Exam 1 -- Corneal Endothelial Dystrophies and Other Conditions

Question 1

Fuch’s dystrophy

Subjective findings

Answer 1

• Symptomatic age 50-60
• Decreased VA, fluctuating due to edema
• Photophobia and glare
• Bullae cause painful erosion

Question 2

Fuch’s dystrophy

Objective findings

Answer 2

• Females > males
• Glutata formation
• Disrupts endothelial pump
• Stromal edema (striae, thickening)
• Epithelial edema (microcysts, bullae)
• Central corneal thickness > 600 um

Question 3

Fuch’s dystrophy

Treatment

Answer 3

• Hypertonic solution and ointment
• Hot air (hair dryer)
• Bandage CL
• Dilation
• Keratoplasty

Question 4

Congenital hereditary dystrophy

Subjective findings

Answer 4

• Decreased VA

* Can lead to blindness (epithelial caused)

Question 5

Congenital hereditary dystrophy

Objective findings

Answer 5

• Recessive: has nystagmus, congenital
• Dominant: no nystagmus, onset 1st-2nd decade
• Rare/absent endothelial cells
• Increased corneal thickness
• Edema
• Thickening of Descemet’s
• Bullae and erosions

Question 6

Congenital hereditary dystrophy

Treatment

Answer 6

• Hypertonic solution
• Keratoplasty
• Often poor results

Question 7

Posterior Polymorphous dystrophy

Subjective findings

Answer 7

• Can be asymptomatic
• Photophobia
• Foreign body sensation
• Decreased VA

Question 8

Posterior Polymorphous dystrophy

Objective findings

Answer 8

• Endothelium displays characteristics of epithelium
• Vesicular, band-like, geographic pattern of opacities on posterior cornea
• Asymmetric
• May also have iris membranes, posterior synechiae, corectopia, glaucoma
• Can lead to edema, bullae
• Usually autosomal dominant

Question 9

Posterior Polymorphous dystrophy

Treatment

Answer 9

• Lubrication
• Hypertonic solution or ointment
• Bandage CL
• Treat erosions

Question 10

Pannus

Causes

Answer 10

• Rosacea, staph hypersensitivity
• CL tight / overwear
• Phlyctenule
• Chlamydia
• SLK
• Vernal/allergic
• Herpes simplex
• Chemical burn / trauma

Question 11

Pannus

Subjective findings

Answer 11

• Asymptomatic

* Decreased VA if central

Question 12

Pannus

Objective findings

Answer 12

• Superficial vascular invasion, fibrous tissue bed
• Chronic result of inflammatory response
• At Bowman’s membrane

Question 13

Pannus

Treatment

Answer 13

• Treat underlying cause
• Discontinue / reduce CL wear
• Vasoconstrictors to reduce redness

Question 14

Pterygium

Causes

Answer 14

• Pinguecula
• Sun, wind, dust exposure
• Higher prevalence in populations near equator (Latino)

Question 15

Pterygium

Subjective findings

Answer 15

• Possible reduced VA

* Irritation (dry gritty eyes)

Question 16

Pterygium

Objective findings

Answer 16

• “Wing” of elevated conjunctival tissue
• Becomes inflammed (red)
• Irregular astigmatism
• Corneal distortion

Question 17

Pterygium

Treatment

Answer 17

• Protect eyes (sunglasses, goggles, hat)
• Lubricants / ointments
• Vasoconstrictor
• NSAID
• Mild steroid
• Surgical removal if near visual axis (can recur)

Question 18

Interstitial keratitis

Causes

Answer 18

• 90% caused by syphillis (congenital [bilateral] or acquired [unilateral])
- Acute form 5-15 years after systemic infection
- Congenital form can present at age 15
• TB (unilateral, sectoral)
•Cogan’s syndrome
•Leprosy
• Herpes simplex
• Lyme disease

Question 19

Interstitial keratitis

Subjective findings

Answer 19

• Redness
• Pain
• Decreased VA

Question 20

Interstitial keratitis

Objective findings

Answer 20

• Unilateral, may become bilateral
• Triad: 
   - Stromal infiltration, haze and edema
   - Stromal thinning
   - Neovascularization
• Beaded corneal nerves
• Nodules on iris
• Iritis
• Conjunctivitis / episcleritis
• Salt-and-pepper retinopathy
• Hutchinson's triad for congenital form:
   - Notched incisor teeth
   - Deafness (Cogan's)
   - interstitial keratitis

Question 21

Interstitial keratitis

Treatment

Answer 21

• Acute
   - Cycloplegic
  - Steroid
   - Glaucoma meds if elevated IOP
   - Treat underlying disease
• Chronic
   - Corneal transplant
   - Refer to ENT or rheumatologist

Question 22

Recurrent Corneal Erosion

Causes

Answer 22

• Injury, iatrogenic, corneal dystrophies, diabetes
• Damage to epi BM or Bowman’s layer causes weakening or loss of epithelium-stroma adhesions
• BM repair requires 2-3 months

Question 23

Recurrent Corneal Erosion

Subjective findings

Answer 23

• Pain waking up or rubbing eyes
• Sandy gritty irritation
• FB sensation
• Lid spasms
• Photophobia
• Decreased VA

Question 24

Recurrent Corneal Erosion

Objective findings

Answer 24

• Loose rough epithelium
• NaFl lightly outlines area, stains brightly if epithelial defect
• Dots, fingerprint, map patterns suggest EBMD or Fuchs
• Stromal edema
• Anterior chamber reaction

Question 25

Recurrent Corneal Erosion | Treatment

Answer 25

* Cycloplegic *  Bandage CL *  Antibiotic * Steroid * Sunglasses / hat * Hypertonic solution *  Lubrication * Corneal epi debridement * Anterior stromal puncture *  Phototherapeutic keratectomy