Clinical Pearls

• Abrasions are very common and usually due to some form of mechanical trauma (CTLs, scratching your eye, chemical irritation)

• They are immensely painful as the cornea has the highest density of nerves anywhere in the body! 

• Some patients come into the office in tears begging to be seen due to the pain. If a patient comes in covering their eye with their hand, chances are that they likely have an abrasion

• They usually resolve after BCTL placement and antibiotic drops to prevent infection 

• This is basically an open sore on the cornea and is very painful

• It can start from a corneal abrasion or improper CTL wear

• It can become infected and lead to vision loss

This is the death of small clusters of corneal epithelial cells scattered all over the cornea

It is non- specific, but found in many different conditions such as

1. Dry eye disease (most common)

2. Contact lens wear

3. Viral & bacterial infections

4. Allergic reactions (to CTLS, drops, environmental allergens)

5. Autoimmune Diseases (Sjogren's)

• This is a ring made of cholesterol at the edge of the cornea

• It is very common in older people and not harmful in any way

Clinical Pearls

• This is a benign growth that starts on the sclera, but can grow and cover the cornea

• AKA "Surfer's Eye" because they are caused by long exposure to sunlight, windy, or dusty environments. 

• Surfers get this regularly as sunglasses  can't be worn while surfing, and exposure is doubled due to direct exposure to the sun and also the reflection of the sunlight on the water. 

• Pinguecula: When it is confined to only the sclera

• Pterygium: When it has progressed to the cornea

• Surgery is the only treatment !

Clinical Pearls

Highly Contagious!! Wipe down your room and all equipment afterwards!!

1) Bacterial Conjunctivitis

• You will see puss on lids/lashes. This is because bacterial infections have a cell- mediated immune response that involve Neutrophils directly killing the bacteria. Puss is essentially dead Neutrophils., bacteria, and tissue debris. 

2) Viral Conjunctivitis

• You will usually not see puss, but the eye will be very inflamed with profuse tearing (commonly caused by Adenovirus). Usually, no puss is seen because the immune response is humoral (antigen & antibody mediated), but it is possible to have an overlying bacterial infection.

• Patients will often also have a cold/flu (sneezing, runny now, and running a high temperature)

3) Allergic Conjunctivitis

• Presentation is similar to viral conjunctivitis, but patients will usually also have Rhinitis (sneezing & runny nose, but not have a cold/flu and no temperature)

4) Note: 

• Lots of things can present looking like conjunctivitis, such as dryness, blepharitis, and iritis (AKA: anterior uveitis) 

• Lots of times patients make appointments thinking they have conjunctivitis, but only have dry eyes! 

Epidemic Keratoconjunctivitis (EKC)

• This is one of the worst forms of viral conjunctivitis that involves both the conjunctiva and the cornea. It is highly contagious and usually caused by Adenovirus. 

Clinical Pearls

• This is one of our biggest "emergencies". 

• Patient's usually come in panicking because they woke up and saw this in the mirror. 

• They are not serious and usually go away all on their own in about 1 week!

Photo courtesy of Arax Karalian (Steve's Mother😂😁)

• In Keratoconus, collagen fibers in the cornea become weakened and unstable 

• You will see thinning and bulging of the cornea into a cone shape

• We treat this with collagen cross-linking to prevent the progression

• Last resort treatment is a corneal transplant

• These patients often need scleral contact lenses for the best possible vision because regular ones can't form to the bulged shape in these patients 

Clinical Pearls

• Presentation in very similar to viral & allergic conjunctivitis

• Hallmarks are moderate to severe photophobia (light sensitivity). As the Iris is inflamed, there is pain when it constricts/dilates to limit the incoming light

You will see cell & flare in the anterior chamber 

• Cell: Inflammatory cells (Lymphocytes) floating around in the aqueous humor

• Flare: Smokey appearance of aqueous humor  from proteins leaked by vessels

It looks very similar to conjunctivitis!

Keratic Precipitates on corneal endothelium 

• These are inflammatory cells that get stuck to the corneal endothelium

• This is infection of the cornea by Herpes Simplex Virus (HSV-1 is most common)

• Dendritic Pattern Seen in HSV Keratitis because they look like dendrites in neurons 

• Patients could require a corneal transplant eventually

• There are many different types of corneal dystrophy, but this is the most common one

• This is dystrophy in the endothelial cells of cornea

• Fluid will build up in the cornea and cause your cornea to swell

• We use hypertonic ointment as a treatment as this will draw fluid out of the cornea (it's called Muro 128)