Cornea (Misc conditions)

Exposure keratitis

Damage to cornea due to dryness from incomplete lid closure → TF changes

Exposure keratitis clinical findings

• PEEs

• Lagophthalmos

Exposure keratitis complications

• Decreased TBUT or tear meniscus

• Filamentary keratitis

• Corneal edema, thinning, or ulceration

Exposure keratitis Tx

• Non-preservative artificial tears (constantly using so don’t want preservatives)

• Amniotic membrane

• Bandage CL

Lagophthalmos Tx

• Taping of lids at night

• Sleep mask

• Tarsorrhaphy

• Gold weights

Filamentary keratitis

Primarily associated with OSD

Filamentary keratitis clinical findings

• Inc mucus in tears

• Areas of epi loss with mucus adherence

• Mucus surrounded by cellular debris

Filamentary keratitis complications

Secondary infection

Filamentary keratitis Tx

• Mechanical removal

• Artificial tears

• Bandage CL

Rosacea

Dermatological condition that can affect the eyes

Ways rosacea affects the cornea

• Inferior PEEs

• Neovasc and scarring

• Marginal keratitis

• Thinning and perforation

Thygeson superficial punctate keratitis

Chronic condition that has episodes of exacerbation and remissions

Etiology is unknown but may have viral origin

Thygeson superficial punctate keratitis clinical findings

• Bilateral but asymmetric

• Round gray/white epi opacities that may stain with fluorescein

Thygeson superficial punctate keratitis complications

Ocular irritation

Thygeson superficial punctate keratitis Tx

• Short course steroid during symptoms

• Topical immunomodulators to prevent reactivation

Xerophthalmia

Caused by vit A deficiency, commonly seen with malnutrition, malabsorption, chronic alcoholism, and highly selective eating

Why could GLP-1s cause xerophthalmia?

Decrease appetite → Not getting enough nutrients

Vitamin A

Essential for maintenance of epi surface and retinal function

Xerophthalmia clinical findings

• Night blindness

• Conj xerosis

• Bitot spots

• Corneal xerosis

• Ulceration and keratomalacia

• Bilateral scarring

• Retinal function and structure changes (chronic deficiency)

Conjunctival xerosis

Dry conj spots with goblet cell loss

Bitot spots

White dry opacities on bulbar conj

Typically interpalpebral

Corneal xerosis

Dry and hazy cornea with PEEs

Reversible with high dose of vit A

Keratomalacia

Liquification of the cornea from chronic necrosis

Not reversible

Xerophthalmia complications

• Secondary bacterial infection

• Perforation

• Blindness

Xerophthalmia Tx

Ocular:

• Non-preservative artificial tears

• Topical antibiotic solution

• PK

Systemic:

• Large dose vit A

Why is a large dose of vit A dangerous?

Toxic to MGs

Would rather save cornea than MGs