External Disease and Cornea

7/27/2019 External Disease and Cornea

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PART I : EXTERNAL DISEASE

American Academy of Ophthalmology


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Section A

EYELID DISEASE


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Meibomian Gland Dysfunction

Enlargement , Irregularity, Inspissation, Plugging of the meibomian

gland orificies


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Angular Blepharitis

Maceration and crusting of the skin at the lateral (sometimes medial)

canthus


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Molluscum Contagiosum

Papule and enlarging to a waxy nodule with an umbilical center


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Hordeolum and Chalazion

External hordeolum focal, erythematous swelling of the anterior eyelid margin, often an

infected gland of Zeis


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Hordeolum and Chalazion

Chalazion : chronic lipogranuloma of an occluded meibomian gland


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Viral Papilloma

Painless, keratanized cutaneous lesion, usually without inflammation


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Seborrheic Keratosis

Pigmented, well demarcated and slightly elevatedWarty and crusted, oftern has a stuck on appearance, with visible keratotic plugs


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Xanthelasma

Yellow to-tan plaque that often involves the medial portion of the upper and lower eyelidsSuperficial dermis contains foamy histiocytes, filled with cholesterol esters


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Basal Cell Carcinoma

Nodular lesion with teleangiectic vessels at its borderLarger lesions umbilicated with smooth, pearly borders.


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Squamous Cell Carcinoma

Keratinized lesion, often affecting the eyelid margin


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Sturge-Weber Syndrome

Facial port-wine stain, with or without leptomeningeal angiomatosisChoroidal hemangioma is most common intraocular abnormality associated with Sturge-

Weber syndrome.


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Capillary Hemangioma

Reddish purple tumor strawberry nevusAmbliopia can occur secondary to ptosis, strabismus, or astigmatism and anisometropia


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Allergic Contact Dermatitis

Development of acute irritation, erythema, swelling and dry or wet (eczema) of the skinaround the lids, with application of a preparation to the periocular facial skin or the eye


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Section B

LACRIMAL SYSTEM DISORDERS


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Canaliculitis

Tearing, a prominent punctum, and swelling and tenderness over the canaliculusMilking the canaliculus


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Dacryocystitis

Tender swelling over the lacrimal sac, accompanied by pain, erythema, and discharge


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Normal Tear Film

Three layer : Mucin layer, Aqueous layer, Oil layer


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Keratoconjunctivitis Sicca

Diffuse ppunctate erosions and conjunctivitis over the interpalpebral

area


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Section c

CONJUNCTIVAL DISEASE


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Follicular Conjunctival Reaction

Conjunctival vascular dilation, sometimes accompanied by

conjunctival edema and discharge


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Papillary Conjunctival Reaction

Upper tarsal conjunctiva, a papillary response is a fine mosaic pattern

of dilated, telangiectatic blood vessels.


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Adenoviral Conjunctivitis

Hyperemic and congestive conjunctival reaction

Serous discharge and preauricular lymphadenopathy


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Epidemic Keratoconjunctivitis

External ocular adenovirus infectionPreauriculer lymphadenopathy and a mixed papillary-follicular conjunctivitis


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Membranous Conjunctivitis

Inflammatory discharge of fibrin with polymorphonuclear leukocytes

and fibrin coagulates of the conjunctival surface


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Gonococcal Keratoconjunctivitis

Rapid progression, copiously purulent conjunctival discharge, marked

conjunctival hyperemia and chemosis, and eyelid edema


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Chlamydial Keratoconjunctivitis

Prominent follicular response with nontender preauricular

lymphadenopathy


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Trachoma

conjunctival scarring can subsequently lead to a dry eye, trichiasis, and

entropion


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Trachoma

Herberts pits are small depressions at the limbus that represent areas

of slight thinning at the site of necrotic follicles


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Allergic (Hay Fever) Conjunctivitis

Conjunctival hyperemia, chemosis and mucoid discharge


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Atopic Keratoconjunctivitis

Small to medium-sized papillae that are equally prominent on the upper

and lower palpebral conjunctiva, milky bulbar conjunctival edema


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Vernal Keratoconjunctivitis

Palpebral vernal diffuse papillary hypertrophy develops with giant

(cobblestone) papillae


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Vernal Keratoconjunctivitis

Sterile epithelial ulcers with an oval or shield shape, and underlying

stromal opacification, may also develop in the midsuperior cornea


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Giant Papillary Conjunctivitis

Chronic inflammation of the conjunctiva with prominent papillary

hypertrophy of the superior tarsus


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Superior Limbic KeratoconjunctivitisFine papillary reaction on the superior tarsal conjunctiva; injection and thickening of the superiorbulbar conjunctiva and hypertrophy of the superior limbus; and fine punctate fluorescein and rosebengal staining of the superior bulbar conjunctiva above the limbus and of the superior cornea justbelow the limbus


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Stevens-Johnson Syndrome

Acute, inflammatory, vesicobullous reaction of the skin and mucous

Mucopurulent conjunctival discharge


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Conjunctival Nevus

Congenital hamartomas that consist of nests of modified melanocytes

Junctional, compound, and subepithelial nevi occur in the conjunctiva


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Adrenochrome Deposits

Conjunctival or corneal darkly pigmented deposits can occur in

patients who are using topical epinephrine compounds for glaucoma


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Pinguecula

Degenerative lesion of the bulbar conjunctiva that occurs adjacent to the limbus inthe interpalpebral zone, most often nasallyYellow-white amorphous, subepithelial deposits, gradually enlarge


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Pterygium

Benign proliferation of fibrovascular tissue covered by conjunctival-

like epithelium extending onto the peripheral cornea


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Pyogenic Granuloma

This raised, fleshy, red pedunculated lesion can arise from skin or

conjunctiva usually accompanied by mucopurulent or purulent discharge


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Phlyctenulosis

Focal, translucent lymphocytic nodules generally located at the limbus

and usually accompanied by significant inflammation


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Conjunctival Viral Papilloma

Pedunculated or sessile appearance


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Conjunctival/Cornea Intraepithelial Neoplasia

Gelatinous, sessile appearance with numerous tiny superficial

corkscrewlike blood vessels typically located at the limbus


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Conjunctival/Cornea Intraepithelial NeoplasiaIf CIN spreads onto the adjacent cornea, the cornea epithelim will typically have anirregular opalescent appearance with small, white, intraepithelial opacities and a

central fimbriated edge


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Conjunctival Lymphoma

Both bening reactive lymphoid hyperplasia and malignant lymphoma

of the conjunctiva can produce a salmon-colored tumor


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Primary Acquired Conjunctival Melanosis (PAM)Intraepithelial melanocytes proliferate to produce multiple flat, brown,intermittently changing patches of unilateral pigmentation within the superficial

conjunctiva


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Section d

SCLERAL DISEASE


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Scleritis

Active inflammation violaceous hue best seen in natural sunlight

Engorgement of the deep vascular plexus is evident


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Scleromalacia PerforansPainless necrotizing scleritisBluish color in affected regions as uveal pigment begins to show through the thinned

sclera


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Congenital Melanosis Oculi

Congenital blue nevus of the episclera and sclera associated with

increased pigmentation of the uveal tract


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PART II : CORNEA

American Academy of Ophthalmology


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Section A

INFECTIOUS & INFLAMMATORY CORNEAL DISEASE


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Bacterial Keratitis : Streptococcus Pneumoniae

Corneal ulcers with relatively distinct borders, sometimes with

overhanging edges


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Bacterial Keratitis : Pseudomonas Aeruginosa

Rapid evolution ulcers and a marked tendency to spreadFrequently a tenacious, mucopurulent discharge adheres to the ulcer surface


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Fungal Keratitis

Gray-white, dry-appearing infiltrate that has a delicately filamentous

or feathery edge


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Acanthamoeba Keratitis

Stromal infection occurs central cornea gray white superficial infiltratesPartial or complete ring infiltrate in the paracentral cornea


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Primary Herpes Simplex Virus InfectionUnilateral vesicular blepharoconjunctivitisTypical epithelial dendrites are seen in some cases, but mostly scattered punctate

epithelial lesions or only a follicular conjunctivitis

i l i d i i d hi


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Herpes Simplex Virus Dendritic and Geographic

Epithelial Keratitis

HSV dendrites most commonly occur in the center of the corne; theirbranches have a characteristic morphology referred to as terminal bulbs

H Si l Vi D d iti d G hi


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Herpes Simplex Virus Dendritic and Geographic

Epithelial Keratitis

Centrifugal spread of HSV infection from a central dendrite toward the

peripheral cornea


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Herpes Simplex Virus Disciform KeratitisNonnecrotizing keratits focal, circular area of microcystic edema overlying a mild(lymphocytic) stromal inflammatory infiltrate and stromal edema wit Descemets

folds and underlying keratitic precipitates


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Herpes Simplex Virus Necrotizing Stromal Keratitis

Severe stromal inflammation, corneal neovascularization, thinning,

and sometimes stromal necrosis and perforation

T hi E ith li l D f t F ll i HSV St l


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Trophic Epithelial Defect Following HSV Stromal

KeratitisPostinfectious keratopathy trophic, indolent, or metaherpetic ulcerRound or oval ulcer with smooth, thickened edges that often overlie an area of

stromal inflammation or inactive stromal scarring


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Herpes Zoster Dendritiform KeratitisDendritiform keratitis, in which the pseudodendites differ in appearance from thedendrites that characterize HSV keratitsHave heaped-up epithelium with unusual branching patterns, but they lack terminal bulbs


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Herpes Zoster Ophthalmicus Mucous Plaque Keratopathy

Elevated mucous plaques resembling dendrites can occur weeks tomonths after resolution of cutaneous lesions


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Rosacea KeratitisOculodermatologic disease characterized by facial telangiectasia and erythema;sebaceous gland dysfunction of the face, neck and shoulders; and vasomotorinstability


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Rosacea Keratitis

Corneal neovascularization and scarring can follow repeated bouts ofocular surface inflammation


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Thygesons Superficial Punctate KeratitisRecurrent episodes of tearing, foreign body sensation, photophobia and reduced vision.Corneal epithelial lesions are round or vertically oral conglomerates of gray, granularopacities that tend to cluster in the central cornea


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Luetic Interstitial Keratitis

Corneal scarring, thinning, and ghost vessels in the mid-to-deepstroma


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Section B

CORNEAL DYSTROPHIES/ECTATIC

DISORDER/INHERITED DISEASES

Corneal Epithelial Basement Membrane Dystrophy


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(Map-Dot-Fingerprint Dystrophy)

Gray patches in the central epihtelium



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(Map-Dot-Fingerprint Dystrophy)

Fine lines in the central epithelium


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Lattice Corneal Dystrophy

Lattice lines refractile lines, small white dots, and haze in thecentral supercial stroma


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Granular Corneal Dystrophy

Discrete, chaly, granular opacities in the axial cornea with clar areas ofintervening stroma


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Macular Corneal Dystrophy

Deposits of glycosaminoglycans, grayish white, irregular, feathery lesionsoriginating in the axial stroma, but ultimately involving the cornea at all levels


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Cornea GuttataRound, dark, drop like prominences at the level ofDescemets membarane and the corneal endotheliumThe guttae represent thickening and localize anvil-shaped excrescences ofDescemets membrane


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FuchsEndothelial Dystrophy

Significant density of cornea guttae


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FuchsEndothelial Dystrophy

Attenuation and dysfunction of endothelial cells, which leads tocorneal edema


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Posterior Polymorphous Dystrophy

Scattered asymptomatic vesicles, extensive polymorphous and geographic lesions,or broad bands with scalloped edges on Descemets membrane


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KeratoconusThe central or paracentral cornea undergoes progressive thinning and bulging so that the corneatakes on the shape of a coneVogts striae, Fleischers ring, apical anterior stromal scarring, irregular scissoring retinoscopic relex


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Posterior Embryotoxon

Thickened and anteriorly displace Schwalbes ring


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Riegers Anomaly and Riegers Syndrome

Congenital condition consisting of a centrally displaced Schwalbesring, prominent iris processes, and atrophy of the iris stroma

CORNEAL DEGENERATIONS


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Section C

CORNEAL DEGENERATIONS


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Vogts Limbal Girdle

Corneal degeneration consisting of chalky white, superficial opacity located justanterior to and parallel to the limbus in the interpalpebral fissure


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Spheroidal Degeneration

Translucent, golden brown globular deposit in the cornea


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Calcific Band KeratopathyBand-shaped opacity seen in the interpalpebral fissure in typical casesFirst presents with fine, white, dust like deposites in the peripheral Bowmans layer,with a lucid interval between the limbus and the deposit


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Secondary Lipid Keratopathy

Deposition of yellow white lipids in the corneal stroma as a result oflong standing deep corneal vascularization


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Salzmanns Nodular Corneal Degeneration

One or more bluish gray, raised nodules on the corneal surfacesMore commonly seen in the midperphery


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Neurotrophic Keratopathy

Keratopathy that generally involves the central or inferior paracentral corneaSurrounded by raised, rolled up, gray edges


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Moorens Ulcer

Chronic, progressive, idiopathic ulceration of the peripheral cornealstroma and epithelium


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Peripheral Corneal Ulceration from Rheumatoid Arthritis

Noninfectious corneal ulcers begin within 2 mm of the limbus, oftenshow minimal cellular infiltrate


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Terriens Marginal Degeneration

Nonulcerated depression at the superior (rarely inferior) limbus andprogresses slowly

CORNEAL INJURIES


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Section D

CORNEAL INJURIES

l i d


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Corneal Foreign Body

Common and the patient usually has an appropiate history

Alk li B


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Alkali Burn

Extensive limbal epithelial damage and ischemia, stromalopacification, and intraocular chemical penetration

Alk li B


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Alkali Burn

Blanching of the inferior perilimbal conjunctiva and sclera with a fewscattered conjunctiva hemorrhages and chemosis

Mi ll


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Miscellaneous

New vessels formation on chronic ulcer of the cornea


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External Disease and Cornea