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Corneal Path. Lecture 08/25/08: Corneal Dystrophies. Arcus Senilis. Elevated Cholesterol See PCP for blood work-up. Arcus Senilis. Hudson Stahli Line. A brown, horizontal line across the lower third of the cornea, occasionally seen in the aged. No Tx. Hudson Stahli Line.

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arcus senilis
Arcus Senilis
  • Elevated Cholesterol
  • See PCP for blood work-up
hudson stahli line
Hudson Stahli Line
  • A brown, horizontal line across the lower third of the cornea, occasionally seen in the aged.
  • No Tx
band keratopathy
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
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
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
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
Corneal Farinata
  • Bilateral speckling of the posterior part of the cornealstroma
  • VA unaffected
pellucid marginal degeneration keratoglobus
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
lecture 09 08 08 ebmd bergmanson
Lecture 09/08/08 EBMD (Bergmanson)
  • Keratoconus (continued)
    • Making the Dx
fleisher s ring
Fleisher’s Ring

Cause: Thickened tear film where lids meet


Rupture in Descemet’s membrane



Epithelial Basement Membrane Dystrophy

meesmann s dystrophy
Meesmann’s Dystrophy

Intraepithelial cysts with amorphous material/cellular debris

Tx: usually not needed

map dot fingerprint dystrophy aka anterior membrane dystrophy
Map/ Dot/ Fingerprint Dystrophyaka “Anterior Membrane Dystrophy”

BM is laid down abnormally by epithelial cells build up of material

Pts > 60

Negative staining

tx for ebmd
Tx: for EBMD
  • Lubricant/gtts; ung
  • Bandage CL
  • Stromal puncture
  • Epithelial scraping
  • PTK
surgical tx
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
Reis-Buckler’s Dystrophy

Autosomal dominant dystrophy

Characterized 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)

inherited band keratopathy
Inherited Band Keratopathy

Tx: Chelating agent EDTA

stromal dystrophy
Stromal Dystrophy
  • Granular Dystrophy
  • Lattice Dystrophy
  • Gelatinous drop-like dystrophy
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

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
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 Keratitis

*Pseudomonas can progress fast! Within 24 hours

-hypopyon, infiltrates in cornea, KPs, plasmoid aqueous (AC is jello)

-pain, decreased VAs, redness

corneal fb
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 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
Traumatic Cataract

*Most common complication of non-perforating and perforating injuries to the globe.

hypermature morgagnian cateract
Hypermature/Morgagnian Cateract

*May me caused by severe trauma.

*Liquified cat with intact nucleus inferiorly displaced.

bollus keratopathy
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
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
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…

bacterial corneal ulcer
Bacterial corneal Ulcer

gram (+) Vigamox, gram (-) Zymar

acanthamoeba keratitis
Acanthamoeba keratitis
  • Epithelial debridement
  • Artificial tears
pubic lice
Pubic lice
  • Bacitracin ointment
iris nevus
Iris nevus
  • Asymptomatic, no tx
  • Malignant with growth, refer
combination antibiotics
Combination Antibiotics
  • Tobramycin
  • Polymixin B
  • Neomycin (hypersensitvity common)
  • Sulfacetamide
  • Bacitracin

Medications used to treat ocular inflammation and prevent microbial infection. Also used for superficial burns.

Examples: corneal infiltratres, meibomian gland dys., blepharitis

corneal ulcers
Corneal Ulcers

TOC: 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
Corneal Ulcers(additional treatments)


-Gentamycin (ung, gtt)

-Ofloxacin (gtt)

-Ciprofloxacin (gtt)

-Tobramycin sulfate (ung, gtt)


  • Polysporin ung ( polymixin B & bacitracin)
  • Neosporin ung ( poly b/ neomycin / bacitracin)
  • Polytrim gtt ( poly B & trimethoprim) -- least toxic
bacterial conjunctivitis
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
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
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


Acular qid

- Steroids (only if severe)

Alrex, Lotemax, or Pred Forte qid