Exam 1 -- Corneal Dystrophies

Question 1

Epithelial Basement Membrane Dystrophy (EBMD)

Subjective findings

Answer 1

• Mild
   - Asymptomatic
   - Irritation when waking up
•Moderate
   - Irritation may wake them up
   - Transient visual fluctuations
   - Photophobia, glare
• Severe
   - History of spontaneous recurrent corneal erosions
   - Reduction in VA

Question 2

Epithelial Basement Membrane Dystrophy (EBMD)

Objective findings

Answer 2

• TBUT instantaneous
• Maps: gray, geographic patterns, 1-3mm
• Dots: gray/clear round spots, clustered,

Question 3

Epithelial Basement Membrane Dystrophy (EBMD)

Treatment

Answer 3

• Chronic, no cure, treat symptoms
• Mild: hypertonic ointment at night, lubrication
• Moderate: hypertonic solution and ointment, bandage CL, antibiotic, homatropine, diclofenac, lid hygiene
• Severe: anesthetic, bandage CL, hypertonic solution, antibiotic
• Surgical: anterior stromal puncture, lamellar keratectomy, phototherapeutic keratectomy

Question 4

Meesman’s Juvenile Epithelial Dystrophy

Subjective findings

Answer 4

•Only slight decrease in VA

Question 5

Meesman’s Juvenile Epithelial Dystrophy

Objective findings

Answer 5

• Intraepithelial cysts / veicles
• Irregular astigmatism
• Onset: early childhood to 2 years
• May have epithelial erosions after age 40

Question 6

Meesman’s Juvenile Epithelial Dystrophy

Treatment

Answer 6

• Treat symptoms

Question 7

Reis-Buckler’s Dystrophy

Subjective findings

Answer 7

• Painful RCE

* Decrease in VAs by age 20-30

Question 8

Reis-Buckler’s Dystrophy

Objective findings

Answer 8

• Grey-white irregular opaque pattern in Bowman’s, may project into epithelium
• Mottled fish-net appearance
• Causes anterior stromal opacification

Question 9

Reis-Buckler’s Dystrophy

Treatment

Answer 9

• Treat erosions

* Keratoplasty

Question 10

Anterior Mosaic Dystrophy

Subjective findings

Answer 10

• VA not affected

Question 11

Anterior Mosaic Dystrophy

Objective findings

Answer 11

• Gray polygonal opacities

* True dystrophy or age-related process?

Question 12

Granular dystrophy

Subjective findings

Answer 12

• VA gradually drops by age 60

Question 13

Granular dystrophy

Objective findings

Answer 13

• Before age 10
• Round oval white spots
• Increase, enlarge, and coalesce

Question 14

Granular dystrophy

Treatment

Answer 14

• Keratoplasty

Question 15

Lattice dystrophy

Subjective findings

Answer 15

• VA good early on

Question 16

Lattice dystrophy

Objective findings

Answer 16

• Anterior stromal lines
• Dots, flakes, stellate opacities between lines
• Thickens and creates stromal haze
• Can have RCE

Question 17

Lattice dystrophy

Treatment

Answer 17

• Treat erosions

* Keratoplasty usually by age 40

Question 18

Crystalline dystrophy

Subjective findings

Answer 18

• VA not affected

Question 19

Crystalline dystrophy

Objective findings

Answer 19

• White/yellow crystals form a ring
• Cholesterol crystals
• Dense arcus by 30-40
• May see xanthelasma
• Assoicated with hypercholesterolemia

Question 20

Crystalline dystrophy

Treatment

Answer 20

• Referral for CV workup

Question 21

Macular dystrophy

Subjective findings

Answer 21

• VA drops substantially by age 30

Question 22

Macular dystrophy

Objective findings

Answer 22

• Stroma invaded by mucopolysaccharide
• Diffuse corneal clouding by age 5-9, involves full thickness by teens
• Gluttata possible

Question 23

Macular dystrophy

Treatment

Answer 23

• Keratoplasty

Question 24

Keratoconus

Subjective findings

Answer 24

• Slow reduction of VA
• Starts age 15-25, progresses 5-6 years
• Glare, photophobia
• Diplopia

Question 25

Keratoconus | Objective findings

Answer 25

* Frequent Rx changes * Scissors reflex on ret, oil drop reflex with o-scope *  Steeper K's, mires distorted *  Better VA with contacts *  Inferior central thinning *  Topogrophy shows steep inferior central cornea *  Munson's sign * Fleisher's ring *  Vogt's striae *  Perforation and hydrops

Question 26

Keratoconus | Treatment

Answer 26

* RGP and specialty CL * Treat edema * Keratoplasty

Question 27

Which of the corneal dystrophies affect the epithelium?

Answer 27

Epithelial Basement Membrane Dystrophy (EBMD) | Meesman's Juvenile Epithelial Dystrophy

Question 28

Which of the corneal dystrophies affect Bowman's layer?

Answer 28

Reis-Buckler's Dystrophy | Anterior Mosaic Dystrophy

Question 29

Which of the corneal dystrophies affect the stroma?

Answer 29

Anterior Stromal: - Granular Dystrophy - Lattice Dystrophy - Crystalline Dystrophy Full thickness stromal: -Macular Dystrophy

Question 30

Which corneal condition is considered ectatic?

Answer 30

Keratoconus