Term
| What is the bowmann's layer and what happens when it is damaged? |
|
Definition
| Superficial layer of stroma that scars when damaged |
|
|
Term
| what are punctacte epithelial erosions? |
|
Definition
| small epithelial lesions that stain with fluorescein. Are non specific (numerous etiologies) |
|
|
Term
| Describe punctate epithelial keratitis. What kind of infection does it predominantly manifest from? |
|
Definition
-hallmark of viral disease
-granular opalescent swollen epithelial cells
-visible without stain |
|
|
Term
What are the features of Corneal Edema? |
|
Definition
-acute increase in IOP
-loss of normal corneal lustre
-may be vesicles and bullae
-could be sign of endothelial decompensation |
|
|
Term
| What do corneal filaments stain well with? |
|
Definition
| -rose bengal but not with fluorescein |
|
|
Term
What are filaments associated with?
|
|
Definition
-keratoconjunctivitis sicca
-superior limbic keratoconjunctivitis
-recurrent erosions |
|
|
Term
|
Definition
-subepithelial ingrowth of fibrosvascular tissue from limbus
-inflammatory of degenerative |
|
|
Term
|
Definition
-focal areas of active stromal inflammation
-accumulation of leukocytes and cell debris |
|
|
Term
What can cause infiltrates? |
|
Definition
-non-infectious antigen sensitivity like contact lenses or keratitis
-infectious keratitis (bacteria, virus, fungi, protozoan) |
|
|
Term
| What is a major cause of increase in corneal thickness? |
|
Definition
| -stromal edema, due to keratoconus, fuch's dystrophy, surgery |
|
|
Term
| What vessels are usually visible in stromal vascularization? |
|
Definition
|
|
Term
What are two limiting feature of topical steroids?
|
|
Definition
-limit corneal repair
-contraindicated in herpes simplex epithelial disease |
|
|
Term
| When might we use systemic immunosuppresives? |
|
Definition
-severe peripheral corneal ulceration associated with systemic connective tissue disease |
|
|
Term
| What might cause folds in descemet's membrane? |
|
Definition
| -stromal inflammation or edema |
|
|
Term
| What is usually preceded by epithelial hypoxia and/or an epithelial break? |
|
Definition
|
|
Term
| What are the features of MK on corneal tissue? |
|
Definition
| -excavation, necrosis, and infiltration |
|
|
Term
| Which bacteria can penetrate an intact epithelium |
|
Definition
|
|
Term
| Which bacteria is often found in Bacterial Keratitis? |
|
Definition
|
|
Term
| What is a likely Dx for a contact lens wearer who comes in with a painful red eye and with a white spot on their cornea? |
|
Definition
|
|
Term
| A Px comes in with a corneal infection, is a wearer of contact lenses, had a corneal trauma before and has chronic blepharitis. What is a likely Dx? |
|
Definition
|
|
Term
| What might you Diagnose a Px who comes in with moderate to sever pain, PP, blurred vision, eyelid edema, discharge? |
|
Definition
|
|
Term
| Px present with conjunctival and circumcorneal injection, epithelial defect with infiltrate, stromal edema and hypopyon. What might you suspect? |
|
Definition
|
|
Term
| What are some important management steps of BK? |
|
Definition
-no patching
-cease contact lens wear
-oral pain killers
-fluoroquinolones |
|
|
Term
| What differentiates mild bacterial keratitis Tx for CL and non-CL wearers? |
|
Definition
| -prescribe Tobramycin ointment for CL wearers. Both use fluoroquinilones |
|
|
Term
| How would you treat a Px who comes in with med. size peripheral infiltrates, epithelial defects, anterior chamber with moderate discharge? |
|
Definition
|
|
Term
| What are the most common pathogens of fungal keratitis? |
|
Definition
| -Asperigillus, fusarium, Candida |
|
|
Term
| A person comes in with keratitis and reports to have had a tree branch scrape his eye last week. What is the likley form of Keratitis? |
|
Definition
|
|
Term
| Px comes in with a mildly painful keratitis but is reduced to counting fingers. What is a likely Dx? |
|
Definition
|
|
Term
| Px has greyish stromal infiltrate, underlying endothelial plaque and hypopyon? What type Keratitis? |
|
Definition
| -fungal filamentous keratitis |
|
|
Term
| Px presents with a yellow white, densely suppurative corneal infiltrate? What possible infection? |
|
Definition
|
|
Term
| Px has keratitis with conjunctival follicular conjunctivitis. What is most likely Dx? |
|
Definition
|
|
Term
| Px has unilateral red eye, pain, photophobia, and blepharoconjunctivits, what type of infection is this? |
|
Definition
|
|
Term
| Why is it important to avoid giving steroids for HSK? What are the clinical consequences? |
|
Definition
-because it may spread
-geographic amoeboid ulcer and disciform keratitis |
|
|
Term
| Px comes in with fever, unilateral headache, blurred vision, red eye and reduced corneal sensation upon cotton wisp test. What is likely Dx? |
|
Definition
| Herpes Zoster Opthalmicus (retained in dorsal root ganglion) |
|
|
Term
| CL Px comes in with CLPU. How would you manage his CL use and what is Tx? |
|
Definition
-remove and monitor for first 24hrs
-cease wear for 3-14days
-lubricants, lid hygiene (eliminate bacteria) |
|
|
Term
| What is a localized area of corneal thinning/depression? |
|
Definition
|
|
Term
| What are some reasons/causes for dellen? |
|
Definition
-local dehydration of stroma
-poor blink
-poor tear film quality
-idiopathic |
|
|
Term
| Px comes in with Hx of chronic staph. Blepharitis, has mild corneal irritation and discomfort. Slit lamp shows sub. epith. marginal infiltrates seperated from limbus with clear zone. What is likely Dx? |
|
Definition
|
|
Term
| What is a common drug for Marginal Keratitis? |
|
Definition
| Tobradex (topical steroid and antibiotic) |
|
|
Term
| What are some signs you expect to see in Rosacea Keratitis? |
|
Definition
-marginal keratitis
-neovascularization
-inferior punctate epithelial defects |
|
|
Term
| What drugs would you use for systemic treatment of Rosacea Keratitis? |
|
Definition
-tetracycline
-doxycycline |
|
|
Term
| What topical Tx would you prescribe for rosacea keratitis? |
|
Definition
-FML, antiobiotic ointment (6weeks) and lubricants
|
|
|
Term
| Px presents with Keratitis but with no ocular finding to explain. What systemic conditions might you suspect? |
|
Definition
| Rheumatoid arthritis or systemic vasculitis |
|
|
Term
| What corneal defect might you expect in a Px on hydroxychloroquine or amiodorone? |
|
Definition
|
|
Term
| What rare disease is characterized by corneal deposits of copper? |
|
Definition
|
|
Term
| What corneal dysfunction is known for deposition of calcium salts in bowmann's membrane? What is Tx? |
|
Definition
Band keratopathy
-due to chronic keratitis or chronic uveitis, age, metabolic, or hereditary
-Tx: chelation |
|
|
Term
| Upon slit lamp examination you see what appears like an accumulation of collagen on descemets membrane. Appears wart like secreted by endothelial cells. What is this dysfunction called? |
|
Definition
|
|
Term
| You are on a mission in a developping country, and a Px presents with chronic keratitis, with elevated nodules in superficial stroma. What defect might you suspect? |
|
Definition
Salzman nodular degeneration
base of nodules may be surround by iron deposits |
|
|
Term
| What do you call a group of corneal opacifying disorders? |
|
Definition
|
|
Term
| What are the hallmarks of corneal dystrophies? |
|
Definition
-progressive
-usually bilateral
-largely genetically determined
-non-inflammatory
-onset from 1st to 4th decade |
|
|
Term
| What is the most common corneal dystrophy seen in clinical practice? |
|
Definition
| Cogan epithelial basement membrane dystrophy (aka map dot fingerprint) |
|
|
Term
| What type of dystrophy might you suspect with a Px who comes in with simultaneous bilateral recurrent corneal erosions? |
|
Definition
| EBMD (10% develop recurrent corneal erosions) |
|
|
Term
| What are classic signs of EBMD? |
|
Definition
-dot like opacities
-epithelial microcysts
-subepithelial map like matterns
-whorled fingerprint like lines |
|
|
Term
| Px comes complains of sharp pain early this morning on waking up, says that last night his brother scraped his eye with his fingernail. What might you suspect? |
|
Definition
| Recurrent Corneal Erosion |
|
|
Term
| What are the hallmarks of Fuchs endothelial dystrophy? |
|
Definition
uncommon but 3rd most common dystrophy after EBMD and keratoconus
-more common in women
-onset is old age |
|
|
Term
| Px comes in with central guttata and endothelium with beaten metal appearance. What might you suspect? |
|
Definition
| Fuchs Endothelial Dystrophy |
|
|
Term
| Px comes in with pain signs of bullae, blurred vision, central stromal edema and slight epithelial edema. What might you suspect? |
|
Definition
| Fuchs endothelial dystrophy |
|
|
Term
| What are some hallmarks of keratoconus? |
|
Definition
-thinning of central cornea
-degenerative, non inflammatory
-apex inferonasally
-variable rate of progression
-central scarring
-bilateral but asymmetrical |
|
|
Term
| Px presents with reduced vision with Spectacles, mild photobia and monocular diplopia. What might you suspect? |
|
Definition
|
|
Term
|
Definition
| bulging of lower lid in downward gaze in Pxs with keratoconus |
|
|
Term
| Upon slit lamp examination you find vogts striae and cone like appearance encircled by iron pigment. What might suspect? |
|
Definition
|
|
Term
| What can cause an increase/enlargement in epithelial defects and infiltrates? |
|
Definition
|
|
Term
| What is a key feature of Sxs of fungal keratitis when compared to BK? |
|
Definition
-they are gradual in onset
-less painful that bacterial |
|
|
Term
| What are the two forms of Acanthameoba (protozoan)? |
|
Definition
-cystic (dormant)
-trophozite (active)
-exposure to tap or stagnant water |
|
|
Term
| Which MK has a scattered dendritic like appearance (misdiagnosed as viral) and is pathognomonic for radial perineuritis? |
|
Definition
-Acanthamoeba keratitis
-look for anterior chamber activity and a ring abscess due to coalescence of infiltrates |
|
|
Term
| What does adenoviral keratitis look like and how does it present itself? |
|
Definition
-acute self resolving follicular conjunctivitis
-extrememly contagious (2-52 weeks) |
|
|
Term
| You notice superficial punctate keratitis in a Px with a history of keratitis for over 6 months. You see subepithelial infiltrates, notice reduced VA . What Dx might you suspect? |
|
Definition
-adenoviral keratitis
-epidemic keratoconjunctivitis |
|
|
Term
| What are bilateral crescent shaped lines in nasal and temporal limbus (age related degen)? |
|
Definition
|
|
Term
| What must you be wary of with recurrent bilateral corneal erosions? |
|
Definition
|
|
Term
| Where is Reis Bucklers Dystrophy? |
|
Definition
|
|
Term
| What is more likely to be a non ulcerative infectious infiltrative keratitis? |
|
Definition
|
|
Term
| What are the possible contact lens adverse reactions? |
|
Definition
-serious (MK)
-significant (CLPU, CLARE, IK, VKC)
-non-significant (AIK, AI) |
|
|
Term
| A Px has an adverse CL reaction that produces or has potential to produce significant visual impairment. What type is this? |
|
Definition
|
|
Term
| A Px has an adverse CL reactiont that warrants temporary or permanent discontinuation of CLs. What type of reaction is this? |
|
Definition
| -significant (mostly symptomatic) |
|
|
Term
| Which is the only serious CL reaction that is potentially blinding? |
|
Definition
| MK (excavation of epithelium, bowmanns, and stroma) |
|
|
Term
| What's the % of CLPUs not associated with symptoms? What are possible etiologies? |
|
Definition
-50%
etiology: bacterial contaminants, closed eye, tight lens, hypoxia, poor hygiene, solution toxcity |
|
|
Term
|
Definition
-inflammation of cornea with focal excavation of epithelium, infiltration and necrosis of anterior stroma. Bowmans intact.
-due to gram +ve exotoxins
-could be associated with URT infection |
|
|
Term
| What is contact lens induced acute red eye (CLARE)? What is Mx? |
|
Definition
-inflammation due to eye closure, with infiltrates with no epithelial involvment
-aka: acute red eye, tight lens syndrome
-Mx: avoid CL, lid hygiene |
|
|
Term
| Which CL adverse reaction shows only circum-corneal and bulbar injection, marginal infiltrates (focal/diffuse) no significant staining, and no AC activity? What is cause? |
|
Definition
-CLARE
-rarely bilateral
-due to gram -ve endotoxins
|
|
|
Term
| Which CL adverse reaction has moderate bulbar limbal redness, stromal focal infiltration, can be bilatral, with or without epithelial staining? Mx? |
|
Definition
-IK
-stop CL wear, no meds, |
|
|
Term
| What are the CL asymptomatic adverse events? |
|
Definition
-asymptomatic infiltrative keratitis
-asymptomatic infiltrates
-key is without Px signs or symptoms |
|
|
Term
| What might you suspect Px with moderate redness, multiple focal infiltrates, bilateral, minimal staining, tender PAN and with tarsal follicles? Mx? |
|
Definition
-adenoviral KC
-Mx: antivirals no value, lubricants, steroids if severe, hygiene |
|
|
Term
| When is filamentary keratitis seen? Mx? |
|
Definition
-sever dry eye Px's
-helix of mucin and dead epithelial cells,
-FB sensation
Mx: remove filaments, lubricants, vitamin A, |
|
|
Term
| What is a delayed hypersensitivity to staph and begins as a unilateral nodule at limbal margin? |
|
Definition
-phlyctenulosis
-uncommon, found in children |
|
|
Term
| What might you suspect if you see yellow material in the stroma with neovascularization? |
|
Definition
-lipid keratopathy
-causes: CL wear, rosacea, |
|
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