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OPT 631 > Exam 1 -- Corneal Degenerations, ICE, and Corneal Pigmentations > Flashcards

Exam 1 -- Corneal Degenerations, ICE, and Corneal Pigmentations Flashcards

(114 cards)

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1
Q

Arcus (Senilis)

Etiology/Cause

A 
• Very common
- 50% by age 50
- 100% by age 80
• More common in African-Americans
• Hyperlipidemia
• High cholesterol
• If under 40, possible CV disease
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2
Q

Arcus (Senilis)

Location

A
  • Bowman’s

* Limbus

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3
Q

Arcus (Senilis)

Objective findings

A 
• Bilateral
• 1-2mm white band mid-periphery
• Cholesterol / lipid deposition 
• Gradual onset
   - Starts superior and inferior
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4
Q

Arcus (Senilis)

Subjective findings

A

Asymptomatic

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5
Q

Arcus (Senilis)

Diagnosis/Treatment

A
  • Refer if under 40 / haven’t been to PCP in 2 years

* Annual follow up if no risk factors

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6
Q

Limbal Girdle of Vogt

Etiology/Cause

A
  • Degeneration of collagen fibers
  • Type 1 associated with band keratopathy
  • Age 45+
  • Women > men
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7
Q

Limbal Girdle of Vogt

Location

A

• Nasal and temporal limbus

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8
Q

Limbal Girdle of Vogt

Objective findings

A
  • Bilateral
  • White line at limbus
  • Avascular
  • Type 1: see clear zone between limbus and line
  • Type 2: no clear zone
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9
Q

Limbal Girdle of Vogt

Subjective findings

A

• Asymptomatic

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10
Q

Limbal Girdle of Vogt

Diagnosis/Treatment

A
  • Type 1: treatment for band keratopathy

* Type 2: nothing

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11
Q

Dellen

Etiology/Cause

A

• Dryness

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12
Q

Dellen

Location

A
  • Often adjacent to pinguecula / conjunctival mass
  • Up to 1/2 corneal thickness
  • Epithelium intact
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13
Q

Dellen

Objective findings

A
  • Focal peripheral thinning near limbus
  • 0.5-1mm, edges sloped or steeply defined
  • Surrounding tissue may be hazy
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14
Q

Dellen

Subjective findings

A
  • Asymptomatic

* Any age

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15
Q

Dellen

Diagnosis/Treatment

A
  • Lubrication

* Bandage CL

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16
Q

Hassall-Henle Bodies

Etiology/Cause

A

• Age

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17
Q

Hassall-Henle Bodies

Location

A

• Descemet’s

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18
Q

Hassall-Henle Bodies

Objective findings

A
  • Small round thickenings in Descemet’s membrane, endothelial displacement
  • Maybe corneal edema
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19
Q

Hassall-Henle Bodies

Subjective findings

A

• Asymptomatic

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20
Q

Hassall-Henle Bodies

Diagnosis/Treatment

A
  • Peripheral gluttata if in periphery
  • DDx Fuch’s if central
  • No treatment
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21
Q

Pellucid Marginal Degeneration

Location

A

• Inferior cornea

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22
Q

Pellucid Marginal Degeneration

Objective findings

A
  • Bilateral inferior corneal thinning
  • Central cornea buldges out
  • Irregular ATR astigmatism
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23
Q

Pellucid Marginal Degeneration

Subjective findings

A
  • Usually asymptomatic

* Decreased VA

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24
Q

Pellucid Marginal Degeneration

Diagnosis/Treatment

A
  • Topography shows kissing birds or crab claw
  • Correct astigmatism with gas permeable CL
  • Keratoplasty
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25
Terrien's Marginal Degeneration | Etiology/Cause
• Rare, 75% males, any age
26
Terrien's Marginal Degeneration | Location
* Stroma | * Begins superior nasal
27
Terrien's Marginal Degeneration | Objective findings
*  Bilateral but asymmetric * Marginal stromal thinning *  Opacification, neovascularization *  Irregular astigmatism *  Minor trauma may cause rupture
28
Terrien's Marginal Degeneration | Subjective findings
* Maybe pain | *  Decreased VA
29
Terrien's Marginal Degeneration | Diagnosis/Treatment
*  Steroids | *  Keratoplasty
30
(Marginal) Furrow Degeneration | Etiology/Cause
*  Idiopathic | * Systemic disease (RA, SLE, leukemia, PAN, TB)
31
(Marginal) Furrow Degeneration | Location
• Stroma
32
(Marginal) Furrow Degeneration | Objective findings
``` • Idiopathic - Bilateral thinning with Arcus - Epithelium intact - No neovascularization • With systemic disease - Ring ulcer ```
33
(Marginal) Furrow Degeneration | Subjective findings
• VA not affected
34
(Marginal) Furrow Degeneration | Diagnosis/Treatment
* None | * Treat systemic cause
35
Mooren's Ulcer | Etiology/Cause
* Males > females * Severe form in Nigerians * Possible autoimmune reaction
36
Mooren's Ulcer | Location
• Epithelium and stroma
37
Mooren's Ulcer | Objective findings
* Older pts: unilateral * Young pts: bilateral 25% * Begins with marginal infiltrate, progresses to limbal ulceration *  3-12 month course with remissions *  Minor trauma may cause perforation * Adjacent conjunctiva injection and neovascularization
38
Mooren's Ulcer | Subjective findings
• Pain, photophobia
39
Mooren's Ulcer | Diagnosis/Treatment
* An infectious ulcer would not cause thinning * Old patients usually respond to treatment *  Young patients difficult to manage * Steroids may speed perforation * Refer to corneal specialist for conjunctiva excision and corneal reconstruction
40
Posterior Crocodile Shagreen | Location
• Descemet's membrane
41
Posterior Crocodile Shagreen | Objective findings
* Bilateral | *  Small grey polygonal "crocodile skin" patches of various sizes
42
Posterior Crocodile Shagreen | Subjective findings
• Asymptomatic
43
Posterior Crocodile Shagreen | Diagnosis/Treatment
• None
44
Amyloid Degeneration | Etiology/Cause
• Secondary to long term disease (trachoma, glaucoma, uveitis, bullous keratopathy)
45
Amyloid Degeneration | Location
• Epithelium and Bowman's
46
Amyloid Degeneration | Objective findings
* Fleshy mass, nodular surface * Pink/yellow/white *  Neovascularization
47
Amyloid Degeneration | Diagnosis/Treatment
* Primary cause prevention (usually too late) * Keratectomy * Corneal transplant
48
Coats White Ring | Etiology/Cause
• Foreign body
49
Coats White Ring | Location
• Epiethlium, but left intact
50
Coats White Ring | Objective findings
* Granular whitish oval ring in cornea (possibly lipid in nature) * May contain iron
51
Coats White Ring | Subjective findings
• Asymptomatic
52
Coats White Ring | Diagnosis/Treatment
• None
53
Band Keratopathy | Etiology/Cause
``` • Calcium deposits • Secondary to ocular inflammation - Chronic anterior uveitis, prolonged glaucoma, phthisis bulbi • Secondary to systemic disease - Hypercalcemia conditions - Autoimmune ```
54
Band Keratopathy | Location
• Bowman's, anterior stroma
55
Band Keratopathy | Objective findings
• White/yellow deposits
56
Band Keratopathy | Subjective findings
* Early stages asymptomatic * Later decreased VA * Pain with recurrent corneal erosion in late stages
57
Band Keratopathy | Diagnosis/Treatment
* Refer if systemic *  Lubrication * Chelating agents (EDTA), scrape off
58
Bullous Keratopathy | Etiology/Cause
• Long term prolonged corneal edema
59
Bullous Keratopathy | Objective findings
• Bubbling of cornea, break down and reform, eventually scar
60
Bullous Keratopathy | Subjective findings
• Acute, painful
61
Bullous Keratopathy | Diagnosis/Treatment
* Antiedema treatment *  Early: bandage CL * Late: treat symptoms, poor prognosis
62
Salzmann's Nodular Degeneration | Etiology/Cause
* Females > males | * Related to previous inflammations, especially phlyctenular disease
63
Salzmann's Nodular Degeneration | Location
• Mid-periphery
64
Salzmann's Nodular Degeneration | Objective findings
* Not inflammatory *  Multiple bluish-white nodules, usually mid periphery *  Bilateral
65
Salzmann's Nodular Degeneration | Subjective findings
* Asymptomatic | *  VA depends on location
66
Salzmann's Nodular Degeneration | Diagnosis/Treatment
* Asymptomatic: monitor 3-6 months *  With epithelial breakdown: bandage CL, antibiotic qid *  Keratoplasty
67
Xeropthalmia / Keratomalacia | Etiology/Cause
• Vitamin A deficiency
68
Xeropthalmia / Keratomalacia | Objective findings
``` • Xeropthalmia - Keratinization of epithelium - Atrophy of conj goblet cells - Corneal edema - Neovascularization • Keratomalacia - Corneal tissue liquefaction • Both can have Bitot spots ```
69
Xeropthalmia / Keratomalacia | Diagnosis/Treatment
• Vitamin A supplement, ocular changes may reverse
70
``` Iridocorneal Endothelial (ICE) Syndrome Etiology/Cause ```
``` • Females > males • Unilateral • Abnormal endothelium - Endothelium proliferates, migrates into angle and onto iris - Causes angle closure glaucoma ```
71
``` Iridocorneal Endothelial (ICE) Syndrome General objective findings ```
• Corectopia • Pseudopolycoria in a previously normal iris • Iris atrophy • Corneal endothelial abnormalities - Hammered appearance similar to Fuch's - Corneal edema due to endothelial defects
72
Iridocorneal Endothelial (ICE) Syndrome Chandler's Syndrome IOP, Corneal Edema, Corectopia, Glaucoma Prevalence
IOP: Normal to high Corneal Edema: Moderate to severe Corectopia: Mild to moderate Glaucoma Prevalence: ~5%
73
Iridocorneal Endothelial (ICE) Syndrome Cogan-Reese Syndrome IOP, Corneal Edema, Corectopia, Glaucoma Prevalence
IOP: Usually high Corneal Edema: Mild to moderate Corectopia: Moderate to severe Glaucoma Prevalence: ~50%
74
Iridocorneal Endothelial (ICE) Syndrome Progressive Iris Atrophy IOP, Corneal Edema, Corectopia, Glaucoma Prevalence
IOP: Usually high Corneal Edema: Mild to moderate Corectopia: Moderate to severe Glaucoma Prevalence: ~37%
75
Kruckenberg's Spindle | Causes
• Old uveitis or pigment dispersion syndrome
76
Kruckenberg's Spindle | Location
*  Inferior 1/3 to 1/2 | * Posterior cornea
77
Kruckenberg's Spindle | Appearance
* Brown | * Vertical spindle shaped
78
Vortex Keratopathy | Causes
* Fabry Disease | *  Drugs: amiodarone, hyrdoxychloroquine, indomethacin, tamoxifen
79
Vortex Keratopathy | Location
* Epithelium | *  Below pupil
80
Vortex Keratopathy | Appearance
* Grey/gold | * Swirl pattern
81
Arlt's Triangle | Causes
• Old uveitis
82
Arlt's Triangle | Location
* 6:00 position | * Posterior cornea
83
Arlt's Triangle | Appearance
* Brown | *  Triangular shaped
84
Brawny Cornea | Causes
*  EBMD | * RCE
85
Brawny Cornea | Location
• Epithelium
86
Brawny Cornea | Appearance
* Brown | *  Edematous haze
87
Ferry's Ring | Causes
• Glaucoma surgery
88
Ferry's Ring | Appearance
* Orange/brown | * Iron deposition around surgical filtration bleb
89
Fleisher's Ring | Causes
• Keratoconus
90
Fleisher's Ring | Appearance
* Orange | *  Iron deposition at base of cone
91
Goar's line | Causes
• Pigmentary glaucoma
92
Goar's line | Location
• Inferior cornea
93
Goar's line | Appearance
*  Brown | * Horizontal line
94
Hemosiderosis | Causes
* Hyphemia | *  Intracorneal bleeding, neovascularization
95
Hemosiderosis | Location
• Intracorneal or posterior corneal surface
96
Hemosiderosis | Appearance
* Red/brown | * Blood stain
97
Hudson-Stahli line | Causes
* Males > females | *  Frequency increases with age
98
Hudson-Stahli line | Location
* Upper and lower lid junction | *  Bowman's
99
Hudson-Stahli line | Appearance
* Orange/brown *  Segmented or continuous line *  May be surrounding opacity * Frequent site of RCE
100
Kaiser-Fleisher Ring | Causes
• Wilson's disease
101
Kaiser-Fleisher Ring | Location
* Posterior cornea | * Anterior angle
102
Kaiser-Fleisher Ring | Appearance
* Orange * Copper deposition * Best seen with gonioscopy
103
Keratic Precipitates | Causes
* Uveitis | *  Trauma
104
Keratic Precipitates | Location
• Endothelial surface
105
Keratic Precipitates | Appearance
• White or pigmented
106
Keratomelanocytosis (Striate Melanokeratosis) | Causes
* Trauma *  Infection * Staph *  Most in patients with high pigment
107
Keratomelanocytosis (Striate Melanokeratosis) | Location
* Limbus | * Most at 4:00 and 8:00
108
Keratomelanocytosis (Striate Melanokeratosis) | Appearance
• Pigmented spokes radiating out into cornea from limbus
109
Salmon Patch | Causes
• Syphilitic keratitis
110
Salmon Patch | Location
• Mid-stroma
111
Salmon Patch | Appearance
* Orange | * Discoloration of mid-stroma, interstitial keratitis
112
Stocker's line | Causes
• Pterygium
113
Stocker's line | Location
• Leading edge of pterygium
114
Stocker's line | Appearance
*  Orange | *  Iron deposition

OPT 631 (5 decks)

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