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ANT SEG IFLAMMATORY CORNEAL DISORDERS WITH CORRECT
SOLUTIONS 1 00 % VERIFIED!!
What are other names for marginal keratitis? Staphylococcal hypersensitivity Marginal infiltrate
What type of hypersensitivity reaction is marginal keratitis? Type 3
What are the symptoms of marginal keratitis? Foreign body sensation Focal Hyperemia Tearing Photophobia Blepharospasm
True or false: marginal keratitis is an active infection False - not an active infection, just a hypersensitivity reaction
What are clinical signs of marginal keratitis? Subepithelial white infiltrates with adjacent conjunctival hyperemia
How do you treat marginal keratitis? Antibiotic-steroid combination x 1-2 weeks Treatment and long-term management of blepharitis
What type of hypersensitivity reaction is phlyctenular keratoconjunctivitis? Type 4
Where does a phlyctenule first appear in the eye? Where does it go? First appears in the conjunctiva Moves onto the cornea
True or false: In the U.S. Staphylococcus epidermis is the most common cause of phlyctenular keratoconjunctivitis? False - Staphylococcus aureus
Why is it important to catch a phlyctenule before it reaches the cornea? Once the phlyctenule reaches the cornea, it will cause neovascularization and haze. It will also be painful for the patient
A patient reports to your office with severe photophobia, corneal haze, and blepharospasm. They tell you they had a small "ball" appear on the white of their eye and now it has moved onto their cornea. They tried using artificial tears but the ball
What happens to collagenases (especially in the peripheral cornea) in patients with PUK? Upregulation of the enzyme
During slit lamp examination, you notice a crescent-shaped ulcer in the infero-temporal cornea of your patient. They came in complaining of light sensitivity and red eyes. What is a good initial diagnosis? Peripheral Ulcerative Keratitis (PUK)
What bloodwork would you order when you diagnose a patient with PUK? CBC and RF (always order these two, most important to know) ANA (Rule out Lupus) ANCA RPR
Why might a patient with PUK need to see a corneal specialist? Surgery may be required to prevent perforation of the cornea (Fun fact: for this picture the iris is actually pushing forward to plug this hole in the cornea!)
A patient is sent from the emergency room to your office. They tell you that the ER doctor said they have PUK. The patient was started on artificial tears, a topical antibiotic-steroid combination, and a low dose of doxycycline. Do you change anything? YES Patients with PUK can NOT be on topical steroids!
What do patients have an autoimmune reaction against when they have a Mooren Ulcer? Corneal Stromal Tissue
How do you diagnose a Mooren Ulcer? By exclusion, you have to rule out systemic disease
Will a Mooren Ulcer perforate on its own? No
What are complications of a Mooren Ulcer? Severe astigmatism Perforation after minor trauma Secondary bacterial infection
(first two most important to remember)
You suspect a patient has PUK, but all blood tests are coming back normal or negative for systemic disease. What is a good differential diagnosis? Mooren Ulcer
overwears their contact lenses? SPK Circumlimbal hyperemia Peripheral infiltrates (marginal keratitis) Corneal neovascularization
A fellow student correctly identified that their patient had a poor contact lens fit, and they are coming to you to ask for help before seeing their preceptor. They have advised the patient to discontinue wearing their contacts, and plan to prescribe a 4th generation fluoroquinolone prophylactally. They mention that the patient has significant corneal inflammation. Is there anything else to add? You can add a steroid since there is significant inflammation
When is it appropriate to give a patient with contact lens corneal sequelae a combination antibiotic-steroid drop? When there is no epithelial staining (rare because SPK is common with CL overwear)
How often do you monitor patients who have issues with a tight/inappropriate lens? Daily to ensure no infection until there is significant improvement. These patients have a high risk of infection.
True or false: interstitial keratitis is an ulcerating inflammation of the stroma? False - non-ulcerating
Are the epithelium and endothelium impacted (by vascularization) in patients with interstitial keratitis? No - just the stroma is impacted by vascularization
What are the symptoms of the acute phase of interstitial keratitis? Pain/photophobia Stromal infiltrates and edema (leads to decrease in VA) Anterior chamber inflammation Conjunctival hyperemia (very red eye)
How can you tell if a patient has had successfully treated interstitial keratitis before? They will have corneal haze and ghost vessels (areas where vascularization took place but then the vessels went away so the "tunnels" they grew in are left)
What are the common causes of interstitial keratitis? Syphilis (both congenital and acquired) TB Cogan's Syndrome HSV/HZV
You correctly diagnose a patient with interstitial keratitis, and you highly suspect the patient has syphilis. What is the most appropriate treatment? Topical Steroids Cycloplegic
True
Where does tissue penetration occur in pannus? between the epithelium and Bowman's Layer
What tissues grow into the cornea with pannus? Collagen and vessels grow into the superficial cornea
Where do keratic precipitates form? Corneal endothelium
True or false: keratic precipitates are only ever white? False - can become pigmented (especially if the patient has pigment dispersion syndrome)
When is a corneal graft rejection most common? Within the first 6 months
What increases the risk of corneal graft rejection? Corneal neovascularization
True or false: most corneal graft rejections can be reversed by topical and systemic steroids? True
What are the symptoms of a corneal graft rejection? Decreased vision Conjunctival redness Discomfort/pain Photophobia
Patient will be VERY symptomatic
What are some signs of a corneal graft rejection? Corneal edema Keratic precipitates on the corneal graft but not on the original cornea Stromal infiltrates Anterior chamber inflammation (cells and flare)
