Page 908 - TNFlipTest
P. 908
OP18 Ophthalmology
V1
V2 V3
Figure 15. Trigeminal distribution
To detect keratoconus, look for bulging of the lower eyelid when the patient looks downward (Munson’s sign)
Cornea Toronto Notes 2019 Herpes Zoster Ophthalmicus
• dermatitisinthedermatomaldistributionofCNV1thatistypicallyunilateralandrespectsthemidline
• Hutchinson’ssign:iftipofnoseisinvolved(nasociliarybranchofV1)thenglobewillbeinvolvedin
~75% of cases
• ifnonasalinvolvement,eyeisinvolvedin1/3ofpatients
Clinical Features
• pain,tearing,photophobia,redeye
• corneal edema, pseudodendrite, SPK • cornealhypoesthesia
Complications
• keratitis,ulceration,perforationandscarring • secondaryiritis,secondaryglaucoma,cataract • musclepalsies(rare)duetoCNSinvolvement • occasionallyseverepost-herpeticneuralgia
Treatment
• oralantiviral(acyclovir,valcyclovir,orfamciclovir)immediately
• topicalsteroids,cycloplegiaasindicatedforimmune-mediatedkeratitis,iritis • erythromycinointmentifconjunctivalinvolvement
Keratoconus
• bilateralthinningandbulging(ectasia)ofthecornearesultinginaconicalshape
• usuallysporadicbutcanbeassociatedwithDown’ssyndrome,atopy,contactlensuse,andvigorouseye
rubbing
• associatedwithbreaksinDescemet’smembraneandBowman’slayer
• resultsindecreasedvisionfromirregularastigmatism,scarringandstromaledema
Treatment
• attemptcorrectionwithspectaclesand/orrigidgaspermeablecontactlens
• cornealcollagencross-linkingtreatmenttohaltdiseaseprogression
• intrastromalcornealringsegmentscanhelpflattenthecornealcone
• penetratingkeratoplastyordeepanteriorlamellarkeratoplasty(partial-thicknesscornealtransplant)as
last resort
Arcus Senilis
• hazywhiteringinperipheralcornea,<2mmwide,clearlyseparatedfromlimbus
• common,bilateral,benigncornealdegenerationduetolipiddeposition,partoftheagingprocess • maybeassociatedwithhypercholesterolemiaifage<40yr,checklipidprofile
• noassociatedvisualsymptoms,complicationsortreatmentnecessary
Kayser-Fleischer Ring
• brown-yellow-greenpigmentedringinperipheralcornea,startinginferiorly • duetodepositionofcopperpigmentinDescemet’smembrane
• associatedwithWilson’sdisease
• noassociatedsymptomsorcomplicationsofring
• treatunderlyingdisease
© Crista Mason 2005
