Cornea 3.pdf

Keratitis by Injury Corneal abrasions ○ Loss of epithelial cells from injury Superficial Loss of superficial/squamous cells Takes hours to a day to heal (not that long, sometimes less than...

Keratitis by Injury Corneal abrasions ○ Loss of epithelial cells from injury Superficial Loss of superficial/squamous cells Takes hours to a day to heal (not that long, sometimes less than that) Deep Loss of cells to basal cells layer or to BM May take 3-4 days to a week to heal BM damage may take 8-12 weeks to heal Superficial abrasion ○ Causes Transient FB, may be trapped underneath eyelid Mascara Blunt trauma CL (overuse) Nail Plants EBMD, corneal dystrophies ○ Symptoms Pain: cornea is so richly innervated Photophia FBS Tearing Hx of scratching the eye ○ Signs + NaFL due to squamous cells loss; staining is diffuse and light FB track No pooling or deep staining (BM) Conjunctival injection Mild eyelid edema Mild corneal edema Mild A/C reaction ○ Work-up History: material, time, determine cause of abrasion: organic, contact lens Anesthetic Evertion of lids (FB) Irrigate and swab w/ Q-tip all surfaces R/O traumatic uveitis– examine prior to NaFL procedure  ○ ○ FB Track ○ Treatment ALWAYS irrigation in office w/ sterile saline Antibiotic (#1 is Polytrim) Unless pt says that once they removed contact lens, they felt something ○ Then give Fluoroquinolone QID Aminoglycoside QID* Polytrim QID*** *downfall If A/C rxn (mild): Cyclopentolate 1% BID For pain: topical NSAIDs (DJ would not use topical unless patient will be seen in F/U in one or two days but can give oral NSAIDs or acetaminophen) Ketorolac, Diclofenac or new ones First 2-3 days or until symptoms resolve Beware of melting Oral NSAIDs or AAP may be used F/U q 2-3 days If related to CL wear D/C contacts Broad-spectrum antibiotic covering for pseudomonas ○ Tobramycin or fluoroquinolone ophth. sol. QID during day ○ Polyosporin ung hs Pain management as before F/U daily NO PATCH ON AN ABRASION Deep abrasion ○ Loss of cells to basal cells layer or to BM ○ Causes Fingernail Papercuts Flying materials Tree branches Mascara brushes ○ Symptoms Pain, photophobia, blepharospasm, tearing ○ Signs Lid edema + NaFL of a “pooling” or “deep staining” Reduced VA if central signs Corneal edema Epithelial tags May have anterior uvea reaction (moderate to severe) ○ Deep abrasions w/ epithelial tags ○ Work-up Measure it Determine cell layers involved Basal cells have a more irregular, “grainy” NaFL pattern BM appears smother, brighter Look for “epithelial tags” @ edge of abrasion ○ R/O Penetration/perforation Stromal entry: “stromal channel”  Endothelial disruption Seidel test Foreign material in aqueous/lens Do not patch, refer to cornea specialist ○ Treatment (Give an antibiotic and refer if it is a perforation, treat deep abrasion) Antibiotic Polytrim QID Fluoroquinolone QID Aminoglycoside QID* in a deep abrasion will cause corneal toxicity, pt may get RCE If A/C reactions (moderate to severe): Homatropine 5% TID For pain: topical NSAIDs Ketorolac, Diclofenac or new ones (QID/TID) First 2-3 days or until symptoms resolve Beware of melting Oral NSAIDs or AAP may be used 5% NaCl if significant edema q 2-4 hrs and ung hs Can use a bandage CL if abrasion > 10 mm (no veg. or infiltrates); F/U accordingly If related to CL wear (pseudomonas) D/c contacts Cycloplege w/ 5% Homatropine 0.25% scopol BID-TID Fluoroquinolone or Tobramycin QID during the day Polysporin ung hs Pain management as before (x3 days) If edema, might add % NaCl q 2-6 hrs RTC next day (24 hr) and on a daily basis until resolved No cl wear, no patch, if needed bandage contact lens W/ a deep abrasion and it doesn’t heal in a week, don’t get discouraged as the pt may have diabetes Corneal Degenerations/Dystrophies Changes in tissue that causes deterioration and can impair function (decrease clarity, can lead to too much distortion, cause opacifications)  Corneal degenerations ○ MC unilateral, but if bilateral, they can be asymmetric ○ Involutional changes (age) or related to a systemic disease ○ No family history, no hereditary factors ○ Usually in periphery of cornea, but can occur in the center ○ Can result in thinning vascularization, or deposition of material into corneal tissue ○ Late-onset ○ Arcus senilis Involutional The white ring in peripheral cornea Starts inferior, then superior and then all 360 degree Clear interval from limbus to arcus Bowman’s layer Accumulation of cholesterol, triglycerides, and phospholipids 60% 40-60; 100% >80 Usually not a hyperlipidemia factor after age 40 Management None if >40 If