does optical pachymeters from pentacams and orbscams underestimate or overestimate the true CCT
what is an inflamed limbal area with leukoplastic lesion growing into cornea that only involves epithelium
what is the most common ocular manifestation of reactive arthritis
what is reactive arthritis or Reiter's syndrome
"gram negative dysentery (salmonella, shigella, yersinia) or non-gonococcal urethritis caused by chlamydia -> arthritis (usually hla-b27+ in 75% of patients)"
what is fleck dystrophy
"dandruff like flecks in the stroma (sparing epithelium/endothelium), autosomal dominant, does not affect vision (only invovlement of epi/endothelium affect vision)"
what are indiciations for ac washout for hyphema
1. IOP > 60 for 2 days 2. IOP > 35 for 7 days 3. IOP > 25 for 1 day in sickle cell patient 4. any sign of corneal blood staining
where are the palisades of vogt
1-2mm posterior to limbus where tenons fuses with conjunctiva
what are indications for interrupted sutures in a PK
1. thin cornea 2. vascularized cornea (can take out sutures where graft is vascularized in specific areas) 3. inflamed corneas 4. children
are iron lines typically visually significant
what are adenochrome deposits
"deposits on cornea with little clinical significance, can be due to chronic epinephrine drop exposure"
what infections do you see Halberstaideter-Prowazek bodies
what agent plays the largest role in inflammation in hsv stromal keratitis
what is a wessely immune ring
"represents coalesecnce of antibodies to antigens with subsequent complement activation, type 3 HSS reaction "
what can cause a wessely immune ring and what does it look like
"several small, peripheral, ring-shaped corneal infiltrates in the inferior cornea; ddx includes neomycin ointment, corneal foreign body, contact lens reaction"
what diseases are type I hss
what diseases are type II hss
ocular cicatricial pemphigoid
what diseases are type III hss
what diseases are type IV hss
"contact dermatitis, corneal graft rejection"
what does rose bengal stain? What does fluorescein stain?
dead and devitalized epithelial and conjunctival cells; epithelial basement membrane
what does rose bengal do to hsv
can inhibit hsv replication
what size perforations can you use glue
less than 1-2mm
what is the treatment for CIN
"surgical excision with 4mm margins and cryo to bordering conjunctiva; MMC drops, 5-FU drops"
what should you do if you get a descemet's tear from phaco wound after ceiol
place air bubble in the anterior chamber (dsaek shows us that air bubble is good for repproimating descemet's to stroma
how does schyner corneal dystrophy present
"second-third decade of life -> corneal opactification starts centrally and next develops in the periphery (arcus lipoides), and then midperiphery -> subepithelial crystals -> then reduced K sensation"
what systemic disease is schynder corneal dystrophy associated with
what is inheritance of schyder dystrophy and what gene is involved
what stain used for schynder K dystrophy
oil red O;
what is treatment for molluscum
complete excision or an incision in center of lesion; cryotherapy (less recommended)
what corneal dystrophy presents earliest
how long should you wait to enucleat a ruptured globe injury before increasing risk of SO
what are ocular manifestations of porphyria cutanea tarda (tea colored urine)
"symblepharon, bullous pemphygoid"
what is used to culture nocardia and mycobacteria
what can aerobic bacteria be cultured with
"chocolate, Blood, thioglycolate broth"
what can anaerobic bacteria be cultured with
what is the classic presentation of thygeson superficial punctate keratitis
"small punctate eleavted epithelial lesions on central cornea b/l, with negative staining -> photophobia and FBS ou"
what is the inittial treatment for thygeson
"ats, restasis also effective but not first line, PF can be used by high risk of recurrence after stopping"
what is treatment for HZO? Immunocompromised? Postherpetic neuralgia?
1. acyclovir 800 mg 5x/day for 7-10 days 2. IV acyclovir 3. oral amitriptyline
what is tx for gonococcal conjunctivitis if PCN allergy
intramusclar spectinomycin x1 or oral fluoroquiniolones x5-7days
what is difference between ched 1 and 2
"ched 1 is AD, clinical signs do not appear until 1-2 so the visual system develops and you dont get nystagmus; CHED2 is AR, more common, clinical signs appear at birth so visual system doesnt develop and you get nystagmus; both get blueish tint to cornea due to thickening"
what type of HSS reaction is staph marginalis
what are CI for donor cornea for dsaek
"leukemia, bacterial endocarditis, active septicemia"
what glands are responsbile for aqueous components of tears
"lacrimal, krause glands, glands of wolfring"
according to HEDS what is tx for stromal keratitis from HSV
"topical trifluridine and topical steroids; although most people treat with acyclovir and topical steroids, this wasn't tested in HEDS; also give acyclvori ppx for more than 1 episode"
what inferior fornicial depth suggests OCP
what is the pathophysiology of ocp
autoantibodies directed against bullous pemphigoid antigen II (BP180) in the basement membrane zone (bmz)
how do you treat OCP
cyclophosphamide in severe disease
is OCP b/l or u/l
do you have preservatino of scopotic or photopic vision in schnider's dystrophy? Why?
"scoptoc vision; in the darkness, pupil is dilated so light can pass around the central K opacity"
what is infantile cystinosis
"associated with dwarfism and renal impairment, AR, corneal crystals appear at 1yo and deposited in anterior cornea"
"what aa deficiency presents with pseudomembranes, recurrent dendrites, mental retardation"
what is fabry's disease
x-linked disease with renal failure and peripheral neuropathy; cornea verticilata (no cherry red spot);
what sphingolipodase has cherry red spot
what is the pathophysiology of disciform keratitis
endothelitis results in round edema of stroma and epithelium
what is benzalkonium chloride
common preservative in topical medications that increases the potency by causign a disruption in epithelial cells
why should you use oral acylovori in disciform keratitis
oral acyclovir can better penetrate to endothlium through the aqeous
are acids or bases more likley to precipitate corneal proteins
do acids or bases more likely to lead to glaucoma
bases because it can more easily enter Anterior chamber
what was the purpose of topical trifluiridine for stromal keratitis in HEDS
prevent epithelial keratitis
what are diabetic changes to cornea
"mild corneal hyposthesia, poor adherence of epithelium to stroma, delayed healing time with removal of epithelium"
why shouldnt you do phototherapeutic keratectomy (PTK) in band K
calcium will ablate at a slower rate than cornea and will wind up with irregular astigmatism
what is Rizzutti sign
"in KC, shine penlight from temporal cornea and you see conical shape on nasal cornea"
what systemic condition assocaited with mooren like PUK
how do you differentiate between moorens ucler and PUK
PUK involves both cornea and sclera while mooren involves only cornea
where is hyaline deposited in salzmann nodular degeneration
what type of collagen is sclera
"type I (mneumonic, the L in sclera is 1)"
what type of collagen is associated with stromal wound healing
what type of collagen is associated with basement membrane
type 4 (mneumonic; four is the floor)
what is the most common risk factor for fungal keratitis
trauma with vegetable matter
what can cause recurrent sch
"diabetes, hypertension, bleeding diasthesis"
what ophthalmic condition is associated with MEN IIB
"enlarged corneal nerves occur in 100% of patients, ganglioneuromas occur in 95%; men IIB is medullary thyroid cancer, hyperparathyroidism, pheochromocytoma"
what is treatment for candida and aspergillus keratitis
" amphotericin B, although voriconazole is newer and can be given topically and orally (more expensive); use natamycin for fusarium infections"
what fungal infection is most common in southern US
what dystrophy is combo of lattice and granular corneal dystrophy and what stain do you use
avellino; congo red and mason trichome
"when do you get negative staining, and what conditions"
area of interest projects above the tear film -> vzv pseudodendrites (collection of heaped cells while hsv is epi defect) and thygeson superficial punctate keratophaty
"after chemical injury with limbal stem cell destruction, when should you wait to perform stem cell transplant"
logner the better because inflammation can lead to cell death and poor prognosis
how often is congenital syphillis present b/l in both eyes; acquired syphillis?
why is endothelial rejection the most importnat rejection?
endothelial cells cant replace themselves
"what are the differences between keratoglobus, KC, and pellucid marginal degeneration"
"thinning in keratoglobus is generalized with thinnest areas in periphery resulting in global overall corneal curvature; thinning in KC is paracentral and at the apex; in PMD, normal thickness peripherally with thinning in a band centripetal to this resulting in inferior thinning with protusion of the cornea above the thinnig; keratoglobus is also present at birth while other 2 present in puberty"
what bacteria can prenetrate intact epithelium
"""No Hard or Soft Contact Lens""- neiserria gonorrhea, haemophilus aegyptus, shigella, corynebacterium diphtherae, listeria"
where is the thinnest area of cornea
1.5mm temporal to geographic center
what is classic association with Mooren ulcer
describe gelatinous drop like dystrophy
"AR, defect in TACSTD2 gene-> diffuse supepithelial and stromal amyloid deposits -> recurrent erosions, recurrence in 100% of grafts"
whats the most common cause of dacryoadenitis
what is the origin of cells of oncocytoma (caruncle cystadenoma)
ductal and acinar cells of main and accessory lacrimal glands
what is terrens marginal degeneration
"mneumonic: think T's (Thinning of the cornea at the Top [starts superiorly], presents in Thirties, perforation is rare, but treatmetn for perforation is Transplantation [crescent shaped lamellar]), thinng starts from superior and spreads circumferentially, epithelium remains intact and fine pannus transverses area of thinning with a line of lipid deposition at the end of pannus"
what is the dioptric power of the cornea? What percent does it contribute to the eye? Average radius of curvature?
43.25; 75%; 7.8mm
avg thickness of corneal epithelium?
what kind of cataract do you get with wilsons disease and why
"sunflower cataract, deposition of copper in anterior capsule in petaloid configuration"
"what happens to osmalrity, lactoferrin and lysozyme in DES?"
"increased osmolarity, decreaed lactoferrin and lysozyme"
what does fluorescein actually stain
disruption of intercellular junctions
what type of HSS is phlycetnulosis
what bacteria causes phlyctenulosis
staph in developed countries; mycobacterium tuberculosis in developing
"thin man with bowel resection presents with K melting, what do you think ok?"
"vit A deficiency from poor lipid absorption, test for serum retinol-binding protein level"
what is I-S value and what do you see in KC?
"I-S values compare steepness of inferior cornea to superior cornea, I-S > 1.2 associated with KC"
what is the tx for corneal hydrops
what type of HSS is scleritis
type 3; think scl3ritis
what dystrophy has highest rate of recurrence in grafts
reis-buckler > lattice > granular > macular (mneumonic: Rude Little Green Men keep coming back)
which dystrophy has the youngest age of presentation
macular (youngest) < lattice < granular (mneumonic: Might Like to Grow before getting K dystrophy)
what cells make up mutton fat KPs? Small dot KPs? Punctate KPs
macrophages; fibrin; neutrophils and lymphocytes
what is the enzyme deficiency of fabrys
alpha galacotosidase a
"in sjogrens, lacrimal glands are infiltrated by what cells"
where do you see cowdry type I bodies
hsv and vzv
where do you see halberstaedter-Prowazek bodies
what's the least common dstrophies?
macular > granular > lattice (My Gringo Lady is rare)
what is associated with microphthalmos
"dwarfism, trisomy 13, mental retardation"
what's the difference between microophthalmos and nanophthalmos
microphthlamos the eye is small and disorganzied globe; nanophthalmos eye is small but organized
is kaposis sarcoma from proliferation of vascular endo/epithelium?
what threshold K thickness are you worried about poor prognosis after CE; ECC count?
650; ECC < 1000
what's the triad of bietti crystalline corneoreintal dystorphy
"nycatlopia, corneal crystals in periphery, tapetoretinal dystrophy; secondary to defect in lipid metabolism"
what type HSS is SJS
3 (3 letters of SJS)
what's the risk of glaucoma in ocular melanocytosis? Risk of uveal melanoma?
what type of HSS is OCP
what's the most important suture in determing astigamatism in PKP
how many points on the cornea does keratometer use to estimate corneal power
what are important factors about a corneal graft
"death to cooling time (when body is cooled), death to preservation time (ideally <12-18 hours), ECC >20,000, donor infectious disease serology, age of donor from 2-70, tissue storage time should be as short as possible (<4days)"
what is ecc at birth
what fungus is the most destructive
what is ddx of chronic follicular conjunctivitis
"molluscum contagiousm, drug toxicity, chlamydia infection (trachoma or inclusion conjunctivitis- typically presents with large follicles on inferior palpebra)"
how do you treat chlamydia inclusion conjunctivitis
"azithromycin 1g x1, doxy 100 x 7 days, erythro 500 x 7 days"
what are Ses of tetracyclines
"staining of teeth, GI upset, birth defects, CI in children < 10 years old"
what systemic disease is cogan's associated with? Mooren's ulcer? Superior limbic keratoconjunctivitis? Schnyder crystalline corneal dystrophy?
"polyarteritis nodosa, hep C, autoimmune thyroid disease, hyperlipidemia"
what underlying bacteria is cause of styes
what are styes
in cogans what lab do you want to get and why
"RPR, you want to rule out syphillic interstitial keratitis before starting steroids for cogans"
what is the pathophysioloigic cause of superior limbal keratoconjunctivitis
mechanical trauma of the upper eyelid on the superior limbal area
what are findings of superior limbal KC
"papillary reaction on palpebral conj, hypertrophy of superior conj, PEE, fine superior corneal pannus"
what part of the cornea does UV radiation damage (from snowblindness or welding burn)
what layer of the cornea is missing in a dellen
"none, it's just thinning of epithelium and stroma"
what does hyaluroindase do for lidocaine? Epinephrine? Sodium bicarb?
helps disperse lidocaine; decreases elimination of lidocaine by constrictinv blood vessels; decreases pain
what causes wavelike irregularity of the ocular surface emanating from the limbus upon fluorescein dye
"LSCD, from conjunctivazation of the cornea"
what is ddx for uniltaeral arcus? Arcus in a young person?
contralateral carotid disease vs ocular hypotony; hyperlipoproteinemia
what is associated with nanophthlamos
"hyperopia, short axial length, angle closure glaucoma, strabismus"
how much limbal stem cells do you need to properly replenish cornea
how does HSV and VZV affect iris respectively
HSV causes patchy iris atrophy while VZV causes sectoral
what dystrophy and degeneration result in diamond shaped opacities with clear intervening spaces?
central cloudy dystrophy of francois and posterior crocodile shagreen degeneration
how does alkaptonuria present and how do you prevent arthropathy
deposition of pigmented material near medial rectus and lateral rectus muscle insertions; vit C to prevent arthropathy
what is reponsible for the majority of eyes refractive power
what's the classic topographic pattern of pellucid marginal degeneration
what should you give for chemical injuries and why
"tetracycline and vit C- tetracycline bind intracellular calcium and prevent PMN degranulation which causes corneal thinning, vit C is a cofactor necessary for collagen synthesis"
what conjunctival melanoma features have worst prognosis
"arising de novo, not involving limbus, residual melanoma after surgical excision"
what are filaments in filamentary keratitis? What do you treat? Is there a tear deficiency state?
strands of epithelial cells with mucus core; 10% N-acetylcysteine; yes
"AD disease, b/l, characterized by a cluster or linear arrangement of vesicles in the posterior cornea surrounded by gray haze, glaucoma in 10-15% of patients"
what medium is best for fungal culture? AK? Neisseria?
saboraud's agar; non-nutrient agar with e. coli overlay; thayer-martin
what bacteria releases gas and causes foamy appearance of bitot spots from vit A deficiency
what are characteristics of neurotrophic ulcers
elevated rounded eptiheloial edges generally in inferonasal location; commonly associated with HSV and VZV
what medication to treat wegeners
is interstitial keratitis usually from acquired or congenital sypillis? How can you tell?
congenital; rarely get IK from acquired syphillis and 60% is unilateral if acquired
at what corneal thickness would MCE most likely occur
how much ECC in 60 yo; cataract age patient?
are epithelial erosions more frequent and severe in reis buckler or theil benke
what happens to bowmans layer in reis-buckler? Theil benke?
bowman layer is disrupted and replaced with sheetlike connective tissue layer; bowmans replaced with fibrocellular material in saw tooth pattern
what inheritance pattern is reis buckler
"if you see extensive molluscum, what test should you get "
what is the ddx for immunoglubulin overproduction resulting in crystals thorughout all layers of cornea
"features lattice corneal dystorphy and systemic amylodosis, caused by mutation in gelsolin gene, autosomal dominant; other findings are masked facies, lagophthalmos, cranial and peripheral nerve palsies, loose skin"
"in HEDS, what environmental factor was significantly associated with HSV"
what is infectious crystalline keratopathy
characterized by white crystalline opacities within the stroma and a relative paucity of inflammation -> usually 2/2 low virulent alpha-hemolytic strep species like strep viridians -> usually occurs in grafts or corneas treated crhonically with steroids
when do seis occur with ekc
what is ddx for enlarged corneal nerves
"neurofibromatosis, men type IIB, phytanic acid storage disorder (refsum disease), leprosy (hansen disease), AK, familial dysauttonomia (riley day)"
what conditions cause corneal nerves to be more visible