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Hudson Stahli Line
• A brown, horizontal line across the lower third of the cornea, occasionally seen in the aged.
• No Tx
Band Keratopathy
• Precipitation of calcium salts on the corneal surface (directly under the epithelium)
• Patients with band keratopathy complain of the following:– Decreased vision– Foreign body sensation– Ocular irritation– Redness (occasionally)
• Tx: Debridement
Limbal Girdle of Vogt
• Very common, bilateral, age-related condition.Corneal degeneration.Clinical features:Symptoms: asymptomatic and requires no therapy.Signs:Crescenteric, white opacities of the peripheral cornea in the interpalpebral zone along the nasal and temporal limbusMay be separated from the limbus by a clear zone or without a clear zone in between
Salzmann’s Nodular Degeneration
• Usually following trachoma or phlyctenular keratitis
• Characterized by multiple superficial blue white nodules in the midperiphery of the cornea
• Medical therapy consists of lubrication, warm compresses, lid hygiene, topical steroids, and/or oral doxycycline
Climatic Droplet Keratopathy
• Degenerative condition characterized by the accumulation of translucent material in the superficial corneal stroma
• Sector iridectomy, corneal epithelial debridement, lamellar keratoplasty, and penetrating keratoplasty have all been employed in the treatment of visually incapacitating CDK.
Corneal Farinata
• Bilateral speckling of the posterior part of the corneal stroma
• VA unaffected
Pellucid Marginal Degeneration / Keratoglobus
• Bilateral, noninflammatory, peripheral corneal thinning disorder characterized by a peripheral band of thinning of the inferior cornea
• Tx: RGPs / Keratoplasty• Surgery needed for Keratoglobus
Meesmann’s Dystrophy
Intraepithelial cysts with amorphous material/cellular debrisTx: usually not needed
Map/ Dot/ Fingerprint Dystrophyaka “Anterior Membrane Dystrophy”
BM is laid down abnormally by epithelial cells build up of materialPts > 60Negative staining
Surgical Tx
• PKP (Penetrating) vs. LKP (Lamellar)– Most surgeons tx w/ PKP– Adv of LKP
• Not intraocular• Fewer complications• Preserved endothelium• Low risk of rejection• Preserves global strength
Reis-Buckler’s Dystrophy
Autosomal dominant dystrophyCharacterized by small discrete opacities centrally just under the epithelium which may have a honeycomb pattern ALL is being replaced by reticular material (scar-like tissue)
Bacterial Keratitis
-WBCs only found in infectious keratitis.-Acute (24-48 hrs), rapidly progressive corneal destructive process or a chronic process.-Caused by corneal epithelial disruption caused by trauma, contact lens wear, contaminated ocular medications and impaired immune defense mechanisms.-Tx. With Polytrim, Vigamox, and broad spectrum antibiotics
Radial Keratotomy Problems
*Refractive surgery procedure to correct mild to moderate degrees of myopia (2 to 5 D).*Incisions can split open making them vulnerable to corneal infections (fungal/bacterial)
-If infection happens w/i 24 -48 hrs, bacterial and not fungal.-Tx aggressively with Polytrim, Vigamox, or broad spectrum antibiotics.-F/U in 1 day.
Fungal Keratitis
• Feathery Borders, w/ hx of plant/vegetable matter trauma.• Tx w/ prolonged course of systemic and topical anti-fungal (Natamycin), and
frequent scrapings or localized debridement to remove necrotized epithelial tissue.
Pseudomonas Keratitis
*Pseudomonas can progress fast! Within 24 hours-hypopyon, infiltrates in cornea, KPs, plasmoid aqueous (AC is jello)-pain, decreased VAs, redness
Corneal FB
*May develop corneal ulcer.*r/o intraocular FB.*Remove FB, unless removal will cause more damage than leaving it undisturbed.
-Topical antibiotics after removal-Topical NSAID (Ketorolac) or short acting cycloplegic for relief of symptoms
Intraocular Foreign Body
*Intraocular FB –passes basement membrane of cornea.-Improper removal can cause collapsed AC, traumatic glaucoma, endophthalmitis if infected.
*Refer to surgeon.
Traumatic Cataract
*Most common complication of non-perforating and perforating injuries to the globe.
Hypermature/Morgagnian Cateract
*May me caused by severe trauma.*Liquified cat with intact nucleus inferiorly displaced.
Bollus Keratopathy
*Compromised endothelial cell pump mechanism as the endothelial cell density decreased and decompensated; Folds in stroma from stromal edema.*Can be induced by cataract surgery or other trauma.*Manage w/ NaCl 5% gtts and ung; CL for pain; IOP lowering meds; Penetrating Keratoplasty in advanced cases.
RA-associated peripheral ulcerative keratitis
*Hx of CT dz.*May cause stromal thinning, descemetocele (only PLL and endothelium left due to corneal thinning) in progressive keratolysis, and perforation.*Promote re-epithelialization by ocular surface lubrication, patching or bandage soft contact lens.
Alkaline Burn
*Immediate irrigation of eye until the pH of the cul-de-sac has returned to neutrality. (pH= 7.0)*Prophylactic broad spectrum antibiotic; cycloplegic drops; topical steroids to decrease inflammation; lubrication; soft CL…
Iris nevus
• Asymptomatic, no tx• Malignant with growth, refer
Combination Antibiotics • Tobramycin• Polymixin B• Neomycin (hypersensitvity common)• Sulfacetamide• BacitracinMedications used to treat ocular inflammation and prevent microbial
infection. Also used for superficial burns.
Examples: corneal infiltratres, meibomian gland dys., blepharitis
Corneal UlcersTOC: 4th generation fluoroquinalones-Zymar (gatifloxacin) 0.3%
-Vigamox (moxifloxacin) 0.5%
-Quixin (levofloxacin) 0.5%-- 3rd generation
-Iquix (levofloxacin 1.5%) qd or bid– 3x conc of Quixin and works better than Zymar and Vigamox without toxicity. Preservative free.
Corneal Ulcers(additional treatments)
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) -- least toxic
Bacterial Conjunctivitis- Azasite (azithromycin 1%) bid-tid steroid added post AB treatment to prevent corneal scarring
- Vigamox (moxifloxacin) FDA approved for bacterial conjunctivits
Topical anit-inflammatories• Steroids- Maxidex (Dexamethasone 0.1%) susp
- FML (flouromethalone 0.1%) – ung or susp
- Pred forte (prednisilone 1%) – susp
• Soft steroids- Lotepredenol etabonate
Alrex 0.2%
Lotemax 0.5%
• NSAIDS (analgesic effect)- Diclofenac (Voltaren 0.1%) soln- Ketorolac (Acular 0.4%) soln
Allergic and CLPC- (contact lens induced papillary conjunctivitis)
Treat with…- Mast cell stabilizers
Crolom bid, Alomide or Alomast qid, Alocril bid
- Mast cell stabilizing antihistamines
Patanol bid/ Pataday qd, Elestat bid, Zaditor bid, Optivar bid
- NSAIDS
Acular qid
- Steroids (only if severe)
Alrex, Lotemax, or Pred Forte qid
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