Podcast
Questions and Answers
What causes the overproduction of melanin in epithelial melanosis?
What causes the overproduction of melanin in epithelial melanosis?
Which systemic metabolic disease is associated with increased melanin production due to excess homogentisic acid?
Which systemic metabolic disease is associated with increased melanin production due to excess homogentisic acid?
Which medication is known to cause the formation of melanin deposits in the cornea due to chronic use?
Which medication is known to cause the formation of melanin deposits in the cornea due to chronic use?
In which ocular condition might melanin deposits occur in the endothelium?
In which ocular condition might melanin deposits occur in the endothelium?
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What differentiates benign primary epithelial melanocytic migration (BEPM) from malignant melanoma?
What differentiates benign primary epithelial melanocytic migration (BEPM) from malignant melanoma?
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Which age group is most likely to exhibit endothelial melanosis due to senile degeneration?
Which age group is most likely to exhibit endothelial melanosis due to senile degeneration?
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What is a potential source of melanin deposition in the stroma?
What is a potential source of melanin deposition in the stroma?
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What condition is associated with a vertical line of pigment in the endothelium?
What condition is associated with a vertical line of pigment in the endothelium?
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What is one potential source of too much pigment in the anterior chamber?
What is one potential source of too much pigment in the anterior chamber?
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What condition leads to endothelial melanosis from trauma?
What condition leads to endothelial melanosis from trauma?
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What type of pigmentation occurs when iron accumulates in the cornea?
What type of pigmentation occurs when iron accumulates in the cornea?
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Which line is characterized by an accumulation of tears due to corneal dryness in older individuals?
Which line is characterized by an accumulation of tears due to corneal dryness in older individuals?
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What can cause traumatic blood staining in the endothelium?
What can cause traumatic blood staining in the endothelium?
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What does the term 'Stocker’s line' refer to?
What does the term 'Stocker’s line' refer to?
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Which pigmentation occurs as a result of a corneal defect and the presence of foreign bodies?
Which pigmentation occurs as a result of a corneal defect and the presence of foreign bodies?
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What is the physiological consequence of a corneal defect causing iron accumulation?
What is the physiological consequence of a corneal defect causing iron accumulation?
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What is the primary characteristic of Haab’s striae?
What is the primary characteristic of Haab’s striae?
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Which conditions are associated with Haab’s striae?
Which conditions are associated with Haab’s striae?
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What is the treatment protocol for iridocorneal dysgenesis?
What is the treatment protocol for iridocorneal dysgenesis?
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Which feature is characteristic of Rieger Anomaly?
Which feature is characteristic of Rieger Anomaly?
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What differentiates Haab’s striae from Posterior Polymorphous Corneal Dystrophy (PPCD)?
What differentiates Haab’s striae from Posterior Polymorphous Corneal Dystrophy (PPCD)?
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Which disease is characterized by a copper deposition leading to a Kayser-Fleischer ring?
Which disease is characterized by a copper deposition leading to a Kayser-Fleischer ring?
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What is the primary source of vortex epitheliopathy/corneal verticillata?
What is the primary source of vortex epitheliopathy/corneal verticillata?
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Which of the following is NOT a characteristic of microcornea?
Which of the following is NOT a characteristic of microcornea?
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Which substance is indicated by the presence of brown deposits in the cornea due to chlorpromazine?
Which substance is indicated by the presence of brown deposits in the cornea due to chlorpromazine?
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What enzyme is affected by Wilson's disease, leading to copper metabolism issues?
What enzyme is affected by Wilson's disease, leading to copper metabolism issues?
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Which condition is potentially fatal and is associated with ocular signs along with severe kidney and heart disease?
Which condition is potentially fatal and is associated with ocular signs along with severe kidney and heart disease?
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What type of glaucoma is specifically associated with microcornea?
What type of glaucoma is specifically associated with microcornea?
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Which of the following is NOT a consequence of excessive copper deposition?
Which of the following is NOT a consequence of excessive copper deposition?
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Which medication is likely to cause vortex epitheliopathy?
Which medication is likely to cause vortex epitheliopathy?
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Which disease is characterized by brown whorl-like opacities that may cause halos of light?
Which disease is characterized by brown whorl-like opacities that may cause halos of light?
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What is a characteristic feature of megalocornea?
What is a characteristic feature of megalocornea?
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Megalocornea is classified under which type of inheritance?
Megalocornea is classified under which type of inheritance?
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What distinguishes corneal plana from other corneal conditions?
What distinguishes corneal plana from other corneal conditions?
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Which of the following symptoms is associated with optic nerve head hypoplasia?
Which of the following symptoms is associated with optic nerve head hypoplasia?
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Which type of corneal scleral condition always leads to blindness?
Which type of corneal scleral condition always leads to blindness?
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What is the primary management strategy for corneal scleral conditions?
What is the primary management strategy for corneal scleral conditions?
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Which condition can lead to the development of open-angle glaucoma?
Which condition can lead to the development of open-angle glaucoma?
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What is a typical refractive error associated with corneal plana?
What is a typical refractive error associated with corneal plana?
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Which condition is primarily caused by congenital glaucoma?
Which condition is primarily caused by congenital glaucoma?
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Study Notes
Corneal Pigmentation
- Pigmentation can be found in different layers of the cornea (epithelium, Descemet's, stroma)
- Melanin and iron are common causes of corneal pigmentation
- Certain medications can cause deposits
- Systemic metabolic diseases can cause pigmented deposits
- Always consider the patient's medication history when evaluating corneal pigmentation
Melanin Pigmentation
- Melanin can deposit in anterior, stromal, or endothelial layers; any corneal location
-
Epithelial Melanosis:
- Congenital: excessive melanin production, potentially anywhere
- Benign Primary Epithelial Melanocytic Migration (BEPM/BEMM): common in dark-skinned individuals, benign, migratory melanin cells
- Differentiation from melanoma involves looking for elevated lesions
- Melanomas: cancerous
-
Adrenochrome:
- Epinephrine can oxidize and form melanin
- Chronic epinephrine use can lead to melanin formation
- Very darkly colored melanin
Stromal Melanosis
-
Ochronosis (Alkaptonuria):
- Increased homogentisic acid leads to melanin production
- Systemic disease causing excessive melanin deposition in tendons, skin, and eyes
- Characterized by a brownish-purple discoloration of the skin
Endothelial Melanosis
- Congenital: present at birth
- Senile: common in older individuals (late 70s-80s)
- Development or inflammation can contribute to melanin build-up
- Systemic diseases (diabetes, herpes, etc.)
- Pigmentary glaucoma
- Trauma
Hematogenous (Blood) Pigmentation
- Epithelial: anemia (hemochromatosis)
- Stromal: interstitial keratitis (abnormal blood vessels secondary to systemic diseases like syphilis), Traumatic hyphema (blood in the anterior chamber)
- Endothelial: traumatic hyphema, subconjunctival hemorrhages (blood beneath the conjunctiva)
- Metallic pigment/Siderosis: corneal defect/dryness allows iron accumulation (iron in tears stains the cornea)
Other Pigmentation Considerations
- Foreign body (FB) iron coat's ring: oxidized iron deposits
- Hudson Stahi line: greenish-brownish line below cornea (inferior parts of cornea exposed to air leads to dryness)
- Ferry line: limbal elevation increasing corneal tears and accumulation
- Stocker's line: pterygium-associated indentation in the cornea
- Fleischer ring or line: thinning at the base of the keratoconus, tears accumulate
- RK iron line: silver deposits (e.g., surgical tools), associated with surgery
- Gold (Chrysiasis): gold deposits, associated with rheumatoid arthritis
Drug-Induced Pigmentations
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Vortex epitheliopathy/corneal verticillata: whorl-like brown opacities, associated with some medications (anti-malarials, etc.) and systemic diseases
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Copper (Chalcosis), Kayser-Fleischer ring: Wilson's disease (liver disease)
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Chlorpromazine: brown deposits in Descemet's and endothelium layer
Corneal Anomalies
- Microcornea: cornea diameter less than 10mm
- Megalocornea: cornea diameter greater than 13mm, usually in males (X-linked)
-
Sclero(hard)-cornea: opacified cornea, mild to severe forms.
- Type 1 is autosomal dominant, just peripheral
- Type 2 is autosomal recessive, affects the whole cornea, causes blindness
- Corneal plana: corneas are always flat
- Haab's striae: vertical or horizontal lines in Descemet's membrane, commonly seen in congenital glaucoma and rupture of Descemet's because of trauma or keratoconus
- Vogt striae: vertical folds in the posteriors stroma and Descemet's, associated with keratoconus
-
Iridocorneal dysgenesis (ICD):
- Posterior embryotoxon: prominent Schwalbe's line
- Axenfeld-Rieger syndrome: iris hypoplasia, Open-angle glaucoma
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Description
Test your knowledge on corneal pigmentation, including melanin deposits and their implications. Learn about the various layers of the cornea, the role of medications, and systemic diseases that can lead to pigmentation. This quiz is essential for understanding corneal health and diagnostics.
