Transcript Cornea and External Disease

Sara A Mahony, MD, PharmD
Assistant Professor
Department of Ophthalmology & Visual
Sciences
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Traumatic
Shield ulcer (VKC)
Herpetic ulcer
Neurotrophic Keratopathy
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Pseudophakic Bullous Keratopathy
Fuch’s Corneal Dystrophy
Endothelial Failure from uveitis
Hydrops
Angle Closure
Degenerations
Visual acuity
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with and without pinhole
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Quantification – 20/30+ 2, 20/40 -2, CF at how many feet? HM
with or without direction at how many feet. Always pinhole even
if patient is CF.
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History of trauma – dropped intraocular lens, dehiscence of
natural lens with high plus prescription (pinhole will clue you)
Workup
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Autorefract, Topography, Refraction
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Pachymetry – corneal edema, fuchs, pseudophakic or aphakic
bullous keratopathy
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Large K ulcer – be prepared for md to request b scan to rule out
endophthalmitis
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if patient is dry, place artificial tears during topography,
refraction, and autorefraction, ask patient to blink blink blink
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Slit lamp photo (when requested)
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Red or painful and watery eye or blurry vision with acute
presentation
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?HSV ?HZV
Chemical burns, thermal injuries
History of HSV or HZV or brain tumor or facial trauma
(?trigeminal nerve involvment – schwannoma, acoustic neuroma,
memingioma, aneurysms, radiation therapy to route of CN5))
History of neurotrophic keratopathy in chart, multiple sclerosis
Zebras: Congenital -Ridley-Day syndrome, anhidrotic ectodermal
dysplasia, Moebius syndrome, Goldenhar syndrome, and
congenital corneal anaesthesia
Medications causing K anesthesia: timolol, betaxolol, trifluridine, s
Sulfacetamide, diclofenac, antipsychotics, antihistamines
Always check for apd as cn5 anesthesia + apd may suggest
intraconal nerve injury ? Tumor
Cornea ulcers, Epithelial Defects
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As previously mentioned with regards to
proparacaine use
Post op day 1 DSAEK, no pressure should be
placed on globe, do not touch the eye or eyelid,
only visual acuity check (not an issue with
PKP)
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Corneal edema
Goldmann is not as accurate as tonopen
 Corneal hysteresis altered, distorted meyers
 Tonopen contacts one spot
 Underestimate iop
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Corneal calcification (band keratopathy)
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Falsely elevated iop
In general goldmann is more accurate than
tonopen, except in above case
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Swab and cultures brought to room prior to
physician arrival. Technician available to assist
with eyelid holding, labeling, and transport of
samples
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Rooms stocked with fluoroscein and rose
bengal strips for vital staining
Rooms stocked with jewelers, bandage contact
lens, punctal plugs, 30 gauge needle
Appropriate Culture media