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Less serious degeneration's
Arcus
- Stromal
- Clear band at limbus
- Check lipids if under 50
- Check carotids if unilateral
Coats white ring
- White ring around area of previous foreign body
Dellen
- "Gaule spot"
- "Fuchs dimples"
- Depression of cornea at 3:00 and 9:00 next to a raised mass
- Localized dehydration of top 3 layers of cornea
- Hay fever, conjunctivitis, ptyrgium, scleritis, blebs, sutures
Hassle - Henle bodies
- "Decemets warts"
- Small round thickenings of Decemets membrane at periphery
- "Peripheral guttata"
Marginal furrow
- Bilateral thinning at limbus
- No inflammation and no problem
Posterior crocodile shagreen
- Diffuse gray polygonal degeneration of posterior cornea
Spheroid degeneration
- Keratinoid
- Oily appearing subepithelial droplets
White girdle of Vogt
- 50+ females
- Bilateral narrow band of fine crystal yellow - white opacities
- Along nasal or temporal limbus
Foreign bodies
- Deep rust may rise to surface with time
- Hole will fill-in in 24-48 hr's
- Edema ring will disappear in 48-72 hr's
- Traumatic iridocyclitis may occur 24-36 hr's after injury and
should subside after re-epithelialization
- If Bowmans membrane is damaged scarring will result
Keratoconjunctivitis
- Acute pain or foreign body sensation without injury or irritation
- Superficial erosions
- Microcystic edema
- Punctate infiltrates
- Superficial pannus
- Deeper neovascularization
- Dendritic ulceration - H Simplex and H Zoster
- Infiltrative keratitis is usually epithelial and non-infectious. Usually
a focal response (Staph?)
- Sub-epithelial infiltrate usually indicates virus
- If it leaves a scar it must have been deep? Likely viral
- Ulcerative keratitis is usually stromal and infectious
Membranes
- Pseudo-membrane on top of conjunctiva
- True membrane fibrin fibers interdigitates with epithelium and
will bleed on removal
Lymph nodes
- Swelling indicates viral or sever bacterial infection
Palpable, not tender, not visable
- PCF
- Chlamydia
- Newcastle
- Enterovirus 70
Palpable, tender, non-visable
- EKC
- Herpes
- Pre-septal cellulitis
Palpable, tender, grossly visable
- Oculoglandular syndrome
- Tuberculosis
- Sarcoid
- Severe EKC
- Infectous granulomatous disease
Seasonal variation
Strept pneumonia most common in winter in the north-east US
H. flu most common in summer and fall in south-east US
Problem degeneration's
Amyloid degeneration
- Deposits following long-standing disease
Anterior keratoconus
- First sign at 15-25
- Progresses for 6 yrs
- Allergies and frequent eye-rubbers
- Autosomal recessive
- Stromal thinning
- Ruptures in Decemets membrane
- Distorted mires on keratometer
- Fit with contact lenses
- Munsons sign on downgaze
Band keratopathy
- Bilateral whitish - yellow haze (calcium) in epithelium and bowmans
- "Swiss cheese" appearance to intrapalpebral cornea
- Decreased acuity
- Foreign body sensation
- Lubricate and check parathyroid gland
- Causes
- Sarcoid
- Hyperparathyroid
- Vitamin D toxicity
- Multiple myeloma
- Renal failure
- Hyper or hypophosphatemia
- Long standing inflammatory conditions (Arthritis),
- Chronic topical medications preserved with
mercury
Bullous keratopathy
- #1 cause is post operative
- #2 cause is Fuchs endothelial dystrophy
- #3 cause is result of endothelial cell loss over lifetime
- Before bullae form treat with antiedema therapy
- If bullae soft lens bandage and antibiotics
- Eventual painful fibrotic blind cornea
Cogans degeneration
- Older males develop large 1-2 mm peripheral microcysts
- Treat RCE
Essential iris atrophy
- 30-40 white females
- Unilateral anterior synechia leads to atrophy and glaucoma
Keratoconjunctivitis sicca (KCS)
- Filimentary keratitis
- lip and tongue ulcers, caries
- Tears
- Lipid layer Meibomian and Zeiss
- Aqueous Lacrimal, Krause Wolfring
- Mucin Goblet cells
- Dry eyes:
- Lipid abnormalities
- Blepharitis
- Bacteria break down lipid into free fatty acids
- Lid scarring
- Aqueous deficiency (KCS)
- Mucin deficiency
- Hypovitaminosis A
- Steven Johnson
- Trachoma
- Burns
- Lid surface abnormality
- Nocturnal lagophthalmos
- 7th nerve paralysis
- Dry eye tests
- Rose bengal - best test
- BUT < 10 (actually a test of lipids)
- Shirmer test - Normal is 10-30 mm
- Test 1 - Measures reflex + base tearing
Positive if <5 mm
- Test 2 - Anesthetize cornea and irritate nasal
mucosa for 10 sec
measures only base tearing
Positive if <15 in 2 minutes
- Lysozyme
- Lactoferrin
- Impression cytology
- Tear osmolarity
Moorens ulcer
- White - gray infiltrates and conjunctival hyperemia
causes breakdown of epithelium and degeneration of anterior stroma
leading to central overhang
- Peripheral serpiginous ulcer (Fungal?)
- No discharge
- Two forms
- Unilateral in older patient -
responds well
- Bilateral in 20-40 yr old patient - responds poorly
- Most lateral to medial
Differentiation:
Marginal furrow is painless
Pellucid is inferior
Terriens is superior
Pellucid marginal degeneration
- Age 20-40
- Bilateral inferior corneal thinning (80%)
- Epithelial and endothelium normal
- Bowmans membrane missing
- Decemets folded
- Increased against the rule astigmatism
- May be a form of keratoconus
Pemphigoid
- Mainly females
- Onset usually 60-70
- Keratinization, shrinkage, scarring
- Ectropian
- Ptyrgia
- Blebs
- Epitheliopathy
- Herpetic scarring
- Vth nerve damage
- Persistent edema
Recurrent erosions
- 50% have EBMD
- Surgical trauma
- Vitreous touch of intact vitreous face
- Trauma
Rupture of decemets membrane
- Forceps delivery
- Congenital glaucoma
Salzmans nodular degeneration
- Elevated blue - gray nodules of hypertrophic collagen on periphery
- Between epithelium and bowmans membrane
- RCE
- More often women
Terriens marginal degeneration
- Age 20-50 males
- Progressive
- Non-inflammatory
- Unilateral superior nasal thinning of stroma
- Epithelium remains intact
- Fine vascular pannus across area of thining
- Leads to scarring, neovascularization and astigmatism
- Treat with steroids
- Increased against the rule astigmatism
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