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245 > 7.2 Anterior Uvea > Flashcards

7.2 Anterior Uvea Flashcards

1
Q

What is iridodialysis?

A

Rupture of iris root secondary to blunt trauma or penetrating eye injury

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2
Q

Symptoms of iridodialysis?

A

Monocular diplopia, glare, photophobia

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3
Q

What is a peripheral iridectomy?

A

Surgical procedure with an intracapsular cataract extraction -> meant to prevent pupil block angle closure glaucoma

Rarely seen today because most surgeries are extracapsular now

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4
Q

What is laser peripheral iridotomy? Signs?

A

Use a laser to burn holes into the periphery of iris

Small superior holes in the iris (place superiorly to prevent issues with glare)

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5
Q

What is the purpose of laser peripheral iritodotomy?

A

Surgical tx for glaucoma (allow aqueous flow to anterior chamber)

Prevent angle closure glaucoma in Px with narrow angles

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6
Q

What should you never do if a patient has an iris supported intraocular lens?

A

Dilate! You never dilate these patients!

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7
Q

What is an iris supported intraocular lens?

A

First type of IOL (1980s and earlier), lens clipped or sutured to the iris

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8
Q

Who might you see an iris supported IOL in?

A

Px who had cataract surgery 20+ years ago

Px who had complications with cataract surgery (problems with posterior chamber IOL)

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9
Q

What is an iris nevus?

A

Common benign tumour of the iris; includes freckles or diffuse nevi

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10
Q

What does an iris nevi look like?

A

Flat or slightly elevated

Pigmented lesion on superficial layer of iris

Circumscribed, usually <3mm in diameter

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11
Q

Iris nevi - location, number, laterality

A

Usually found inferiorly

Usually multiple

Usually bilateral

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12
Q

Iris nevi - how might this affect others structures

A

May distort pupil if large

May extend into TM

May see ectropion uveaae

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13
Q

Iris nevi in Cogan-Reese syndrome

A

Diffuse nevi + nodules

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14
Q

Iris nevi in neurofibromatosis 1

A

Lisch nodules

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15
Q

What is neurofibromatosis 1?

A

Disorder that affects cell growth of neural tissues (AD inheritance, variable penetrance)

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16
Q

Systemic features of neurofibromatosis 1?

A

Intracranial tumours

Neurofibromas

Cafe au lait spots (skin)

Skeletal changes

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17
Q

Ophthalmic features of neurofibromatosis 1? (Anterior segment)

A

Eyelid neurofibromas

Iris lisch nodules

Congenital ectropion uvea

Mammilations (nodules on iris surface)

Prominent corneal nerves

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18
Q

Ophthalmic features of neurofibromatosis 1? (Posterior segment)

A

Optic nerve glioma

Orbital neural tumours

Choroidal nevi

Glaucoma

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19
Q

Iris nevi management?

A

Measure and document size and shape of all nevi (photos useful)

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20
Q

Signs of malignant transformation of an (iris) nevi

A

Vascularity

Rapid growth (diameter/thickness)

Diffuse spread

Seeding

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21
Q

Frequency of iris cysts?

A

Rare

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22
Q

Types of primary iris cysts?

A

Epithelial or stromal

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23
Q

Types of secondary iris cysts?

A

Secondary iris cysts develop as a result of

  1. Implantation (deposition of cornea or conjunctiva epithelium onto iris after surgery)
  2. Miotic (prolonged use of long-acting miotic)
  3. Parasitic (ie. tapeworms)
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24
Q

Primary epithelial iris cyst - symptoms?

A

Usually asymptomatic

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25
Q

What is a primary epithelial iris cyst?

A

Cyst between the 2 layers of the iris pigment epithelium

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26
Q

Primary epithelial iris cyst - signs? laterality? number?

A

Brown or transparent globular structures

Unilateral or bilateral

Solitary or multiple

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27
Q

Primarily epithelial iris cyst - location

A

Found at pupil border, midzone or iris root

May dislodge and float free

28
Q

Primary epithelial iris cyst - treatment?

A

Only if visual axis obstructed

29
Q

Primary stromal iris cyst - presentation, assocations

A

Presents in 1st years of life

Remain dormant for many years or suddenly enlarge -> cause 2ndary glaucoma & corneal decompensation

30
Q

Primary stromal iris cyst - signs?

A

Solitary

Unilateral

Smooth translucent anterior wall

May break free and float in anterior chamber

31
Q

Primary stromal iris cyst - treatment?

A

Needle aspiration or

Surgical excision

32
Q

Secondary iris cysts - implantation (what it is, frequency)

A

Deposition of cornea or conjunctiva epithelium onto iris after surgery

Most common of the secondary iris cyst subtypes

33
Q

Secondary iris cysts - implantation (subtypes)

A

Pearls

Serous

34
Q

Secondary iris cysts - implantation (pearls)

A

Pearls: stromal, white, opaque walls, not connected to the wound

35
Q

Secondary iris cysts - implantation (serous subtype, complications)

A

translucent fluid filled and often connected to the wound

Risk of corneal edema, anterior uveitis, glaucoma

36
Q

Secondary iris cysts - miotis (appearance)

A

Bilateral, small, multiple cysts at pupil border

37
Q

Secondary iris cysts - miotics (prevention)

A

Prevent with concomitant use of 2.5% phenylephrine

38
Q

Secondary iris cysts - miotics (details of cause)

A

Prolonged use of long-acting miotics

39
Q

Secondary iris cyst - parasitic (example, frequency)

A

Parasite example: tapeworms

Frequency: very rare

40
Q

Iris metastasis (frequency, appearance)

A

Very rare

Fast growing, white, pink or yellow mass

41
Q

Iris metastasis may be associated with…

A

Anterior uveitis

Hyphema

42
Q

Frequency of uveal melanoma?

A

Most common intraocular tumour in adults

Incidence increases with age

43
Q

Uveal melanome can affect…

A

Iris (8% of uveal melanomas)

Ciliary body (12%)

Choroid (80%)

44
Q

Uveal melanoma prognosis?

A

40% of uveal melanoma Px will die of liver metastases!

Survival rate: 5-10 years

45
Q

Risk factors for uveal melanoma?

A
  • Fair skin
  • Light iris (blue/green)
  • Numerous cutaenous nevi
  • Congenital ocular melanocytosis
  • Oculodermal melanocytosis (Naevus of Ota)
  • Dysplastic cutaenous nevi (atypical moles)
  • Familial cutaneous melanoma
  • NF1 (neurofibromatosis 1)
  • Blue light (not UV) exposure
46
Q

What is congenital ocular melanocytosis?

A

Increased # of melanocytes in the iris, choroid, and surrounding tissue

47
Q

What are the possible complications of congenital ocular melanocytosis?

A

May develop melanoma of uvea, orbit, or meninges

Glaucoma

48
Q

What is Nevus of Ota (aka oculodermal melanocytosis)? Appearance?

A

Trapped melanocytes in the skin

Blue hyperpigmentation that occurs on face (sclera affected in 2/3)

49
Q

Nevus of Ota (Oculodermal melanocytosis) is localized to…

A

the first two branches of the trigeminal nerve

50
Q

Iris melanoma frequency?

A

Extremely rare iris malignancy (8% of all uveal melanomas)

51
Q

Iris melanoma - presentation?

A

Presents in 4th -5th decades

Enlargement of pre-existing lesion

52
Q

Iris melanoma - most common in which populations?

A

Moer common in blue eyes than brown

Rare in African Americans

Males = females

53
Q

Iris melanoma - prognosis

A

May invade anterior chamber angle or ciliary body

Overall prognosis: good

Very small chance of metastases (5% within 10 years of treatment)

54
Q

Iris melanoma - signs?

A
  • Very slow growing tumour (may invade angle)
  • Nodule usually >3mm diameter, >1mm thick
  • Nodule usually in lower half of iris
  • Surface blood vessels usually
  • Possible pupil distortion, ectropion uveae, localized cataract
55
Q

Iris melnoma - what is on your list of differential diagnosis?

A
  • Iris nevus (if nevus large and distorting pupil)
  • Ciliary body melanoma (ciliary tumour may extend through iris root)
  • Metastasis to iris (rare, in Px with known systemic malignancy)
  • Iris cysts and very rare iris tumours (adenomas, leiomyomas, iris cysts)
56
Q

Iris melanoma - treatment?

A
  • Get a second opinion
  • Lifelong observation (slit lamp, gonio)
  • Iridectomy
  • Iridocyclectomy
  • Enucleation
57
Q

What is iridectomy and when is it used in iris melanoma treatment?

A

Iridectomy: surgery, removes part of iris

Only for small tumours

58
Q

What is iridocylectomy and when is it used for iris melanoma Tx?

A

Iridocyclectomy: surgical removal of iris and CB

Used if angle involved

59
Q

What is enucleation and when is it used for iris melanoma?

A

Enucleation: removal of eye

For diffusely growing tumours

60
Q

Frequency of ciliary body melanoma?

A

Rare

12% of all uveal melanomas

61
Q

Presentation of ciliary body melanoma?

A

Presents in 6th decade with vision Sx

62
Q

Procedures to Dx ciliary body melanoma?

A
  • Gonioscopy
  • Dilated fundus exam
  • Transillumination
  • Ultrasound
  • Biopsy
63
Q

Ciliary body melanoma: signs?

A

Large dark mass in anterior chamber angle

  • may be visible on fundscopy after dilation
  • may extend to iris root and mimic iris tumour
  • may extend through the sclera or to choroid

Sentinal vessels (dilated episcleral vessels in same quadrant)

64
Q

Ocular associations of ciliary body melanoma?

A

Astigmatism (due to lens distortion)

Exudative retinal detachment

65
Q

Ciliary body melanoma - Tx?

A
  • Iridocyclectomy (small-med tumours)
  • Enucleation (large tumours)
  • Radiation
66
Q

Veteporfin (Visudyne) is a possible uveal melanoma Tx beecause…

A

It acts on YAP pathway (protein cascade) that is genetically abnormal in ~70% of all px with uveal melanoma

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