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disorders of the cornea
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96
Health Care
Graduate
08/20/2009

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Term
define: cornea
Definition
transparent structure forming the anterior part of the fibrous tunic of the eye
Term
cornea is always covered with :
Definition
tear film
Term
cornea contains highest concentration of ______ _______ of any body structure.
Definition
nerve fibers
Term
does the cornea heal quickly?
Definition
yes
Term
cornea vascular?
Definition
no
Term
four functions of cornea
Definition
1. let light enter the eye
2. helps shield the rest of the eye
3. major refractive surface of eye
4. majority of eye's total focusing power
Term
how many layers make up the cornea?
Definition
five
Term
which instrument is used to determine how many layers a foreign body has penetrated within the cornea?
Definition
slit lamp
Term
where does the cornea's moister come from?
Definition
anterior chamber
Term
when would vessels be present within the cornea?
Definition
vessels may come into the cornea in the presence of continued irritation
Term
5 significant presentations associated with foreign bodies
Definition
1. pain
2. tearing
3. photophobia
4. finding of particulate matter
5. may have rust ring
Term
4 complications of foreign bodies
Definition
1. rust ring
2. infection
3. corneal ulceration or scaring
4. globe perforation; leakage of fluid
Term
6 treatments for foreign bodies
Definition
1. check visual acuity
2. saline irrigation
3. removal with damp steril cotton swab
4. removal with 25 gauge needle(slit lamp)
5. topical antibiotic coverage
6. reevaluate in 24 hrs
(ck infection/healing)
5.
Term
3 etiologies of corneal abrasion
Definition
1. trauma
2. contacts
3. spontaneous
Term
superficial corneal abraision
Definition
involves the epithelium of the cornea only. most heal quickly and completely without scaring (24-48hrs)
Term
deep corneal abraision penetrates ________ but not _________ and increases the risk of __________
Definition
Bowman's membrane but not Descement's membrane & increases the risk of scaring.
Term
7 presentations for corneal abraision
Definition
1. pain
2. redness
3. swelling
4. photophobia
5. blurred vision
6. foreign body sensation
7. abraision stains with fluorescein dye.
Term
3 conditions that require differential diagnosis from corneal abraision
Definition
1. corneal ulcer
2. retained corneal foreign body
3. herpes simplex keratitis
Term
5 factors of diagnosis for corneal abraision
Definition
1. history
2. eye exam
3. visual acuity
4. pen light and fundoscopic exam
5. fluoroscein exam
Term
what should be documented at time of injury?
Definition
time, place, surroundings, size location, shape and depth
Term
3 complications of cornea abraision
Definition
1. recurrent corneal erosion (10%)
2. infection
3. corneal ulcer
Term
define: recurrent corneal erosion
Definition
erosion with sudden eye pain weeks after healing = refer
Term
for corneal abraision when would topical antibiotics be waranted?
Definition
when the abraision is caused by contact lenses (pseudomonas)
Term
Why might you use oral instead of topical NSAIDs?
Definition
topical can delay healing time.
Term
4 treatment optioins for corneal abraision
Definition
1. topical antibiotic
2. oral or topical NSAIDs
3. follow up visit in 24hrs
4. a third visit at 3-4 days for contact wearers
Term
5 indications for fluorescein
Definition
1. corneal inflammation
2. corneal trauma
3. corneal abraision
4. corneal foreign body
5. keratitis
Term
which bacteria can easily grown in flourescein solution?
Definition
pseudomonas
Term
what exactly does the fluoroscein stain?
Definition
epithelial defects
Term
what are the 2 lamps effective for viewing fluorescein staining?
Definition
woods lamp or cobalt blue lamp
Term
you should always __________ the eye after staining to avoid eye reaction to the dye
Definition
irrigate
Term
what type of lesions are caused by UV radiation? What are the sources of UV?
Definition
1. diffuse punctate lesions
2. sunlight and welding arcs
Term
define: corneal ulcer
Definition
local defect in the surface of the cornea
Term
etiology of corneal ulcer (2 broad)
Definition
1. infection
2. non-infection (dryness, allegies, inflammatory disorders, exposure and neurotropic keratitis)
Term
6 presentations for corneal ulcers:
Definition
1. pain
2. photophobia
3. tearing
4. reduced vision
5. circumcorneal injection
6. corneal appearance varies with organism
Term
complications of corneal ulcers:
Definition
leads to corneal scaring which obscures vision
Term
corneal ulcer treatment
Definition
URGENT REFERAL TO OPTHALMOLOGIST
culture, topical treatment around the clock, close supervision
Term
which is more acute, corneal abraision or ulcer
Definition
abraision
Term
which is usually related to trauma, ulcer or abraision of the cornea?
Definition
abraision
Term
describe corneal appearance during an ulcer
Definition
there is a white necrotic area
Term
in which condition is iris detail obscured?
Definition
corneal ulcer
Term
how is corneal thickness affected by a corneal ulcer?
Definition
may have crater/defect thining
Term
corneal ulcer may extend into the
Definition
stroma
Term
etiology of bacterial keratitis (4)
Definition
1. s. aureus
2. p. aeruginosa
3. pneumococcus
4. Moraxella
Term
define bacterial keratitis
Definition
inflammation of the cornea
Term
5 pathophysiologies
Definition
1. direct corneal trauma
2. chronic eyelid disease
3. tear film abnormalities
4. hypoxic trauma from contact lens wear
5. microbial invasion
Term
3 major complications of bacterial keratitis
Definition
1. collagen and stroma undergo degredation, necrosis and thining
2. cornea may perforate
3. scaring leads to reduced vision
Term
presentation of bacterial keratitis
(6 points)
Definition
1. usually unilateral occular redness, pain, photophobia
2. reduced visual acuity
3. corneal edema surrounding the infiltrate
4. may have thick ropy mucopurulent discharge
5. edematous eyelid
6. may have hypopion in severe cases
Term
define: hypopyon
Definition
accumulation of blood/pus in anterior chamber
Term
treatment for bacterial keratitis
Definition
referal: culture, topical antibiotics,steroids once infection is resolved, followed daily until infection under control
Term
most common virus foudn in humans
Definition
herpes simpolex virus
Term
how is HSV-1 transmitted?
Definition
body fluids usually saliva
Term
Herpes Simplex Keratitis occurs most often in children btwn the ages:::
Definition
6months - 5yrs
can occur at any age
Term
which nerve is HSV housed in Herpes simplex kertaitis?
Definition
trigeminal
Term
In apx 25% the virus is reactivated by which 5 factors?
Definition
1. fever
2. trauma
3. stress
4. immunosuppressive agents
5. UV light
Term
within the eye the virus replicates and causes disease within the
Definition
corneal epithelium
Term
do we refer HSV keratitis?
Definition
yes
Term
what is the halmark sign of herpes simplex keratitis?
Definition
dendritic corneal ulcer
Term
presentation of herpes simplex keratitis (7)
Definition
1. unilateral red eye
2. pain/irritation
3. photophobia
4. decreased vision
5. tearing
6. dendritic corneal ulcer
7. ulcer stains with fluoroscein dye
Term
2 complications of herpes simplex keratitis
Definition
1. corneal scaring
2. increased severe corneal opacity with each recurrence
Term
treatment of herpes simplex keratitis
Definition
refer: topical antivirals, oral acyclovir, avoid topical steroids incase of active HSV
Term
pathophysiology of herpes zoster opthalmicus:
Definition
virus in trigeminal nerve involves the opthalmic division of the nerve and damages the eye and surrounding structures by secondary perineural and intraneural inflammationof sensory nerves
Term
herpes zoster opthalmicus presentation (6)
Definition
1. prodrom phase: flu like symptoms
2. dermatome rash/pain of forehead
3. if tip of nose is involved, 75% that eye is involved
4. lid:edema, ptosis, inflammation
5. photophobia
6. decreased vision
Term
define Hutchinson's sign:
Definition
if tip of nose is involved in rash assoc. w. herpes zoster then 75% involve the eye as well
Term
hallmark of herpes zoster opthalmicus:
Definition
dermatomal rash distribution and repects the midline
Term
8 complications of herpes zoster opthalmicus
Definition
1. chronic occular inflammation
2. corneal perforation/scaring
3. loss of vision
4. debilitating pain
5. neurotrophoc keratopathy
6. uveitis
7. glaucoma
8. cataract formation
Term
herpes zoster opthalmicus treatment
Definition
urgent referal: antivirals
Term
important cause of keratitis in contact lens wearers
Definition
acanthamoeba keratitis
Term
acanthamoeba keratitis persentation
Definition
pain
perineural & ring infiltrates in the corneal stroma
Term
treatment of acanthamoeba keratitis is hampered by the organsims ability to
Definition
encyst within the corneal stroma
Term
acanthamoeba keratitis treatment
Definition
epithelial debridement may be useful in early infections
corneal grafting may be required
Term
define Hyphema
Definition
circulating or layered RBCs in anterior chamber
Term
define anterior chamber
Definition
area btwn iris and cornea
Term
4 presentations for hyphema
Definition
blurred vision, pain, photophobia, lacrimation
Term
hyphema treatment
Definition
referal: acetominophen (not NSAIDs)
Term
define arcus senilis
Definition
deposition in the coreal periphery of a grey to white or yellow band of opacity
Term
which is the most common corneal degredation?
Definition
arcus senilis
Term
epidemiology of arcus senilis
Definition
most common corneal degeneration
most common in men 40-80
prevalence increases with age
women 50-90yrs
Term
what are the arcus senilis depostions made up of?
Definition
lipoproteins mostly of low density
Term
what other test would you definately want to run on a 50yomale presenting with arcus senilis?
Definition
Lipid panel
Term
arcus senilis prognosis
Definition
in elderly there is no correlation with mortality
in pt <50 there is a 4X increse in risk of mortality from coronary heart disease and cardiovascular disease
Term
define kayser-fleischer ring
Definition
brown-yellow-green pigmented ring in periphery of cornea
Term
kayser-fleischer ring is composed of:
Definition
copper pigment depostion
Term
kayser-fleischer ring is indicative of what disease?
Definition
Wilson's Disease
Term
define wilson's disease
Definition
liver doesn't release copper in bile, copper builds up and damages liver which then releases copper into blood stream which then damages kidneys, brain and eyes
Term
define episclera
Definition
thin layer of vascularized tissue btwn the sclera and conjunctiva
Term
etiology of episcleritis
Definition
idiopathic; collagen vascular diseases or infections
Term
episcleritis signs and symptoms
Definition
usually asymptomatic, may present with mild pain and red eye
Term
episcleritis diagnosis
Definition
place drop of phenylephrine in affected eye, 10-15 minutes later- episcleral vessels should branch scleral vessels would not
Term
episcleritis treatment
Definition
generally self limited
recurrent in 2/3 of cases
topical steroid Rx from opthalmologist
Term
name two types of scleritis:
Definition
anterior and posterior
Term
anterior scleritis may cause:
Definition
scleral thining
Term
posterior scleritis may cause:
Definition
exudative retinal detachment
Term
is scleritis usually unilateral or bilateral?
Definition
bilateral
Term
scleritis can be a manifestation of which diseases, but 50% of the time is __________.
Definition
system diseases:infections, thyroid, collagen disorders
50% of the time scleritis is idiopathic
Term
scleritis signs and symptoms:
Definition
severe pain, photophobia, redness, decreased vision, scleral edema, failure to blanch
Term
scleritis treatment:
Definition
systemic NSAIDs, treat underlying cause
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