Professional Documents
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Flashcards Cornea
Flashcards Cornea
;"Causes
• Enterovirus type 70
• Coxsackie A24
• Adenovirus type 11
Associations
• Follicular conjunctivitis
• Subconjunctival hemorrhage"
What is the percentage of patients with conjunctival lymphoid tumor that have
extraocular lymphoma?;"• 20%
• Non-Hodgkin's B cell
• Most common in > 50 years old or
immunocompromised"
What is the inheritance pattern and extraocular malignancies associated with ataxia
telangiectasia?;"• Autosomal recessive
• Increased risk of breast cancer and T cell leukemia"
What is the most common branch of cranial nerve V1 involved in herpes zoster
infection?;"• V1 frontal branch"
What are the causes of enlarged and prominent corneal nerves?;"○ Enlarged corneal
nerves
• Multiple endocrine neoplasia (MEN) type 2B
• Medullary carcinoma of thyroid gland, pehochromocytoma, mucosal neuromas,
marfanoid habitus
• Phytanic acid storage disorder (Refsum disease)
• Leprosy (Hansen disease)
• Familial dysautonomia (Riley-Day syndrome)
• Neurofibromatosis
• Acanthamoeba perineuritis
○ Prominent corneal nerve
• Keratoconus
• Ichthyosis
• Fuch’s corneal dystrophy
• Corneal edema
• Congenital glaucoma"
What are the surgical risk factors in posterior polar cataract and Mittendorf dot
cataract?;"• Risk of posterior capsule breaks
• Avoid hydrodissection, instead perform
hydrodelineation"
What does tear osmolarity measure and how is it affected in dry eye?;"• Measures
aqueous tear deficiency
• Elevated in aqueous tear deficiency (>300 mOsm/L)
• This test is not necessarily diagnostic of dry eye in
isolation
• There can be variable results at the same appointment
• Results should be considered in context of clinical signs"
What are the signs of cornealc edema?;"• Waite-Beetham lines = faint deep stromal
wrinkles,
early sign
• D-folds = stroma increased thickness 10% or more"
Which protein does TGFB1 gene code for and which chromosome is it located on?;"•
Keratoepithelin
• Chromosome 5q31"
What are the causes of neurotrophic ulcers?;"• Topical medications: beta blockers,
CAIs, NSAIDs,
trifluridine
• Topical anesthetic abuse
• Corneal HSV/VZV – zoster with patchy hypoesthesia
• BAK preservative
• CN V palsy (surgery for trigeminal neuralgia) - diffuse
hypoesthesia
• Diabetes
• Chronic contact lens wear
• LASIK
• Familial dysautonomia (""Riley-Day syndrome"")
• Leprosy"
What are ideal methods to obtain corneal bacterial cultures?;"• Best by platinum
Kimura spatula (heats and cools
rapidly)
• Also, metal blade, calcium alginate, Dacron swab"
What are the least ideal methods to obtain corneal bacterial cultures?;"• Cotton
swabs, can inhibit growth"
What is the best way to obtain corneal viral cultures?;"• Dacron swab
• Calcium in calcium alginate and wood from cotton
swab can inhibit viral recovery"
What is the best way to obtain anaerobic bacteria culture?;"• Thioglycolate broth"
What is the best way to obtain aerobic bacteria culture?;"• Blood agar
• Chocolate agar
• Thioglycollate broth (also for anaerobic bacteria)"
What is the best way to culture mycobacteria and Nocardia species?;"• Lowenstein
Jensen"
Which systemic infection is Mooren-like PUK ulcer associated with?;"• Hepatitis C"
What is the prevalence of the 3 main corneal stromal dystrophies?;"• Most common –
Granular
• 2nd most common – Lattice
• 3rd most common - Macular"
What corneal findings are associated with birth trauma?;"• When forceps are used,
compression of globe
vertically which stretches the cornea horizontally
• Vertical pattern of Descemet's tears
• Left eyes are more commonly affected than right eye
• Usually unilateral
• Differential diagnosis includes PPMD, the edges are
scalloped with wide endings, in Haabs striae the
borders are smooth with tapered ends"
What is the most common risk factor for fungal keratitis?;"• Trauma with vegetable
matter"
What are normal age-related endothelial cell counts?;"• At birth: approx. 4,000
• Young adults: approx. 3,000
• 60 years: approx. 2,500
• Cell count decreases linearly until age 60 years, then
slower rate"
What are conjunctival papillae?;"• Central vascular tuft represented by ""red dot""
in the
middle of the bump, surrounded by edema and
inflammation"
What are corneal stem cells?;"• Located at limbus, in palisades of Vogt region
• Radially oriented fibrovascular ridges, perpendicular to
corneal margin
• More concentrated in the inferior and superior limbus
• Limbal stem cells from palisades migrate centripetally
to create basal epithelial level"
What is associated with unilateral arcus senilis in an young patient (<40 years
old)?;"• Hyperlipoproteinemia (check lipid panel)"
What is the most detrimental type of corneal graft rejection?;"• Endothelial graft
rejection, leads to inflammation and
death of grafts endothelial cells. Because they cannot
replace themselves, this types of rejection is most
detrimental
• Also most common type of corneal graft rejection"
What is the least detrimental type of corneal graft rejection?;"• Epithelial and
stromal rejection
• Treated with topical steroids
• Once inflammation resolved, corneal epithelium and
stroma generally return to normal"
What is a Fleischer ring?;"• Iron line deposited at the base of the cone
• Landmark for peripheral edge of cone
• Use cobalt blue light to detect early signs
• Seen in keratoconus"
What is the ocular effect of the Dieffenbachia plant?;"• House plants that contain
needle shaped calcium
oxalate crystals – raphides
• Cause acute keratoconjunctivitis associated needle-like
crystals in the cornea when sap of this plant gets into
eyes"
What are the risk factors for graft rejection?;"• Deep stromal neovascularization
• Peripheral corneal thinning
• Ocular surface disease"
What is Peters plus syndrome?;"• Peters anomaly with the addition of systemic
defects:
congenital brain defect, heart defects, craniofacial
anomalies"
What are the different types corneal iron lines?;"• ""Ferry's line"" = leading edge
of filtering bleb
• ""Fleischer ring or line"" = base of cone in keratoconus
• ""Stocker's line"" = leading edge of pterygium
• ""Hudson-Stahli line"" = upper border of normal tear
lake (elderly pts)"
What is the immune privilege of the cornea?;"• Responsiveness to foreign antigens
is relatively
suppressed due to the following
• Absence of blood vessels and lymphatics
• Expression of immunosuppressive factors
• Increased expression of Fas ligand (CD95)
• Down regulation of MHC molecules"
What is the threshold tear meniscus below which is considered abnormal and a sign
of dry eye?;"• 0.3 mm"
What is the corneal vertex?;"• Point located at the intersection of the line of
fixation
and corneal surface. For refractive surgery, center your
ablation around corneal vertex."
What are the criteria for a donor cornea?;"• Endothelial cell count 2000 or more
• Death-to-preservation time 12-18 hours
• Age of donor between 2 years to 70 years
• Exclusion criteria: death of unknown cause, active
septicemia, HIV/hepB/hepC, active ocular
inflammation"
What is the gene defect in gelatinous drop like dystrophy?;"● Defect in tumor
associated calcium signal transducer 2"
What is an axial power map or "sagittal curvature" map?;"• Based on reference axis
through the line of sight
• Better estimation of central corneal power and less
accurate at measuring peripheral cornea"
What is Peters anomaly type 2?;"• Lens touch to area of vascularized corneal
opacity
• Failure of lens vesicle to separate from surface
ectoderm
• Mutation in FOXE3"
What was the stromal keratitis arm of the HEDS study?;"• Treated with PF q2h and
trifluridine QID
• Topical antiviral used to prevent outbreak of epithelial
keratitis
• No benefit to adding oral acyclovir to topical
prednisone + trifluridine"
What are the three sphingolipidoses that cause corneal verticillata?;"• Fabry
• Multiple sulfatase
• Generalized gangliosidosis"
What is cornea plana?;"• Flat cornea with central corneal power < 43 D
• Cornea curvature similar to adjacent to sclera
• Isolated cases occur in Finnish individuals
• Seen in other ocular abnormalities like sclerocornea
and colobomas
• Associated with Ehlers-Danlos syndrome
• Open and chronic angle closure glaucoma can be
found"
What are the exam findings in limbal stem cell deficiency?;"• Loss of palisades of
Vogt
• Peripheral pannus formation
• Late staining of epithelium (""wavelike"" irregularity)
• Punctate epithelial keratopathy
• Persistent epithelial defects - lead to stromal loss
(ulcers), stromal scarring, corneal perforation
• Conjunctivalization - conjunctiva grows onto the
cornea to fill epithelial defects"
What are different parts of the orbicularis muscle and their function?;"• Orbital
portion: responsible for voluntary eyelid
closure
• Pretarsal and preseptal: responsible for unconscious
blinking of eyelids"
What are the common cornea complications of hard CL?;"• Central epithelial edema →
treat with discontinuing
lens
• Corneal warpage"
What are the most common etiologies of post refractive surgery infectious
keratitis?;"• Within 10 days - gram positive bacteria
• More than 10 days after surgery - atypical
mycobacteria"
What are the risk factors for fungal keratitis?;"• Trauma with plant or vegetable
matter
• CL wearer
• Prior corneal surgery (PKP and RK)
• Chronic keratitis
• Topical steroids"
What are the systemic and corneal findings in congenital syphilis?;"• Interstitial
keratitis, presents late in 1st decade,
immune-mediated manifestation
• Dental deformities (notched incisors, mulberry
molars)
• Saddle nose, saber skins, frontal bossing, perforation
of palate
• Deafness
• Mental retardation"
What are the ocular findings in acquired syphilis?;"• Much less likely to develop
interstitial
keratitis compared to congenital syphilis
• If interstitial keratitis occurs, unilateral 60% of time
• Uveitis and retinitis more common sequelae in
acquired than congenital"
What are the risk factors for corneal decompensation after intraocular surgery?;"•
> 640 microns central corneal thickness
• Endothelial cells <1,000"
What is the rate of pterygium recurrence?;"• Highest rate of recurrence with bare
sclera, leaving
involved area open; 40-75% rate of recurrence
• With simple closure, amniotic membranes, or
conjunctival autograft, rate of recurrence is 3-5%"
What is the most common cause of explosive endophthalmitis after penetrating eye
trauma?;"• Bacillus cereus - spores, found in soil/vegetative
material
• Species are motile
• Treated with intravitreal vancomycin or clindamycin
• 25% of post traumatic endophthalmitis"
At what corneal thickness does corneal epithelial edema occur?;"• 700 microns or
more"
What is the inheritance pattern and ocular findings in Hunter syndrome?;"• X-linked
recessive
• Pigmentary retinopathy"
What were the results of the HEDS trial?;"• Topical trifluridine and topical
steroids expedite
resolution of stromal inflammation in HSV stromal
keratitis
• Adding oral acyclovir did not provide additional
improvement
• Long term oral antiviral prophylaxis reduces
recurrences of HSV keratitis (recommend if >1 episode
of HSV keratitis)
• This trial did not test whether topical trifluridine +
topical steroids is better than oral acyclovir
• General consensus: oral antiviral with topical steroid is
good alternative (compared to topical trifluridine +
topical steroids)
• Antiviral agent used in isolated HSV stromal keratitis to
prevent epithelial keratitis while on steroid drops"
What is Rizzuti sign?;"• Conical reflection on the nasal cornea when penlight is
shone temporally
• Seen in keratoconus"
What are the screening serum markers and ocular effect of Sjogren’s syndrome?;"•
Screening: ANA, SS-A, SS-B
• Lymphocytic infiltration of lacrimal gland
• Topical beta blocker and Diamox worsen dry eyes"
What is the difference between DMEK an DSEK?;"• DMEK - transplant just Descemet
membrane and
endothelium
• DSEK - transplant Descemet membrane/endothelium
and portion of posterior stroma"
What is disciform keratitis?;"• Overlying stroma and epithelium have edema in round
pattern
• Secondary to endotheliitis
• Treat with oral acyclovir (penetrate deeper cornea
tissues via aqueous) + topical trifluridine or ganciclovir
• Most commonly due to HSV and VZV, both present the
same"
What is the a platinum kimura spatula most useful for?;"• Obtaining bacterial
cultures"
What are the indications for anterior chamber washout in an eye with hyphema?;"•
IOP ≥ 60 mmHg for ≥ 48 hours
• Hyphema does not decrease ≥ 50% by 8 days
• IOP ≥ 25 mmHg with total hyphema for ≥ 5 days
• IOP 24 mmHg for ≥ 24 hours (or any transient increase
IOP 30 mmHg) with sickle cell trait/disease
• Signs of corneal blood staining
• Children at risk for amblyopia
• Significant visual impairment"
Involvement of which branch of CNV1 has the highest risk of ocular involvement?;"•
Nasociliary branch"
What is homocystinuria?;"• Patients are tall and 50% have intellectual disability
• Inferonasal dislocation of lens
• Brittle zonules
• Prone to thromboembolic events with general
anesthesia
• Treat with dietary restrictions with low methionine
and high cysteine"
How soon can limbal stem cell transplantation be performed after chemical
injury?;"• 2 weeks
• Reducing inflammation prior to transplantation
increases grafts odds of survival because inflammation
leads to cell death
• Same goes for corneal transplant"
What are diagnostic tools that can be used to analyze the posterior corneal
surface?;"● Scheinflug tomography
● Pentacam
● Galilei"
What are the differences between Diffuse Lamellar Keratitis and Infectious
Keratitis?;"● Diffuse Lamellar Keratitis
○ Within 24 hours of surgery
○ Begins at flap periphery
○ More intense inflammation in periphery
○ Minimal to no anterior chamber reaction
● Infectious Keratitis
○ 2-3 days postoperatively
○ Anywhere under flap
○ Focal inflammation around infection
○ Mild to moderate anterior chamber reaction"
What wavelength of light can cross-link collagen and what is it used for?;"• 365 nm
with concomitant administration of topical
riboflavin
• Treats corneal ectasia"