis to Terrien’s Marginal Degeneration?

A

Mooren’s Ulcer

17
Q

What is shown in these photo’s of Terrien’s Marginal Degeneration?

A

Vascularizatio and a Pseduo-pterygium

18
Q

What is this disease?

A

Mooren’s Ulcer

19
Q

What are the signs and symptoms of Mooren’s ulcer?

A

Painful

Red Eye

Photophobia

Typically progressive near the limbus

Thinning

Stromal melting

Potential perforation

20
Q

What is Mooren’s Type I?

A

Typically older patients, unilateral and responds well to treatment

21
Q

What is Mooren’s type II?

A

Younger (indian/african) 20-30 yr old, bilateral and poor response to treatment.

22
Q
A

Mooren’s Ulcer

23
Q

How do you differentiate between Terrien’s and Mooren’s Ulcer?

A

Terrien’s Does Not/Is Rarely

Stain w/ NaFl

Painful/Inflammatory

Aggressive

Moves Centrally

Perforates

24
Q

What must you do if you suspect vasculitis or collagen vascular disease?

A

You must do a mandatory referral to rheumatology for a systemic work up.

25
Q

What is the course of treatment for Mooren’s Ulcer?

A

Nothing well established and mostly supportive

Conjunctival resection, radiation

Bandage CL

Topical steroid, cyclosporine or systemic immunosuppression

If perforation: treat with cyanoacrylate or lamellar keratoplasty

26
Q

What autoimmune diseases is Peripheral Ulcerative Keratitis associated with?

A

Rheumatoid Arthritis

Wegener’s Granulomatosis

et al

27
Q

What is Limbal Crescent Ulceration and what disease is it associated with?

A

It is associated with Peripheral Ulcerative Keratitis (PUK)
It includes an epithelial defect, thinning

Progresses circumferentially & maybe centrally, with potential extensions into sclera

Risk of progressing rapidly to perforation

28
Q

What disease is Peripheral Ulcerative Keratitis usually associated with?

A

Episcleritis or Scleritis

29
Q

What is the main treatment for Peripheral Ulcerative Keratitis?

A

Rheumatology referral to confirm for systemic immunosuppression

30
Q

What can you not treat Peripheral Ulcerative Keratitis with?

A

Topical Steroids

31
Q

How does polymorphic amyloid degeneration present?

A

Deep stroma, bilateral appears similar to Lattice Dystrophy

32
Q
A

Spheroidal Degeneration

33
Q
A

Salzmann’s Nodular Degeneration

34
Q
A

Salzmann’s Nodular Degeneration

35
Q

How does Salzmann’s normally present?

A

> females

> 50 yo

May be inflammatory

Dry Eye Symptoms

Decreased VA if central

Irregular astigmatism

36
Q

What are the Salzmann’s nodules made of?

A

Hyaline nodules that replace Bowman’s that are elevated, and bluish white

37
Q

What is Salzmann’s Nodular Degeneration often associated with?

A

Chronic ocular surface disease and/or previous inflammation, especially viral

There is rarely no clear history of preceding eye disease

38
Q

How do you manage Salzmann’s Nodular Degeneration?

A

Lubricants, steroid if inflammed, bandage contact lenses

Severe Cases: nodules can be removed by corneal specialist, penetrating keratoplasty

39
Q
A

Band Keratopathy

40
Q

What is band keratopathy?

A

Interpalpebral Ca++ deposits in Bowman’s with clear zone seperating the limbus

41
Q

Why does Band Keratopathy have a swiss cheese appearance?

A

Clear areas and small circular areas where nerve endings perforate the Bowman’s layer are seen within the band.

42
Q

How to differentiate between Vogts and Band Keratopathy?

A

Vogt’s II: no lucid interval, no swiss cheese, bilateral, does not spread across central cornea

Vogt’s I: very similar but doesn’t cross centrally

43
Q
A

Band Keratopathy

44
Q

How should you treat and manage Band Keratopathy?

A

Monitor

Ocular Lubricants for mild cases

Refer for hypercalcemic work up by PCP

Severe Cases: Chelation using 2% EDTA

PTK: Phototherapeutic keratectomy (excimer laser)

45
Q

What is Phthsis Bulbi?

A

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

46
Q

How does Keratoconus present?

A

Bilateral: Forme fruste

After puberty it progresses then stabilizes

Greater in asians

Greater association with Down’s, Ehlers-Danlos, Marfan’s

Oculodigital Sign

47
Q
A

Keratoconus

48
Q
A

Keratoconus

49
Q

What kind of pathologies are often associated with Keratoconus?

A

Irregular epithelium

Breaks in Bowman’s

Fibrosis beneath epithelium

Stromal scarring

Corneal thinning

50
Q

What kind of test results will make you think Keratoconus? (K values, astimatism, etc.)

A

Keratometry >47.2

Inferior steepening 1.2D > superior

Skewing of axis of astigmatism > 21 degrees

51
Q

What is Charleaux’s Sign?

A

Oil droplet sign upon retroillumination

52
Q

What sign is this?

A

Rizutti’s sign (triangle of light on distal iris)

53
Q

What sign is this?

A

Munson’s sign

54
Q

What is in this picture and which one can be reduced with digital pressure?

A

Vogt Striae and Fleischer Ring

Vogt Striae can be reduced with digital pressure

55
Q
A

Fleischer ring under cobalt blue light

56
Q
A

Prominent corneal nerves

57
Q

How to treat keratoconus?

A

Appropriate optical correction

Speciatly RGP, cleral RPG, hybrid CL
Penetrating keratoplasty (20%)

Intacts

Collagen Crosslinking

58
Q

How do you NOT treat keratoconus?

A

Refractive surgery

59
Q
A

Intacs

60
Q
A

Corneal Hydrops

61
Q
A

Corneal Hydrops

62
Q

What are corneal hydrops?

A

Acute break in Descemet’s

63
Q

What are the yellow and red arrows pointing at?

A

Red = break in Descemet’s

Yellow = corneal edema

64
Q

How does Posterior Keratoconus present?

A

Posterior curvature increase

Normal anterior surface

Non-inherited

Unilateral

Non-progressive

Females >> male

65
Q

Keratoglobus

A

Bilateral

Congenital or Aquired

Diffuse corneal thinning > peripherally

66
Q

Where does Pellucid Marginal Degeneration most often occur?

A

Inferior limbus from 4:00 to 8:00

67
Q

What is a name for how the cornea looks while affected by Pellucid Marginal Degeneration?

A

“Pot belly” cornea

68
Q

What kind of topography pattern will be seen with Pellucid Marginal Degeneration?

A

“kissing dove” topography pattern

69
Q
A

Pellucid Marginal Degeneration

70
Q
A

Pellucid Marginal Degeneration

71
Q
A

Pterygium

72
Q
A

Pinguecula

73
Q

What is this pterygium related feature?

A

The Pterygium Stocker Line

74
Q
A

Hudson-Stahli Line

75
Q
A

Iron Lines