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Answers: 2009 Series -  July 14, 2009 Lecture 25 of 52  NEXT»

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QOW081109_1A QOW081109_1B

A 25-year-old female comes in complaining of a painful right eye and decreased vision of one day duration. The patient admits to being a contact lens user, but she is not wearing them now.

1. Which of the following examination techniques will be MOST useful in diagnosing the above condition:

d -- examination of the fellow eye

This patient has the underlying condition of keratoconus.  Because most cases are bilateral, even though one eye may be more severely affected, examination of the other eye can provide important clues to make your diagnosis. Examination findings include scissoring of the red reflex on retinoscopy, high astigmatism (mild forms), irregular astigmatism, fleischer iron ring, vogts lines or scarring in the corneal stroma, thinning and protrusion of the central or paracentral cornea.

2. What pathologic characteristic would you expect to see in the above patient's cornea?

c -- tear in Descemetís membrane

Acute hydrops is the sudden development of corneal edema due to a tear in Descemetís membrane.

3. What is the BEST treatment for this condition at this time?

c -- topical hypertonic agents

Acute hydrops should be treated conservatively with topical hypertonic agents with or without cycloplegics and a bandage contact lens.  Hydrops typically heals over a few months and is not an indication for immediate penetrating keratoplasy.



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