L12 Corneal Degenerations

two conditions that causes corneal thinning

terrien marginal degeneration

furrow degeneration

diseases leave ____ are:

calcific band keratopathy

limbal girdle of vogt

corneal arcus

lipid degeneration

iron deposits

amyloid deposits

deposits

_____ ____ consists of

crocodile shagreen

salzmann nodular degeneration

spheroidal degeneratoin

corneal keloids

hassall henle bodies

cornea farinata

remodulated tissue

terrien marginal degeneration usually affects who (2)

20-40s but can occur in childhood

male

terriens marginal degeneration is characterized by slowly progressive bilateral thinning of peripheral cornea. It begins ______ then spreads _____

superior, circumferential

terriens marginal degeneration is accompanied by (3)

neovascularization, peripheral opacification, lipid deposition

terrien's marginal degeneration can be associated with

episcleral or scleral inflammation

terrien marginal degeneration

___ progression

1. superficial punctate and anterior stromal opacities superiorly

2. linear deposits at leading edge with vascular pannus circumferential thinning

3. ends with steepening in area of thinning leading to irregular astigmatism / high ATR astigmatism

terrien marginal degeneration

terrien marginal degeneration is occularly significant due to ______ corneal astigmatism, high _____ and high risk for _____

irregular, ATR, perforation

what are differentials for TMD (2)

mooren ulcer (pain & ulcer)

furrow degeneration (lack astig. shift)

what is the tx for TMD (2)

special CL for vision

surgery intervention for perforation or high risk of it

what is another name for furrow degeneration (2)

senile furrow degeneration and marginal furrow degeneration

furrow degeneration tends to affect who

older pts like 60+

furrow degeneration is characterized by ?

painless, non inflammatory peripheral thinning in avascular zone between arcus and limbal vascular arcade

furrow degeneration has areas of thinning that are similar or equal ______ ____ resulting in no ____ shift

tensile strength, astigmatic

what is the treatment for furrow degeneration

asymptomatic with no treatment

(calcific) band keratopathy affects who

any age

(calcific) band keratopathy has two forms:

calcific and non calific

(calcific) band keratopathy is characterized by calcium deposits in ______ layer located ____ along horizantal axis

bowman, interpalpebral

when (calcific) band keratopathy progresses, ____ ____ and ____ ___ can occur

avascular pannus, epithelial atrophy

besides calcific and non calcific, what are the two forms (calcific) band keratopathy can have

primary and secondary

can (calcific) band keratopathy affect vision? why?

yes because it affects visual axis

what are the two tx options for (calcific) band keratopathy

EDTA chelation and remove with lasers

primary (calcific) band keratopathy is

- considered idiopathic

-rare presentation

secondary (calcific) band keratopathy characterization (3)

- chronic ocular inflammation

- ocular trauma

- systemic disease with elevated serum calcium or phophate

(calcific) band keratopathy can create risk of

recurrent corneal erosion

t/f (calcific) band keratopathy can alter vision

true

secondary (calcific) band keratopathy characterizition: 3

-chronic inflamation

- systemic diease with abnormal calcium metabolism

- topical/ intraocular meds that affect calcium metabolism within the eye

tx for (calcific) band keratopathy (2)

EDTA chelation - in office to remove and dissolve Ca

Excimer laser PTK to remove Ca

calcific band keratopathy presents in about ______ of juvenile idiopathic arthritis in pediatrics

1/3

pediatric bank k is associated with

uveitis

t/f in peds= inflammation, band k, cataract

true

Limbal girdle (of vogt) is seen in who

older patient. increased incidence w age

what are characteristics of Limbal girdle (of vogt) (2)

symmetric yellow- white band located at the interpalpebral limbus beneath the epithelium next to bowman

located nasal> temporal

peds bank k

how are the two types of Limbal girdle (of vogt) distinguished?

presence or absence of clear zone between lesion and limbus

Limbal girdle (of vogt) is considered visually _____ and does not require ____

insignificant, treatment

Limbal girdle (of vogt)

there are two types of Limbal girdle (of vogt). type 1 is the absence of _____ ____ and mainly has _____ deposits

clear zone, calcium

there are two types Limbal girdle (of vogt). type 2 has the presence of ___ ___ and is made of (3)

clear zone

made of hyaline deposits, elastic changes, hypertrophy overlying epithelium

types Limbal girdle (of vogt) type 1

types Limbal girdle (of vogt) type 2

what is the term to define patients 40 and up who present with corneal arcus

arcus senilis

what is the term to define patients younger than 40 who present with corneal arcus (2)

arcus juvenilis OR posterior embryotoxin

___ ____ is can be described as

bilateral, slow progressive lipoprotein deposits in peripheral with a chance of rapid onset of hyperemia

corneal arcus

how does corneal arcus distribute itself around the limbus?

starts inferior cornea then superior cornea and then makes full ring

how does corneal arcus distribute itself within the layers of the cornea?

starts in decemets to bowmans and then in between stromal lamellae

___ ___ is pathophysiology is described as

- lipoproteins cross capillary walls

- elevated circulating LDL disrupts _____ junction of limbal vasculture edothelium

- _____ can accelerate it

corneal arcus, Tight, hyperemia

is corneal arcus ocularly significant in people over 40? yes or no

no

is corneal arcus ocularly significant in people under 40? yes or no

yes

corneal arcus presenting in people under 40 could show risk of _____ ____ disease and _________

coronary artery, hyperlipoproteinemia

what is hyperlipoproteinemia presenting as

premature arcus with xanthelasma

yellow near lids= xanthelasma

unilateral presentation of corneal arcus could mean risk of carotid artery occlusion on the side side _______ arcus

without

what are the two types of lipid degeneration

primary and secondary

______ lipid degeneration presents as

no neo or inflammation

normal lipid levels

rare

primary

what is another name for secondary lipid degeneration

lipid keratopathy

____ ___ ___ presents as or with

neo and inflammation

increased HDLs

secondary lipid degeneration

____ lipid degeneration is commonly seen with herpetic infections, ulcers, and truam

secondary

lipid degeneration

primary lipid degenerations can occur bilaterally with risk for central lipid formation and ____ formation

crystal

secondary lipid degeneration can either uni or _____. presence of white- yellw deposit with _____ vessel accompanied with other signs such as ____

bilateral, stromal, inflammation

what is the demographics for lipid degeneration

depends on etiology

lipid degeneration is characterized by (3)

- white yellow deposits in all cornea layer

- highest in midstroma

- sea fan shape with featherlike edges

- +/- crystals

can lipid degeneration affect vision? yes or no

yes

tx for lipid degeneration for neo or vision affected?

neo = anti vegf or tx feeder vessel

vision= surgery (penetrating keroplasty)

where do iron come from and where do they deposit?

come from tear film. deposit in epithelium

what is the best way to detect iron deposisits

cobalt or red free

if there is iron in the epithelium and you use cobalt or red free how will it appear

look like a black line

iron deposits are commonly seen with (5)

- keratoconus

- filtering blebs

- pterygiums

- salzmanns nodules

- cornea surgery

iron deposits in lower third of cornea is called

hudson-stahli line

iron deposits at leading edge of pterygium is called

stockers line

iron depositing at the base of cone in keratoconus is called

fleishers ring

iron depositing associated with filtering blebs is called

ferrys line

hudson stahli line

stockers line

fleishers ring

ferrys line

amyloid depositis

what is amyloid

group of hyaline proteins with starch like staining characteristics

a characteristic of amyloid deposit is they occur on ___ or _____ from systemic and localized condition

conj, cornea

amyloid deposits present in (4)

corneal dystrophy (lattice, gel. drop like cornea prblms)

trauma

chronic inflammation

degeneration (polymorphic amyloid degen.)

t/f treatment for amyloid deposits is related to etiology

true

t/f amyloid deposits can be visually significant

true

what is polymorphic amyloids degeneration

bilateral glass like deposits made of amyloid in the central stroma that can indent decemets

polymorphic amyloids degeneration occurs in which age

>50 yrs

what is a differential for polymorphic amyloids degeneration

lattice dystrophy

does polymorphic amyloids degeneration impair vision? yes or no

no

____ ____ is bilateral, symmetric mosaic pattern opacities in the stroma

crocodile shagreen

crocodile shagreen

is crocodile shagreen common in the central or peripheral

more common in central but appears in peripheral

what is the composition of crocodile shagreen

reorganization of collagen lamella

what are the two types of crocodile shagreen

anterior and posterior

what is anterior crocodile shagreen assoicated with

trauma, hypotony, band - k, megalocornea, or RGP wear

what is posterior crocodile shagreen assoiciated with

age related degeneration

is crocodile shagreen ocularly significant? yes or no

no

what is the tx for crocodile shagreen

does not need treatment

Salzmann nodular degeneration affects who

middle ages

females more than males

____ ____ can be

- uni lateral or bilateral

- 0.2 to 2mm round oval, elevated, avascular, white blue gray lesions located between epithelium and bowman

- single or multiple in an annular distr.

- iron line at base of nodules is possible

- slow progression

- adjacentt to pannus or scarring

salzmanns nodular degeneration