Office visit procedural codes

Corneal dystrophies

EPITHELIUM

Meesmann's corneal dystrophy

• autosomal dominant
• presents in 1st decade and progresses into adulthood
• diffusely distributed intraepithelial cysts that are usually concentrated in the interpalpebral zone
• in severe cases cysts can rupture on surface causing irritation and photophobia (use bandage CL)

EBMD (Map-Dot fingerprint dystrophy or Cogan's microcystic epithelial dystrophy)

• autosomal dominant or due to trauma or surgery
• geographic epithelial changes (maps), opaque irregularities (dots) or concentric irregular lines (fingerprints)
• results from a thickened basement membrane
• can result in recurrent corneal erosions (bandage CL)
• Muro 128 during the day or ung at night may be necessary for up to 3 months (if this fails to prevent recurrent erosions, may need anterior stromal puncture or PTK

BOWMAN'S LAYER

Reis-Buckler's corneal dystrophy

• autosomal dominant, presents 1st decade of life
• subepithelial reticular changes that progress until middle age
• may opacify or induce irregular astigmatism
• may have erosions (bandage CL)

STROMA

Granular dystrophy

• autosomal dominant, presents 1-2nd decade of life
• grayish white opacities form in the central (almost never periphery) anterior stroma with clear intervening space
• lesions can become larger and more numerous with stromal hazing

Macular dystrophy

• rarest (autosomal recessive)
• anterior stroma becomes hazy in 1st decade, progressing to opacified lesions
• more likely to affect peripheral cornea
• worse visual prognosis

Lattice dystrophy

• autosomal dominant, 1st decade
• refractile lines in the anterior stroma which eventually branch and develop deeper into stroma (lattice design)
• prone to erosions (bandage CL)

ENDOTHELIUM

Posterior polymorphous dystrophy (PPD)

• vesicles deep into the cornea that may be isolated, mutiple/coalesced, or broad bands/train tracks
• may apear blister-like and have a gray white halo aroudn them
• increased risk of glaucoma

Fuch's endothelial dystrophy

• guttata (refractice excrescenses) on posterior cornea due to abnormal functioning endothelial cells (from aging, trauma or inflammation)
• Fuch's is diagnosed when nonfunctioning endo causes corneal edema
• vision worse upon awakening
• muro 128 gtts and ung
• extreme epithelial edema may cause bulae with pain and photophobia (bandage CL)
• usually have cataracts
• cataract surgery may cause a dramatic worsening of Fuch's

BANDAGE CL

• use steeper curve (unless there is no mvmt then use flatter one)

Cross-cylinder calculators

• http://www.aoa.org/x4783.xml
• procare.cibavision.com
• coopervision.com
• ecp.acuvue.com
• eyedock.com