Misc
what treatment do you give someone for seborrheic blepharitis secondary to demodex?
50% tea tree oil scrubs, and if that fails oral ivermectin
What inflammatory cell types is seen in this histologic image of bacterial keratitis? Image 2
Neutrophils
Image 1 - what is the name of this clinical finding?
posterior embryotoxon
Neisseria gonorrhea conjunctivitis generally presents how many days after birth?
Gonococcal, onset 3-5 days: Hyperpurulent discharge
Chlamydia, onset 5-14 days: Mucopurulent discharge
HSV, onset 7-14 days: Watery discharge
Diagnose this - Image 5
posterior KCN
What are the two major organ systems affected by Cogan syndrome?
eyes and ears (typically have interstitial keratitis, vertigo, and hearing loss)
hyaline and fibrillar (i'll take collagenous tissue) material which deposits and replaces the bowman's layer
What disease is this? Image 4
Interstitial keratitis: stormal scarring and ghost vessels
Name four bugs that can penetrate an intact corneal epithelium
Cornebacteria, acanthamoeba, neisseria, hemophilus, listeria, shigella
Give me five causes of band keratopathy
JIA, HSV, hypercalcemia, hyperparathyroidism, sarcoidosis, milk-alkali syndrome, cancer mets, gout, glaucoma, phthsis bulbi, idiopathic, congenital band
All corneal dystrophies are autosomal dominant except for
Macular (and type 3 lattice, gelatinous, type 3 CHED)
How do you differentiate between Reis-Bucklers and Thiel-Benke corneal dystrophy?
electron microscopy which shows curly fibers in TB, or could say saw tooth pattern present in AS-OCT in bowmans layer in TB
What is a key distinguishing exam finding between peipheral ulcerative keratitis (PUK) and Mooren's ulcer?
Mooren's ulcer is limited to cornea; PUK can involve both cornea and sclera
Besides older age, trauma, autoimmune disease, and surgery, what is another infectious risk factor for Mooren ulcer development?
Helminth exposure - typically seen in West Africa; triggered by antigen-antibody interactions to helminth toxins or antigen in limbal cornea
Megalocornea can be seen in this genetic disease
Marfan syndrome (>13mm!)
What are the three main takeaways from the Herpetic Eye Disease Study?
1. HSV stromal keratitis is best treated with topical steroids plus PO antivirals
2. PO antiviral does not help acute stromal disease, but does help prevent recurrence
3. For epithelial keratitis there is no benefit with topical steroids so treat with oral antiviral or topical antiviral (e.g. ganciclovir)
4. For people with multiple recurrence of stromal keratitis, PO antiviral prophylaxis should be lifelong
What is the shape and staining of neisseria gonorrhea species?
gram negative diplococci
By what percentage does the corneal thickness need to increase by before DM folds are seen?
How do we treat microsporidia (typically seen as keratoconjunctivitis or stromal keratitis)?
Topical fumagillin or topical voriconazole 1%
What is the name of this sign that is shown in a patient with keratoconus? (show image 3)
Munson's sign which is a V-shaped indentation of the lower eyelid produced by the conical protrusion of the cornea, specifically when a patient looks downward
Differentiate SJS from SJS-TEN from TEN in terms of degree of skin involvement
SJS: <10%
SJS-TEN: 10%-30%
TEN: >30%
Name two stains used to identify acanthamoeba in conreal ulcers apart from the regular H&E?
PAS
Calcofluor white
Acridine orange
GMS (Grocott methenamine silver)
"Please Colour Acanthamoeba Green"
What is stage 1 of the Foster staging system for mucous membrane pemphigoid?
Stage I: chronic conjunctivitis with subconjunctival fibrosis
Stage II: fornix foreshortening
Stage III: symblepharon formation
Stage IV: ankyloblepharon or frozen globe (keratinization of the ocular surface)
What is the Hutchinson triad of congenital syphilis?
Widely spaced peg-shaped teeth
Sensorineural deafness (CN VIII involvement)
ISK
Focal limbal ischemia indicates what grade of ocular chemical injury?