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Answers: 2005 Series -  July 26, 2005 Lecture 23 of 52  NEXT»

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A 29-year-old woman presents with severe myopia and high astigmatism in both eyes that she feels has progressed over the past few years.  She denies history of prior ocular trauma or known eye disease.  On slit lamp examination, she is noted to have an apical corneal scar in her right eye and centrally thinned corneas with iron rings bilaterally.  On down gaze she has the following lower lid distortion. 

1.  She most likely has:    
 

b -- keratoconus

2.  Her best spectacle correction is count fingers (CF) in both eyes and she cannot be fitted for a rigid gas permeable contact lens given the severity of her corneal curvature.  The next surgical option is: 
 

b -- corneal transplant

Keratoconus

  • Keratoconus is a non-inflammatory thinning of the cornea associated with astigmatism and, in severe cases, corneal scarring. 
  • This figure demonstrates Munson's sign where the conical cornea distorts the curvature of the lower lid on downgaze.
  • Refractive surgery is contraindicated in such patients and may worsen their ectasia.
  • Unfortunately, she cannot be fitted with rigid gas permeable lenses and has an apical corneal scarso.  A corneal transplant is indicated.

Lecture 23 of 52 «Previous Lecture   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52    Next»