L11 Corneal Signs

what are clinical descriptors to describe what you are viewing (6)

shape, location, size, borders, color, and other

when describing general shape what are some ways to describe what you are seeing (4)

round, oval, linear, or irregular

when describing unique shape what are some ways to describe what you are seeing (4)

dendritic, disciform, geographic, nummular

when trying to describe the location of a lesion you can attempt to see what ___ of cornea is affect or what ____

layer, region

what are tools to use to check which layer of the cornea is affect while in the slit lamp (2)

optic section, vital dyes

what layers can be affects based on location (6)

epithelial (superficial)

subepithelial

anterior stroma

mid stroma

posterior stroma

endothelial( at or within endothelium)

what region can be affected based on location (5)

central (w/i visual axis)

paracentral (outside visual axis)

Mid periphery: btwn paracentral and periphery

periphery: near limbus

limbal: at limbus

while describing the size of something you are seeing something in the slit lamp (2)

qualitative and quantitive

while describing something you are seeing in the slit lamp what are some qualitative descriptors (3)

small, medium, large

what are some quantitive measures while try to describe how big something is (2)

measure in mm HxV

photodocument

what is a trick to measure the Height and width of a lesion in the slit lamp

use the slit lamp beam to match the height and width and use a ruler to measure it

qualitative = ___ assessment

quantative= ___ assessment

subjective, objective

while describing a lesion and determining borders you should ask yourself if they are

distinct or indistinct border

what is considered a well defined or distinction (2)

- able to draw an imaginary shape

- contained lesion with minimal involvement of adjacent cornea

what is considered a ill defined or indistinction (2)

unable to draw imaginary shape

may or may not have significant adjacent corneal involvement

describing color: white

may be from infiltrates, scar tissue, calcium, ...

color: red

from blood or RBC dusting

color: blue gray

color: brown

may be from: pigment, copper, iron

color: yellow

may be from: from white-yellow to dark yellow

fatty, lipid deposits

space: diffuse

widespread

space: focal

specific localized

space: marginal

near the border

space: interstitial

spaced between cells

space: circumferential

outside edge

consistency, transparency, quantity, and company it keeps are other clinical ____

descriptors

what are two tools to measure ocular clincial signs

mm ruler and slit lamp light height/ width

what are slit lamp techniques to asses ocular signs (4)

sclerotic scatter

specular reflection

optic section

indirect illumination

what vital dyes can be used to asses ocular signs (2)

superficial

postive vs negative staining

what filters can be used while assessing ocular signs (2)

cobalt with wratten filter

neutral density vs no filter

what is the central thickness of the cornea

555 microns

what is the thickness of the cornea peripherally

670 microns

epithelium is ___ microns

50

corneal stroma is ___ microns

500

endothelium is ____ microns

5

what is pannus

superficial subepithelial fibrosis derived from conjunctival or superficial episcleral plexus

____ ___ is

- non specific response

- lacks blood supply

- appears as subepithelail haze made of various collagenous components

- can occur in many conditions including PRK and salzmann nodular degeneration

avascular pannus

____ ___ is

- fine sheet of fibrosis with blood vessels

can be present in mild or chronic inflammation with varying severity

vascular pannus

what is stromal neovascularization

formation of new blood vessel

___ ___ ___ is

- located subepithelial or anterior stromal

- response to superficial disease

- arises from ACA to conjunctival or superficial episceral plexuses

superficial stromal neovascularization

___ ____ ___

- located from mid stroma

- chronic inflammation

- arises from PCA to deep episcleral plexus vessels

middle stromal neovascularization

__ ___ ___

- located in the posterior stroma

- chronic inflammation

- arises from PCA to deep episcleral plexus vessels

deep stromal neovascularization

superficial stromal neovascularization

middle stromal neo

middle stromal neo

deep stromal neo

inactive neo-> ghost vessels

___ ____ is

- regression of stromal neo

- white and quiet eye

- potential to reactivate

ghost vessels

an inciting event such as microbe, trauma, or autoimmune can lead to : ___ (4) in chronicological order

hyperemia, stromal neovascularization, inflammatory cells and then clinical presentation such as infilitrates with chance of edema & suppuration

what are infiltrates?

inflammatory cells composed of leukocytes

are infiltrates single, multiple, diffuse or all of the above

all of the above

when there is a immune response it will manifest as ___ in the cornea

infiltrates

if there is there is infiltrates in the epithelium it is known as

epithelial infiltrates

if there are infiltrates in the corneal anterior stroma it is known as (2)

subepithelial infiltrates OR stromal infiltrates

if there are infiltrates in the corneal middle stroma OR posterior stroma it is known as

stromal infiltrates

if there are infiltrates in the corneal endothelium it is known as (2)

keratic precipitates

corneal epithelium infiltrates

subepithelial epithelial infiltrates

t/f subepithelial epithelial infiltrates can be located in the anterior stroma

true

t/f a characteristic of stromal infiltrates is that it can be indistinct faint to sense grainy haze

true

can stromal infilitrates present present and without edema? yes or no

yes

stromal infiltrates

___ ___

- inflammatory leuokcytespresents on the back of the endothelium

- shows in various shapes such as fine dusting, large greasy round stellate

keratic precipitates

keratic precipitates

keratic precipitates on series OCT

guttata in central cornea

what is guttata

abnormal thickening of descemets resulting in endothelial cell destruction

a break or tear in descemet

t/f vital dyes can be used to detect epithelial defects

true

sodium fluorscein can be used to detect ___ epithelial cells

MISSING

rose bengal can be used to stain?

dead or devitalized epithelial cells

lissamine green can be used to stain?

dead or devitalized epithelial cells

NaFl detecting missing epithelial cells

dead or devitalized epithelial cells

what 4 types of micro epithelial defects

superficial punctate staining

superficial punctate keratitis

punctate epithelial erosions

persistent epithelial defects

__ ___ ___ is punctate staining without inflammation

superficial punctate staining?

___ ___ __ is small fine staining accompanied by inflammation

superficial punctate keratitis

__ __ __ is punctate staining with repetitive breakdown of epithelium

punctate epithelial erosions

__ ___ ___ is chronic epithelial break that fail to heal in the expected time period

persistent epithelial defect

difference between superficial punctate staining (SPS) and superficial punctate keratitis (SPK) is that __ ___ __ is staining without inflammation, hyperemia, edema, or pain. it also only stain with NaFl. whereas __ ___ ___ does punctate staining with inflammation along with hyperemia, edema and pain. in addition, it can stain with any of the dyes

SPS, SPK

superficial punctate keratitis and punctate epithelial erosions could be similar except punctate epithelial erosion is

repetitive breakdown of the corneal epithelium and there is no improvement with treatment

t/f SPK usually responds well to treatment?

true

SPK

PEE with confluent staining

what is confluent staining?

like a concentration of affected cells in a region

T/F punctate epithelial erosions can lead to persistent epithelial defect

true

loose / missing epithelium can lead to __ ___ __

persistent epithelial defect

what are the 4 types of excavation and/or pseudoexcavation

corneal dellen, corneal ulceration, desemetocele, corneal perforation

what is corneal dellen

pseudo-excavation; desiccation of cornea with al layers intact next to an adjacent area of elevation

___ ___ is excavation with loss of epithelial layer and some stroma

corneal ulceration

___ is excavation with complete loss of epithelium and stroma, leaving only Descemet and endothelium

descemetocele (precursor to perforation)

what 3 reasons a corneal dellen can form

poor rgp fit

bulbar elevation

inflammation or surgery

how does poor fit contribute to corneal dellen

excessive edge lift

How does bulbar elevation contribute to corneal dellen

pinguelca or pterygium

dermoids

blebs

how does inflammation or surgery contribute to corneal dellen

conj edema or chemosis

t/f corneal dellen is not truly an excavation since it has intact layers

true

corneal dellen

how do you confirm if a corneal ulcer is infectious or not?

confirm with culture, stain, pcr

what is keratolysis

process of progressive necrosis of corneal stroma