Statistics and Associations

• Liberation of iris pigment cells into anterior chamber can clog drainage canal and increase pressure
• Typically first seen in white males between 20–40 years old
• Visual fluctuations common with physical exertion
• Pigmentary glaucoma occurs in approximately 10-20% of patients
• If glaucomatous changes occur from PDS, usually happen before fifth decade of life

Management

• No treatment recommended unless glaucomatous changes occur
• Laser treatments quite effective as well as topical medications

Statistics and Associations

• Characterized by inflammatory cells and proteins in the anterior chamber of the eye
• Usually idiopathic
• Recurrent cases should be evaluated with lab tests for autoimmune diseases

Management

• Steroid regimen (dosing is severity dependent) with gradual taper to avoid rebound inflammation
• Cycloplegic agent to decrease inflammation, improve comfort, and prevent synechia of the iris

Statistics and Associations

• Most common hereditary endothelial (deep) corneal dystrophy
• Strong female predilection
• Typically develops in fourth to fifth decade of life with gradual progression
• Leads to decreased, fluctuating vision usually worse in the morning
• Vision decrease secondary to corneal swelling

Management

• Generally no treatment until substantial vision decrease
• Endothelial keratoplasty is the main surgical intervention

Statistics and Associations

• Most common hereditary corneal dystrophy
• Bilateral with early onset (age 30); slight female predilection
• May lead to scarring and decreased vision in severe cases
• 10% of patients with EBMD have corneal erosions and 50% of recurrent corneal erosion patients have EBMD

Management

• Generally no treatment, unless recurrent erosion develops
• May consider artificial tears and/or hypertonic ointment at night to decrease risk of erosions

Statistics and Associations

• Superficial calcification of cornea
• Associated with chronic corneal irritation, gout, and hypercalcemia

Management

• No treatment recommended until visually significant
• EDTA chelation, superficial keratectomy, and penetrating keratoplasty all common surgical interventions

Statistics and Associations

• Most common cause of central infectious keratitis
• Occurs secondary to reactivation of HSV type I through nervous system
• Following one HSK infection, 25% chance of recurrence in one year; 50% chance of recurrence in two years
• Suppressive therapy reduces risk of recurrent keratitis by almost 50%

Management

• Topical antiviral (Viroptic™ q2h or Zirgan™ 5xday) for two weeks, oral antiviral (valacyclovir 500 mg PO TID) for one week.
• Consider suppressive therapy (valacyclovir 500 mg QD) for recurrent cases

Statistics and Associations

• Destruction of corneal tissue with strong association to contact lens overwear as well as dry eye and mechanical trauma
• If central, strong probability of decreased vision post treatment secondary to scarring

Management

• Discontinue contact lenses
• Determine etiology and treat aggressively with strong antibiotics with steroids later to decrease scarring, earlier with central ulcer to increase final visual outcome

Statistics and Associations

• Strong association with contact lens overwear and overnight wear
• Usually peripheral with increased risk of overlying ulcer formation
• Can be sterile or infectious

Management

• Discontinue contact lens until resolution
• Treat as infectious with broad spectrum antibiotic every hour then taper, steroid effective in resolution and preventing scarring

Statistics and Associations

• Micropannus (< 2mm) common with contact lens wear/overwear secondary to corneal hypoxia
• Pannus (> 2mm) can decrease vision secondary to scarring and stromal hemorrhage
• Also common with dry eye, ocular rosacea, and chemical burn

Management

• Discontinue contact lens wear and fit with higher oxygen lens
• Treat any underlying source of ocular inflammation

Statistics and Associations

• 50% association with anterior basement membrane dystrophies
• Also common following severe corneal abrasions; especially from sharp objects such as a fingernail or paper

Management

• Same as corneal abrasion until epithelium is healed, then add hypertonic ointment
• Doxycycline oral medication for persistent cases
• Consider debridement in cases of multiple reoccurrences