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SYSTEMIC PATHOLOGY 3 > 2 – Intraocular Structures > Flashcards

2 – Intraocular Structures Flashcards

1
Q

What is the uvea?

A
  • Vascular tunic of the eye
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2
Q

What are the 2 parts of the uvea?

A
  • Anterior
    o Ciliary body
    o Iris
  • Posterior
    o Choroid
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3
Q

Iris

A
  • Forms the pupil
    o Sphincter muscle=constricts
    o Dilator muscle=dilates
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4
Q

Ciliary body

A
  • Produces aqueous humor
  • Attachment for zonules (equator of the lens and ciliary processes) that suspend the lens
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5
Q

Choroid

A
  • Blood supply to outer retina
  • Contains tapetum lucidum dorsally in the fundus
    o Bright structure that increases light capture
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6
Q

What is the circulation of the aqueous humor?

A
  • Posterior chamber
  • Pupil
  • Anterior chamber
  • Filtration angle
  • Collecting veins into systemic circulation
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7
Q

What is the function of the aqueous humor?

A
  • Maintains intraocular pressure
  • Provides nutrition and waste removal for lens, inner cornea
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8
Q

What are the 2 blood-ocular barriers?

A
  1. Blood-aqueous barrier
  2. Blood-retinal barrier
    *each have an epithelial and endothelial portions
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9
Q

What does a breakdown of blood-aqueous barrier result in?

A
  • Anterior uveitis
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10
Q

What does breakdown of blood-retinal barrier result in?

A
  • Posterior uveitis
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11
Q

Uveal pathology

A
  1. Congenital
    a. Persistent pupillary membranes=vascular strands of iris that failed to regress
    b. Iris hypoplasia
    c. Heterochromia iridis
  2. Inflammation: uveitis
  3. Neoplasia
    a. Ciliary body adenoma
    b. Melanocytomas and melanomas
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12
Q

Anterior uveitis: example

A
  • Iridocyclitis
    o Inflammation of iris and ciliary body
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13
Q

What is anterior uveitis due to?

A
  • Protein and cellular leakage into aqueous humor
    o Protein: aqueous flare
    o WBCs: hypopyon
    o RBCs: hyphema
    o Fibrin
    o Keratic precipitates
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14
Q

What is the sequelae of anterior uveitis?

A
  • Disruption of normal nutrition and waste removal
    o Cornea: edema, degeneration
    o Lens: cataract, zonular breakdown
  • Adhesions and scar tissue formation inside the eye
    o Secondary glaucoma
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15
Q

Posterior uveitis: examples

A
  • Choroiditis: inflammation of choroid
  • **Chorioretinitis: inflammation of choroid and retina
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16
Q

Posterior uveitis: tapetal hyporeflectivity

A
  • Fuzzy, gray exudates within or behind retina or within vitreous that OBSTRUCT view of tapetum lucidum
  • Ex. hemorrhage, retinal detachment and granulomas
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17
Q

Panuveitis

A
  • BOTH anterior and posterior uveitis
  • Endophtalmitis
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18
Q

What is phthisis bulbi?

A
  • Chronic, uncontrolled uveitis leading to a shrunken globe
    o Over time it stops producing aqueous and it gets softer and smaller
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19
Q

What are the 2 broad causes of uveitis?

A
  • Ocular disease
  • Systemic disease
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20
Q

What are some ocular disease causing uveitis?

A
  • Ocular trauma
  • Complex corneal ulceration or laceration
  • Lens-induced
  • Pigmentary uveitis
  • Intraocular neoplasia
  • Scleritis
  • Retinal detachment
  • Iatrogenic
  • Idiopathic
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21
Q

What are some systemic diseases causing uveitis?

A
  • Infectious disease
  • Neoplasia: metastasis to eye
  • Immune-mediated disease
  • Septicemia and endotoxemia
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22
Q

What are 2 potential uveal neoplasia’s?

A
  • Ciliary body adenoma
  • Melanocytic tumor of anterior uvea: large heavily pigmented mass arising from iris and ciliary body
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23
Q

What is filtration angle (iridocorneal angle)?

A
  • Located where iris and cornea meet
  • Pectinate ligaments span opening of filtration angle
  • *drainage of aqueous humor and return to systemic circulation
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24
Q

Filtration angle pathology

A
  • Glaucoma
    o Elevated intraocular pressure due to DECREASED drainage of aqueous humor
    o *NOT from over production
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25
Q

What are the mechanisms of a glaucoma?

A
  • Blockage at filtration angle
  • Blockage at pupil
26
Q

What are the causes of a glaucoma?

A
  • Congenital glaucoma=embryologic errors
  • Primary glaucoma=inherited
  • Secondary glaucoma=ocular disease (uveitis, lens instability)
27
Q

What is posterior synechia?

A
  • Iris is adhered to the lens
  • *blockage at a pupil
28
Q

What do you see with acute glaucoma?

A
  • Corneal: endothelial cell dysfunction=edema
  • Iris: muscle dysfunction=dilation
  • Retina and optic nerve: cellular dysfunction=temporary vision loss
29
Q

What do you see with chronic glaucoma?

A
  • Globe stretching/enlargement (BUPHTHALMOS)
    o Breaks in Descemet’s membrane (striae)
    o Lens zonule breakage and lens luxation
  • Retina and optic nerve ischemia and oxidative stress=permanent retinal ganglion cell death
  • *end stage eye: 1. Irreversible blindness, 2. Pain
30
Q

Lens anatomy

A
  • Outer capsule
  • Anterior lens epithelium and lens fibers
    o Cortex
    o Nucleus=gets harder with age
31
Q

Lens physiology

A
  • Transparent
    o Dehydrated state
    o Avascular: obtains nutrition from aqueous humor
  • Biconvex
32
Q

Lens aging is called

A
  • Nuclear sclerosis
    o Lens fibers proliferate through life
    o New outer fibers push older inner fibers concentrically towards lens nucleus
    o Normal old age change
33
Q

Lens (‘phak’)pathology

A
  • Congenital: aphakia, microphakia
    o Embryologic errors in development
  • Lens instability: luxation and subluxation
    o Due to breakdown of zonules
    o Anterior: in front of iris
    o Posterior: behind iris
34
Q

Zonular break down (lens instability)

A
  • Primary: inherited zonular degeneration (Terriers)
  • Secondary: uveitis, trauma, glaucoma
35
Q

What is the consequence to the eye with lens instability?

A
  • Uveitis due to microtrauma of unstable subluxated lens
  • Glaucoma due to disrupted aqueous humor outflow
36
Q

What is cataract due to?

A
  • Protein and/or hydration changes in lens metabolism
    o Results in altered organization of lens fibers
    o Manifests as an opacity in lens (white)
  • *inherited or metabolic (diabetes)
37
Q

What are the consequences for the eye, if there is cataract?

A
    1. Disrupts vision
    1. Causes inflammation due to leakage of proteins across intact lens capsule
      o Phacolytic uveitis
38
Q

What is phacolytic uveitis?

A
  • Lymphocytic plasmacytic inflammation
39
Q

Phacoclastic uveitis

A
  • Penetrating lens trauma with capsule rupture
    o Cataract with massive release of lens protein through the rent in lens capsule
    o Severe (phacoclastic) uveitis leading to glaucoma
  • SEVERE
40
Q

What is the composition of vitreous?

A
  • Water: 99%
  • Collagen fibers which serve as a skeleton for the gel
  • Cells (hyalocytes)
  • Hyaluronic acid
41
Q

What is the role of vitreous?

A
  • Maintains ocular shape
  • Maintains lens and retina in their normal anatomic position
  • Transmits light
42
Q

Pathology of vitreous

A
  • Persistent hyperplastic primary vitreous (congential)
  • Vitritis
  • Vitreal hemorrhage
  • Liquefaction/degeneration/syneresis: due to old age or previous vitritis
  • Asteroid hyalosis: calcium and phospholipids in vitreous
43
Q

What happens with liquefaction/degeneration/syneresis of the vitreous?

A
  • Condensation of collagen fibrils with liquefaction
  • Puts retina at risk for detachment
44
Q

What are the 2 components of the retina?

A
  • Retinal pigment epithelium (RPE)=one cell layer
  • Neurosensory retina=multiple layers
45
Q

Retinal pigment epithelium (RPE)

A
  • One cell layer thick
  • Support retina
    o Transports ions, removal of waste products, regeneration of photoreceptors
46
Q

Neurosensory retina

A
  • Phototransduction by photoreceptors
    o Conversion of light energy into electrical signal
    o Rods (night vision) and cones (day and colour vision)
  • Blood supply and nutrients
    o Outer: choroid
    o Inner: retinal vessels
47
Q

Retinal pathology

A
  • Retinal dysplasia
  • Retinal degeneration
  • Retinal detachment
  • chorioretinitis
48
Q

Retinal degeneration: retinal thinning

A
  • Dorsal fundus: tapetal hyperreflectivity (looking through less cells)
  • Ventral fundus: pigment clumping and depigmentation
  • *retinal vascular attenuation
49
Q

What causes retinal degeneration?

A
  • Inherited
  • Toxicity
  • Nutritional
  • Glaucoma
50
Q

What is retinal detachment?

A
  • Separation between photoreceptor layer of retina and RPE
    o Embryological potential space between them
51
Q

What does acute retinal detachment lead to?

A
  • Vision loss due to loss of contact between retina and RPE
52
Q

What does chronic retinal detachment lead to?

A
  • Death of photoreceptors due to loss of support from RPE
53
Q

What are the 2 mechanisms of retinal detachment?

A
  1. Rhegmatogenous retinal detachment
    a. Tears or holes, expand due to liquified vitreous entering subretinal space
  2. Non-rhegmatogenous retinal detachment
    a. Fluid and cells
    b. *looks like a ‘seagull’
54
Q

Optic nerve=CNII

A
  • Retinal ganglion cells
  • Optic nerve to optic chiasm to optic tracts to optic radiations to visual cortex
55
Q

Optic nerve pathway

A
  • Optic nerve
  • Optic chiasma
  • Optic tracts
  • Optic radiations
  • Visual cortex
56
Q

Optic nerve congenital pathology

A
  • Optic nerve hypoplasia: reduction in ganglion cells
  • Optic nerve aplasia: ganglion cells absent
57
Q

Optic nerve acquired pathology

A
  • Inflammation: optic neuritis
  • Degeneration: optic nerve atrophy
  • neoplasia
58
Q

What are the signs of optic neuritis?

A
  • Optic disc may be elevated, enlarged, fuzzy
  • Exudates, hemorrhages of optic disc
59
Q

What are the causes of optic neuritis?

A
  • Immune-mediated
  • Systemic infection
  • Trauma
60
Q

What are the signs of optic nerve degeneration?

A
  • Disc appears darker, smaller, cupped
61
Q

What are the causes of optic nerve degeneration?

A
  • Chronic glaucoma: loss of retinal ganglion cells
  • Post-optic neuritis
  • Post-traumatic

SYSTEMIC PATHOLOGY 3 (6 decks)

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