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245 > 7.1 Anterior Uvea > Flashcards

7.1 Anterior Uvea Flashcards

1
Q

What are epicapsular stars? (Definition and appearance)

A

Remnants of embryonic pupil membrane.

Appear as brown pigment flecks on anterior lens surface

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2
Q

Clinical significance of epicapsular stars?

A

No clinical significance.

Very common, don’t affect vision.

BUT do not confuse with pigment dispersion syndrome

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3
Q

What are persistent pupil membranes? (Definition and appearance)

A

Remnants of embryonic pupil membrane.

Appear as fine avascular threads that emanate from collarette (may also attach to pupil margin or lens)

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4
Q

Clinical significance of persistent pupil membrane?

A

No clinical signifance unless has an effect on vision (based on size of defect). Very common

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5
Q

Iris coloboma (definition, appearance)

A

Incomplete closure of optic cup.

Can affect iris, choroid/retina, eyelids.

ALWAYS inferior nasal

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6
Q

Iris coloboma (condition type, Tx)

A

Rare, congenital, *non-progressive* condition.

Can affect vision if retina/optic nerve involved.

Tx: cosmetic contact lens (cosmetic and can reduce glare)

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7
Q

Chediak-Higashi, Hermansky-Pudiak

A

Systemic rare AR diseases associated with albinism.

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8
Q

Ocular albinism (features)

A

Little/no pigment in iris or fundus.

Characteristic iris transillumination

Low vision: foveal hypoplasia, nystagmus, abnormal nerve crossings at chiasm

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9
Q

Anaridia (definition, frequency, features)

A

Congenital bilateral absence of iris, genetic mutation.

Very rare

Retinal (macular) hypoplasia (VA ~6/60)

Nystagmus

Cataract

Progressive corneal opacity

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10
Q

Anaridia (associations, potential complications)

A

Wilm’s tumour (kidney)

High glaucoma risk

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11
Q

Heterochromia iridum vs heterochromia iridis

A

Different iris colours between the 2 eyes vs different iris colours on the SAME eye

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12
Q

Heterochromia iridum (associations)

A

Possible associations: Horner’s syndrome, iris inflammation (Fuch iridocyclitis)

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13
Q

A heterochromia iridis Dx requires you rule out _____

A

A pigmented iris tumour

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14
Q

Pigment dispersion syndrome (definition, associations)

A

Bilateral, pigment shedding from iris pigment epithelium (into anterior segment/chamber)

Associated w pigmentary glaucoma

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15
Q

Pigment dispersion syndrome (pathogenesis)

A
  1. “reverse pupil block” leads to IOP increase (aqueous not flowing easily thru pupil and force iris to bow backwards against zonules)
  2. Posterior pigment layer rubs against lens zonules (2ndary to posterior iris bowing mid periphery)
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16
Q

Pigment dispersion syndrome (signs)

A

CAIGL

Cornea: endothelium pigment deposition, Krukenberg spindle

AC: deep, floating melanin granules

Iris: transillumination!, pigment dusting, pupillary ruff loss, pigment epithelial atrophy

Gonioscopy: mid-peripheral iris concavity, wide open angle, trabecular hyperpigmentation

Lens: occasional Scheie line (line/annular ring of pigment)

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17
Q

Pigment dispersion syndrome (management)

A

Monitor IOP

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18
Q

Pseudoexfoliation syndrome (definition/etiology)

A

abnormal basement membrane of epithelial cells produce fibrillary extracellular materials that is deposited throughout anterior segment

  • Involved epithelial cells from trab. meshwork, equatorial lens capsule, iris, CB
  • Deposition sites: anterior lens capsule, zonules, CB, iris, trabeculum, anterior vitreous, conjunctiva
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19
Q

Pseudoexfoliation syndrome (associations)

A

Relatively common cause of open-angle glaucoma (syndrome more common in women but the glaucoma risk greater for men)

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20
Q

Pseudoexfoliation syndrome (signs)

A

CAIGL

Cornea (endothelium): cellular debris, pigment deposits, diffuse Krukenerg spindle

AC: mild aqueous flare (maybe)

Iris: pupil margin cellular debris, sphincter atrophy (moth eaten transillumination defect)

Gonioscopy: trab hyperpigmentation, cellular debris is trabeculum, Sampaolesi line (pigment on/anterior to Schwalbe line)

Lens: central disk debris, peripheral band debris (clear mid-periphery)

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21
Q

Diseases with transillumination defects

A

Mid-periphery - pigment dispersion syndrome

Moth-eaten/sphincter atrophy - pseudoexfoliation

Entire iris lights up - ocular albinism

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22
Q

You should dilate a suspected pseudoexfoliation syndrome patient because…

A

It allows you to see if there is debris on the lens with a central disk and peripheral band (created by pupil movements)

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23
Q

Iridocorneal endotheliopathy variations

A

“ICE” syndrome

  • Essential iris atrophy
  • Iris nevus (Cogan-Reese) syndrome
  • Chandler syndrome
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24
Q

Iridocorneal endotheliopathy (what it is/associations)

A

Abnormal corneal endothelial layer which has the capacity to migrate across the angle onto the surface of the iris

Corneal decompensation (bc compromised endothelium)

Glaucoma (synechial angle closure) -> 50% of Px develop it -corneal endothelial cells migrate to iris which blocks aqueous outflow and creates synechiae/adhesions b/w cornea and iris

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25
Q

Iridocorneal endotheliopathy (signs)

A

CPI

Cornea: “hammered silver” endothelium, fine guttate-like lesions

Pupil: corectopia (malpositioned pupil), pseudopolycoria (multiple false pupils)

Iris: anterior iris nodules/nevi, anterior peripheral synechiae

26
Q

Iris rubeosis (definition, common causes)

A

Neovascularization of iris 2ndary to severe, diffuse and chronic retinal ischemia

Common: diabetes!!!, central retinal vein occlusion (CRVO)

Uncommon: ocular ischemic syndrome, retinal artery occlusion

27
Q

Must look for _____ in all diabetic patients

A

iris rubeosis

28
Q

Angle neovascularization and iris rubeosis relationship?

A

Angle neovascularization can occur w/o pupil involvement esp CRVO -> use gonioscopy on undilated eyes in high risk Px

29
Q

Iris rubeosis (ocular associations)

A

Neovascular glaucoma -> very difficult to manage!

-neovascularization impairs aqueous outflow; later contracts which causes 2ndary angle closure glaucoma and trabecular damage

30
Q

Iris rubeosis (treatment)

A

Panretinal photocoagulation (PRP)

VEGF agents

Systemic disease control (try to treat the ischemia)

31
Q
A

persistent pupillary membrane

32
Q
A

epicapsular stars

33
Q
A

Epicapsular stars

34
Q
A

iris coloboma

35
Q
A

ocular albinism

36
Q
A

ocular albinism

37
Q
A

ocular albinism

38
Q
A

anaridia

39
Q
A

heterochromia iridis

40
Q
A

heterochromia iridis

41
Q
A

pigment dispersion syndrome - krukenberg spindle

42
Q
A

pigment dispersion syndrome - mid-periphery transillumination defect

43
Q
A

pigment dispersion syndrome - loss of pupillary ruff

44
Q
A

pigment dispersion syndrome - hyperpigmented trabecular meshwork + iris bowing/concavity at the mid-periphery

45
Q
A

pseudoexfoliation syndrome - white cellular debris on pupil margin

46
Q
A

pseudoexfoliation syndrome - debris on lens in centre and periphery (clear mid periphery)

47
Q
A

pseudoexfoliation syndrome - moth eaten transillumination defect

48
Q
A

pseudoexfoliation syndrome - patchy TM pigment

49
Q
A

iridocorneal endotheliopathy - corneal decompensation and glaucoma (synechial angle closure)

50
Q
A

Iridocorneal endotheliopathy - essential iris atrophy

51
Q
A

iridocorneal endotheliopathy - iris nevus syndrome (Cogan Reese)

diffuse nevi on anterior iris or iris nodules

52
Q
A

iridocorneal endotheliopathy - Chandler syndrome

“hammered silver” endothelial abnormalities, blurred vision, halos, corneal edema, minimal iris changes

53
Q
A

iridocorneal endotheliopathy

54
Q
A

iridocorneal endotheliopathy

55
Q
A

iridocorneal endotheliopathy

56
Q
A

iris rubeosis

57
Q
A

iris rubeosis

58
Q
A

iris rubeosis

59
Q

What anterior uvea conditions are associated with glaucoma?

A

Anaridia

Pigment dispersion syndrome (pigmentary glaucoma)

Pseudoexfoliation syndrome (open angle)

ICE (iridocorneal endotheliopathy)

Iris rubeosis (neovascular glaucoma)

…

60
Q

What is essential iris atrophy?

A

Severe atrophic iris changes (a type of iridocorneal endotheliopathy, ICE)

61
Q

What is iris nevus syndrome?

A

aka Cogan Reese syndrome

diffuse nevus OR iris nodules covers anterior iris (a type of iridocorneal endotheliopathy, ICE)

62
Q

What is Chandler syndrome?

A

(a type of iridocorneal endotheliopathy, ICE)

Hammered silver endothelium, blurred vision, halos, corneal edema, minimal iris changes

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