Case Report HELP!

[cpw]

Does this sound like Terrien's to you guys? I have this case report due tomorrow and I think it's either Terrien'3or Pellucid... but I'm leaning towards Terrien's since it's superior w/ pannus.

28HF, decreased VA at distance OU (began 6 months ago)
(-) traume, F/F, infection, redness, Cl wear, diplopia

this is her first exam

PMH: only + for pregnancy (she's 6months post partum)
FH: +DM- father +keratoconus--mom (But I think they put this in here to throw us off)

Meds/All: none NKDA

Exam Findings:

(they gave me a topography but i can't put it here it's too big)

VA (Sc) OD 20/80 OS 20/70
Pupils: 4mm 3+ D/C, (-)RAPD OD/OS
CVF: FTFC OD/OS EOMS: full OU
TAP: 14 OD 11 OS
MRx: -1.00 -1.25 030 OD 20/25 -0.75 -0.75 x020 OS 20/25

SLE: L/L clear OU
conj: clear OU
Cornea: superior peripheral thinning (10-2) with pannus ou, multiple sterile peripheral subpei infiltrates 360 OU, 1+ SPK OU
A/C deep and quiet OU

DFE : no path noted OU



I'm leaning towards Terriens.. but it's usually non-infiltrative and men...
HELP! And pellucid is usually inferior... *sigh*

 

[Andrew_Doan]

Is it painful? Is there neovascularization? Is the epithelium over the thinning intact?

If there is no pain, then Terrien's may be the diagnosis if the epithelium is intact.
This is from the Handbook of Ocular Disease Management:

http://www.revoptom.com/handbook/oct02_sec3_1.htm

The differential includes:
-peripheral corneal melt secondary to collagen vascular diseases such as rheumatoid arthritis and polyarteritis nodosa (bilateral, typically painful and progressive to perforation)

-Mooren's ulceration (unilateral or bilateral, painful corneal thinning with neovascularization)

-pellucid marginal degeneration (painless, inferior, peripheral corneal thinning, a variant of keratoconus)

-furrow degeneration (painless, peripheral corneal thinning, adjacent to corneal arcus, without vascularization)

-dellen (painless, oval thinning secondary to corneal drying)

-marginal keratitis secondary to Staphylococcus hypersensitivity (painful, infiltrate present, inset from limbus)

Topography can help diagnose Terrien's if:
-corneal flattening at the juncture of the furrow;
-corneal steepening 90 degrees from the flattened area;
-a relatively spherical and regular central area

Other references:
http://www.eyeatlas.com/box/226.htm
http://www.mrcophth.com/ophthalmologyhalloffame/terrien.html
http://www.geocities.com/HotSprings/Spa/2001/maps.html

I hope this helps!

 

[cpw]

thanks andrew! I found some of those sites too... the epi is intact.. no pain, no neo

but the infiltrates are throwing me off...

I still think it's terriens.. but I have to put pellucid, keratoconus, and furrow on my r/o list.

thanks for the help! you rock !

 

[Andrew_Doan]

thanks andrew! I found some of those sites too... the epi is intact.. no pain, no neo

but the infiltrates are throwing me off...

I still think it's terriens.. but I have to put pellucid, keratoconus, and furrow on my r/o list.

thanks for the help! you rock !

I think you can rule out pellucid and keratoconus based on the topography. With pellucid, there's thinning and steepening of the inferior, peripheral cornea. Keratoconus has thinning and steepening of the central cornea. Furrow is still on the list.

Good luck!