Saturday, February 25
Last blogged @ 04:54

Dystrophy:
- hereditary condition (congenital)
- not due to arrested development
- usually bilateral
- may be present at birth or does not manifest until later

Degeneration:
loss of function associated with
- ageing
- inflammation
- infection
- vascular disease
- vitamin deficiency

Commonly affected structures:
- cornea
- conjunctiva
- crystalline lens
- vitreous
- choroid
- retina

Thursday, February 23
Last blogged @ 16:24

Degeneration: loss of function associated with
- ageing
- infections
- inflammations
- vascular diseases
- vitamin deficiencies

Dystrophy:
- hereditary condition (congenital)
- not due to arrested development
- usually bilateral
- may be present at birth or do not manifest until later

Commonly affected structures:
- conjunctiva
- cornea
- crystalline lens
- vitreous
- choroid
- retina

Conjunctival Degenerations:
- Pingueculum
- Pterygium
- Concretion

Pingueculum.
Background:
- hyperplasia of the conjunctival tissue
- common
- usually bilateral
Signs:
- white-yellow, slightly elevated, triangular mass of tissue on the bulbar conjunctiva with its base towards the limbus, adjacent to the cornea
Symptoms:
- asymptomatic
- may be of cosmetic concern
DDx:
- Pterygium
- Episcleritis
Management:
- patient education and reassurance
- lubrication (for symptomatic relief)
- monitor anually

Pterygium.
Background:
- degeneration of the bulbar conjunctiva
Signs:
- triangular fibrovascular mass of tissue on the bulbar conjunctiva with its apex towards the cornea
- an iron line (Stocker's line) may be present at the advancing head
- may cause corneal distortion or pupil occlusion
Symptoms:
- cosmetically unappealing
- irritation and hyperaemic appearance
- visual disturbance
Management:
- measure and diagram
- monitor 6-12 months
- if symptomatic (stable), no treatment required
- if symptomatic but stable, lubrication (for symptomatic relief) and refractive correction
- if symptomatic and advancing, refer for surgical removal when the advancing head (apex) is halfway between the limbus and dilated pupil

Concretion.
Background:
- common in elderly patients
Signs:
- small, yellow-white spots on the palpebral conjunctiva
- single or multiple
- discrete
Symptoms:
- usually asymptomatic
- large concretion may cause irritation
Management:
- if asymptomatic, no treatment required
- if symptomatic, excise

Corneal Degenerations:
- Arcus Senilis
- Vogt Limbal Girdle
- Crocodile Shagreen
- Band Keratopathy
- Corneal Guttata

Arcus Senilis.
Background:
- common peripheral corneal opacification
Signs:
- usually bilateral
- whitish peripheral ring of lipid deposits in the stroma
- clear zone between the arcus and limbus
Symptoms:
- age-related
- may be associated with systemic hyperlipidemia or hypercholestrolimia
- may co-exist with ocular tumor; xanthelasma
- aymptomatic
Management:
- refer to General Practitioner

Vogt Limbal Girdle.
Signs:
- thin crescent of lipid deposits at 3&9 o' clock limbus
Symptoms:
- asymptomatic
Management:
- none

Crocodile Shagreen:
Signs:
- greyish-white polygonal opacities in the stroma
Symptoms:
- asymptomatic
- blurred vision
Management:
- none

Band Keratopathy.
Background: deposition of calcium in the Bowman's membrane due to
- age-related
- hereditary
- chronic anterior uveitis
- systemic hypercalcemia
Signs:
- early: white granular cresent at the limbus
- late: spreads centrally to for a band of chalky plaque, common with epithelial erosions
Symptoms:
- decresed vision
- irritation
- pain
- foreign body sensation
Management:
- lubrication for mild symptoms (for symptomatic relief)
- chelation
- monitor 3-6 months

Corneal Guttata.
Background:
- dysfunctional endothelium cells secrete wart-like protrusion on the Descemet's membrane
Signs:
- "dimple" or "beaten metal" appearance of on the endothelium
- guttata at the peripheral cornea is called "Hassall-Henle bodies"
Symptoms:
- onset in middle age
- may affect VA
DDx:
- Fuch's Dystrophy

Last blogged @ 02:49

PINGUECULUM.
Background:
- hyperplasia of the conjunctival tissue
- common
- usually bilateral
Signs:
- yellow-white, slightly elevated, triangular mass of tissue on the bulbar conjunctiva with the base towards the limbus, adjacent to the cornea
Symptoms:
- asymptomatic
- may be of cosmetic concern
Assessment: Ddx with
- Pterygium
- Episcleritis
Management:
- patient education and reassurance
- lubrication (for symptomatic relief)
- monitor anually

PTERYGIUM
Background:
- degeneration of the bulbar conjunctiva
Signs:
- triangular fibrovascular mass of tissue on the bulbar conjunctiva with the apex towards the cornea
- an iron line (Stocker's line) may be present at the advancing head
- may cause corneal distortion or pupil occlusion
Symptoms:
- cosmetically unappealing
- irritation and hyperaemic appearance
- visual disturbance
Management:
- measure and diagram
- monitor every 6-12 months
- if asymptomatic (stable), no treatment required
- if symptomatic but stable, lubrication (for symptomatic relief) and refractive correction
- if asymptomatic and advancing, refer for surgical removal once the advancing head (apex) is half way between the limbus and dilated pupil

CONCRETION.
Background:
- common in elderly patients
Signs:
- small, yellow-white spots on the palpebral conjunctiva
- single or multiple
- discrete
Symptoms:
- usually asymptomatic
- large concretion may cause irritation
Management:
- if asymptomatic, no treatment required
- if symptomatic, excise

Last blogged @ 02:31

Conjunctival Degeneration:
1. Pingueculum
2. Pterygium
3. Concretion

Pingueculum.
Background:
- hyperplasia of the conjunctival tissue
- common
- usually bilateral
Signs:
- yellow-white, slightly elevated, triangular mass of tissue on the bulbar conjunctiva with the base towards the limbus, adjacent to the cornea
Symptoms:
- usually asymptomatic
- may be of cosmetic concern
Assessment: Ddx with
- Pterygium
- Episcleritis
Management:
- patient education and reassurance
- lubrication (for symptomatic relief)
- monitor anually

Pterygium
Background:
- degeneration of the bulbar conjunctiva
Signs:
- triangular fibrovascular mass of tissue on the bulbar conjunctiva with the apex towards the cornea
- an iron line (Stocker's line) may be present at the advancing head
- may cause corneal distortion or pupil occlusion
Symptoms
- cosmetically unappealing
- irritation and hyperaemic appearance
- visual disturbance
Management:
- measure and diagram
- monitor every 6-12months
- if asymptomatic (stable), no treatment required
- if symptomatic but stable, lubrication (for symptomatic relief) and refractive correction
- is symptomatic and advancing, refer for surgical removal once the advancing head (apex) is halfway between the limbus and the dilated pupil

Concretion
Background:
- common in elderly patients
Signs:
- small, white-yellow spots on the palpebral conjunctiva
- single or multiple
- discrete
Symptoms:
- asymptomatic
- large concretion may cause irritation
Mangement:
- if asymptomatic, no treatment
- if symptomatic, excise