Corneal Path

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Slide 1

Corneal Path

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Lecture 08/25/08: Corneal Dystrophies

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Arcus Senilis Elevated Cholesterol See PCP for blood work-up

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Arcus Senilis

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Hudson Stahli Line A cocoa, even line over the lower third of the cornea, once in a while found in the matured. No Tx

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Hudson Stahli Line

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Band Keratopathy Precipitation of calcium salts on the corneal surface (specifically under the epithelium) Patients with band keratopathy gripe of the accompanying: Decreased vision Foreign body sensation Ocular bothering Redness (once in a while) Tx: Debridement

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Band Keratopathy

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Limbal Girdle of Vogt Very regular, reciprocal, age-related condition. Corneal degeneration. Clinical elements: Symptoms: asymptomatic and requires no treatment. Signs: Crescenteric, white opacities of the fringe cornea in the interpalpebral zone along the nasal and worldly limbus May be isolated from the limbus by an unmistakable zone or without a reasonable zone in the middle of

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Limbal Girdle of Vogt

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Salzmann's Nodular Degeneration Usually taking after trachoma or phlyctenular keratitis Characterized by various shallow blue white knobs in the midperiphery of the cornea Medical treatment comprises of grease, warm packs, cover cleanliness, topical steroids, as well as oral doxycycline

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Salzmann's Nodular Degeneration

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Climatic Droplet Keratopathy Degenerative condition portrayed by the collection of translucent material in the shallow corneal stroma Sector iridectomy, corneal epithelial debridement, lamellar keratoplasty, and entering keratoplasty have all been utilized in the treatment of outwardly weakening CDK.

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Climatic Droplet Keratopathy

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Corneal Farinata Bilateral spotting of the back part of the corneal stroma VA unaffected

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Corneal Farinata

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Pellucid Marginal Degeneration/Keratoglobus Bilateral, noninflammatory, fringe corneal diminishing issue described by a fringe band of diminishing of the sub-par cornea Tx: RGPs/Keratoplasty Surgery required for Keratoglobus

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Pellucid Marginal Degeneration

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Lecture 09/08/08 EBMD (Bergmanson) Keratoconus (kept) Making the Dx

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Voght Striae

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Fleisher's Ring Cause: Thickened tear film where tops meet

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Hydrops Rupture in Descemet's layer

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EBMD Epithelial Basement Membrane Dystrophy

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Meesmann's Dystrophy Intraepithelial growths with indistinct material/cell flotsam and jetsam Tx: as a rule not required

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Map/Dot/Fingerprint Dystrophy otherwise known as "Foremost Membrane Dystrophy" BM is set down strangely by epithelial cells  develop of material Pts > 60 Negative recoloring

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Recurrent Corneal Erosion Syndrome

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Tx: for EBMD Lubricant/gtts; ung Bandage CL Stromal cut Epithelial scratching PTK

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Surgical Tx PKP (Penetrating) versus LKP (Lamellar) Most specialists tx w/PKP Adv of LKP Not intraocular Fewer entanglements Preserved endothelium Low danger of dismissal Preserves worldwide quality

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Dystrophies of Bowman's Layer

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Reis-Buckler's Dystrophy Autosomal predominant dystrophy Characterized by little discrete opacities midway simply under the epithelium which may have a honeycomb example ALL is being supplanted by reticular material (scar-like tissue)

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Honeycomb dystrophy of Thiel and Behnke

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Inherited Band Keratopathy Tx: Chelating operator EDTA

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Stromal Dystrophy Granular Dystrophy Lattice Dystrophy Gelatinous drop-like dystrophy

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Granular Dystrophy

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Corneal Trauma Management

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Bacterial Keratitis - WBCs just found in irresistible keratitis. - Acute (24-48 hrs), quickly dynamic corneal ruinous process or a constant procedure. - Caused by corneal epithelial interruption brought about by injury, contact focal point wear, sullied visual drugs and disabled insusceptible barrier components. - Tx. With Polytrim, Vigamox, and expansive range anti-infection agents

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Radial Keratotomy Problems * Refractive surgery method to adjust gentle to direct degrees of astigmatism (2 to 5 D). *Incisions can part open making them defenseless against corneal diseases (parasitic/bacterial) -If contamination happens w/i 24 - 48 hrs, bacterial and not contagious. - Tx forcefully with Polytrim, Vigamox, or expansive range anti-toxins. - F/U in 1 day.

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Fungal Keratitis Feathery Borders, w/hx of plant/vegetable matter injury. Tx w/delayed course of systemic and topical hostile to contagious (Natamycin), and incessant scrapings or confined debridement to expel necrotized epithelial tissue.

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Lecture 09/22/08: Corneal Trauma Mgmt

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Pseudomonas Keratitis *Pseudomonas can advance quick! Inside 24 hours -hypopyon, penetrates in cornea, KPs, plasmoid watery (AC is jello) -torment, diminished VAs, redness

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Corneal FB *May create corneal ulcer. *r/o intraocular FB. *Remove FB, unless expulsion will bring about more harm than abandoning it undisturbed. - Topical anti-infection agents after expulsion -Topical NSAID (Ketorolac) or short acting cycloplegic for alleviation of manifestations

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Intraocular Foreign Body *Intraocular FB –passes storm cellar film of cornea. - Improper expulsion can bring about caved in AC, traumatic glaucoma, endophthalmitis if contaminated. *Refer to specialist.

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Traumatic Cataract *Most regular inconvenience of non-puncturing and puncturing wounds to the globe.

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Hypermature/Morgagnian Cateract *May me brought about by extreme injury. *Liquified feline with in place core poorly dislodged.

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Bollus Keratopathy *Compromised endothelial cell pump system as the endothelial cell thickness diminished and decompensated; Folds in stroma from stromal edema. *Can be instigated by waterfall surgery or other injury. *Manage w/NaCl 5% gtts and ung; CL for agony; IOP bringing down meds; Penetrating Keratoplasty in cutting edge cases.

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RA-related fringe ulcerative keratitis *Hx of CT dz. *May cause stromal diminishing, descemetocele (just PLL and endothelium left because of corneal diminishing) in dynamic keratolysis, and puncturing. *Promote re-epithelialization by visual surface oil, fixing or gauze delicate contact focal point.

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Alkaline Burn *Immediate water system of eye until the pH of the circular drive has come back to lack of bias. (pH= 7.0) *Prophylactic expansive range anti-microbial; cycloplegic drops; topical steroids to decline aggravation; oil; delicate CL…

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Lecture 09/29/08: Corneal Trauma Mgmt (cont.)

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Pseudomonas Keratitis Vigamox

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Bacterial corneal Ulcer gram (+) Vigamox, gram (- ) Zymar

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Fungal Keratitis Natamycin

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Acanthamoeba keratitis Epithelial debridement

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Epithelial Herpes Simplex Viroptic

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Marginal Keratitis Vigamox

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Bacterial penetrate 2 nd to RK Vigamox

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Dellen Artificial tears

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Pubic lice Bacitracin balm

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Iris nevus Asymptomatic, no tx Malignant with development, allude

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Lecture 10/06/08: Corneal Dystrophy (cont.)

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Lecture 10/20/08: Therapeutic Strategy for Ant. Fragment Dz

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Combination Antibiotics Tobramycin Polymixin B Neomycin (hypersensitvity regular) Sulfacetamide Bacitracin Medications used to treat visual aggravation and counteract microbial disease. Additionally utilized for shallow smolders. Illustrations: corneal infiltratres, meibomian organ dys., blepharitis

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Corneal Ulcers TOC: 4 th era fluoroquinalones - Zymar (gatifloxacin) 0.3% - Vigamox (moxifloxacin) 0.5% - Quixin (levofloxacin) 0.5%- - 3 rd era - Iquix (levofloxacin 1.5%) qd or bid– 3x conc of Quixin and works superior to Zymar and Vigamox without harmfulness. Additive free.

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Corneal Ulcers (extra medications) Antibiotics - Gentamycin (ung, gtt) - Ofloxacin (gtt) - Ciprofloxacin (gtt) - Tobramycin sulfate (ung, gtt) Mixes Polysporin ung ( polymixin B & bacitracin) Neosporin ung ( poly b/neomycin/bacitracin) Polytrim gtt ( poly B & trimethoprim) - minimum dangerous

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Bacterial Conjunctivitis - Azasite (azithromycin 1%) offer tid steroid added present AB treatment on forestall corneal scarring - Vigamox (moxifloxacin) FDA endorsed for bacterial conjunctivits

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Topical anit-inflammatories Steroids - Maxidex (Dexamethasone 0.1%) susp - FML (flouromethalone 0.1%) – ung or susp - Pred strength (prednisilone 1%) – susp Soft steroids - Lotepredenol etabonate Alrex 0.2% Lotemax 0.5% NSAIDS (pain relieving impact) - Diclofenac (Voltaren 0.1%) soln Ketorolac (Acular 0.4%) soln

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Allergic and CLPC-(contact focal point instigated papillary conjunctivitis) Treat with… - Mast cell stabilizers Crolom offer, Alomide or Alomast qid, Alocril offer - Mast cell balancing out antihistamines Patanol offer/Pataday qd, Elestat offer, Zaditor offer, Optivar offer - NSAIDS Acular qid - Steroids (just if serious) Alrex, Lotemax, or Pred Forte qid