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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Cause: Thickened tear film where lids meet
Rupture in Descemet’s membrane
Epithelial Basement Membrane Dystrophy
Intraepithelial cysts with amorphous material/cellular debris
Tx: usually not needed
BM is laid down abnormally by epithelial cells build up of material
Pts > 60
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)
Tx: Chelating agent EDTA
-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
*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.
*Pseudomonas can progress fast! Within 24 hours
-hypopyon, infiltrates in cornea, KPs, plasmoid aqueous (AC is jello)
-pain, decreased VAs, redness
*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
*Most common complication of non-perforating and perforating injuries to the globe.
*May me caused by severe trauma.
*Liquified cat with intact nucleus inferiorly displaced.
*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.
*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.
*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…
gram (+) Vigamox, gram (-) Zymar
Medications used to treat ocular inflammation and prevent microbial infection. Also used for superficial burns.
Examples: corneal infiltratres, meibomian gland dys., blepharitis
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.
-Gentamycin (ung, gtt)
-Tobramycin sulfate (ung, gtt)
- Azasite (azithromycin 1%) bid-tid
steroid added post AB treatment to prevent corneal scarring
- Vigamox (moxifloxacin)
FDA approved for bacterial conjunctivits
- Maxidex (Dexamethasone 0.1%) susp
- FML (flouromethalone 0.1%) – ung or susp
- Pred forte (prednisilone 1%) – susp
- Lotepredenol etabonate
- Diclofenac (Voltaren 0.1%) soln
- 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
- Steroids (only if severe)
Alrex, Lotemax, or Pred Forte qid