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IP 11 Ophthalmology > 8: the uvea - pearce > Flashcards

8: the uvea - pearce Flashcards

1
Q

which vascular tunic is the uveal tract?

A

middle vascular tunic

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2
Q

what are the components of the anterior uveal tract?

A

iris

ciliary body

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3
Q

what are components of the ciliary body?

A

anterior: pars plicata
posterior: pars plana

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4
Q

what is the fxn of the pars plicata?

A

aqueous production

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5
Q

what makes up the posterior uveal tract?

A

choroid

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6
Q

where is the choroid loc?

A

behind the retina

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7
Q

what is the significance of the uveal tract being an “immuno sensitive” organ?

A

it tells us a story - manifestation of 1* ocular dz OR is an ocular manifestation / sentinal for systemic dz

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8
Q

what is the importance of the choroid in terms of pharmacokinetics of drugs in the eye?

A

topical medication cannot reach the back of the eye d/t the choroid

NEED systemic meds to reach the back of the eye

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9
Q

what is heterochromia iridis?

etiology?

A

congenital condition

multiple colors occurring w/in one iris

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10
Q

what is heterochromic iridium?

etiology?

A

congenital condition

multiple colors occurring btwn 2 eyes

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11
Q

t/f

in cases of heterochromia iridis, the posterior uveal tract, in addition to the anterior uveal tract, is affected

A

true

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12
Q

what part of the posterior uveal tract is impacted in cases of heterochromia iridis?

A

choroid has less or no pigment - so less or absent tapetum

why the red eye reflection occurs in blue eyes

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13
Q

what is the normal appearance of the reflection of the eye?

how is it different in humans, animals with blue eyes and in cases of heterochromia iridis?

A

normal: green/yellow reflection is the tapetum w/in the choriod
abnormal: red eye reflection b/c non pigmented choroid / lack of pigment / tapetum

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14
Q

what is an iris coloboma?

etiology?

A

congenital conditions

absence / defect of iris tissue

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15
Q

which location does an iris coloboma MC occur?

why?

A

in the “6 o’clock” position

b/c there is an incomplete closure of the embryonic fissure in this location

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16
Q

what are persistent pupillary membranes (PPMs) ?

A

incomplete resorption of iridal embryonal vasculature and mesenchymal tissues

normal: the sheet of mesenchyme in the pupil atrophies in the embryo

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17
Q

what is the result of persistent pupillary membranes?

what is seen in the eye?

A

strands of tissue seen in the eye - originate at the iris collarette [in the middle of the iris]

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18
Q

in persistent pupillary membranes, what are 3 locations the strands can go to?

what is the manifestation of each?

A

iris to iris [more benign]

iris to cornea [corneal opacity]

iris to lens [cataract]

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19
Q

how does synechia differ from persistent pupillary membranes?

A

synechia is adherence of tissue
vs
PPMs are strands

PPMs originate from iris collarette - synechia does not

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20
Q

what is pupil dyscoria?

A

abnormally shaped pupil

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21
Q

what is pupil corectopia?

A

abnormal location of pupil

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22
Q

what is anterior segment dysgenesis also referred to? [why?]

what conditions typically occur with this condition?

A

merle ocular dysgenesis - common with accidental Merle to Merle breeding

  • iris colobomas
  • corectopia
  • PPMs
  • others also
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23
Q

what is anterior segment dysgenesis?

A

lens does not sepaarate properly from corneal tissue

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24
Q

what is iris atrophy?

A

spontaneous progressive thinning of the stroma or pupillary portion of the iris (or both)

common finding in middle-aged and older dogs

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25
Q

why might iris atrophy lead to light sensitivity?

A
  • thin area allows light through instead of through the pupil
  • and/or dec constriction ability of the pupil
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26
Q

2 common degenerative uveal changes?

A
  • cyst

- melanoma

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27
Q

how to differentiate a cyst from a melanoma?

A

melanoma does NOT transilluminate - neoplasia will not let light though

cysts DO transilluminate

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28
Q

what are 2 forms of 1* uveal neoplasia?

A
  • melanocytic iridal neoplasia [melanoma / melanocytoma]

- ciliary body adenoma / adenocarcinoma

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29
Q

what is MC 1* uveal neoplasia?

which species (dog or cat) has the worst prognosis?

A

melanocytic iridal neoplasia [melanoma / melanocytoma]

cat worse prognosis
overall - less than 10% malignant typically

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30
Q

what is the 2nd MC 1* uveal neoplasia?

prognosis?

A

ciliary body adenima / adenocarcionma

  • pigmented or non pigmented

50/50 benign / malignant

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31
Q

what is MC 2* uveal neoplasia?

A

lymphosarcoma

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32
Q

c/s of 2* uveal neoplasia d/t LSA?

what ocular structures are typically affected?

what % of dogs and cats show ocular signs?

A
  • uveitis
  • 40% of dogs show ocular signs
  • 50% of cats show ocular signs
  • iris and ciliary body usually affected
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33
Q

what are less common causes of 2* uveal neoplasia?

A

TVT
HSA
malignant melanoma
carcinomas (renal, panc, thyroid)

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34
Q

what are 3 ways uveal tumors are treated?

A
  • locally - Sx excision, diode laser for focal lesions
  • enucleation
  • chemotherapy [systematic or metastatic dz]
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35
Q

in what cases would enucleation be considered to Tx uveal tumor?

A
  • extensive 1* tumors

- inflamed or glaucomatous eyes

36
Q

what are some benefits to using laser Tx for uveal tumors?

A
  • less invasive Tx option
  • does NOT damage the cornea => only affects damaged tissue
  • good for focal lesions and/or in early stages
37
Q

what is aqueous flare?

what condition is it pathogneumonic for?

A

tyndall effect of haziness in the posterior chamber d/t presence of particulates suspended in the fluid and illuminated by light

anterior uveitis => inflammation leading to inc permeability of ocular vessels [impaired blood/ocular barriers] -> protein leaks out, into the posterior chamber

38
Q

c/s of anterior uveitis?

A 
ciliary flush
corneal edema
dec IOP
dec vision
hyphema
hypopyon / fibrin
iris color change
iris swelling
keratic percipitates
mioosis
pain 
conjunctival hyperemia
39
Q

what is ciliary flush?

A

360* corneal vascularization (“hedge” appearance) that is present with deep intra ocular dz, uveitis, glaucoma, deep corneal dz

40
Q

why is corneal edema seen with anterior uveitis?

A

hazy cobblestone appearance of cornea

b/c endothelial cells are not able to pump fluid out of the cornea like they should do, b/c of the inflammation

41
Q

why does dec IOP occur w anterior uveitis?

A

toxic things floating around in the eye affects its ability to produce fluid - b/c the non pigmented epithelium of the ciliary body does not perform well

dec fluid production -> dec IOP

42
Q

what is hypopyon?

A

pus in the eye

43
Q

what color changes occur to the iris during anterior uveitis?

under what circumstances?

A

darker -> brown to dark brown / black OR blue to yellow
rubeosis iridis

chronic uveitis

44
Q

what is reubeosis iridis and what does it mean?

A

blood vessels grow on the iris surface

pathogneumonic for uveitis

45
Q

what do keratic precipitates look like?

A

a greasy appearance => granulomatous inflammation

46
Q

why does miosis occur with anterior uveitis?

A

inflammation with PGs - stimulates PG receptors of the iris - miosis occurs

also - spasm of iris sphincter M occurs

47
Q

what are c/s of posterior uveitis?

A
  • tapetal hyporeflectivity
  • granulomas
  • retina: edema, detachment, hemorrhage
  • vitreous opacity
48
Q

what part of the uveal tract does posterior uveitis occur in?

A

choroid

49
Q

what is common sequelae of uveitis?

A

cataract
synechia
iris atrophy

50
Q

what is synechia?

A

adherence of iris to lens tissue

posterior: can stick to lens
anterior: can stick to cornea

51
Q

what are common sequelae to uveitis?

A

lens luxation - d/t zonular break down
phthisis bulbi - d/t chronic lack of fluid produciton
iris bombe - 360* adherence of pupil martin -> fluid pushes iris fwd and pupil stays on loc of lens b/c it is stuck there
2* glaucoma

52
Q

what is endophthalmitis?

A

inflammation of intra ocular contents

NOT cornea and sclera

53
Q

what is panophthalmitis?

A

inflammation of all ocular structures ==> including orbital fissure

includes fibrous tuinc (cornea and sclera)

54
Q

the first thing to do when approaching a uveitis patient is to make an etiologic diagnosis. over ____% of cases are idiopathic.

A

50

55
Q

common infectious causes of canine uveitis?

A 
viral - distemper, CAV-1
tick born - RMSF, ehrlichia
fungal
bacT - brucella, lyme
parasitic - dirofilaira
algal - protheca
protozoal - toxo, neospora
56
Q

common causes of feline uveitis?

A

4 Fs and 1 T:

FeLV
FIV
VIP
Fungal
Toxoplasma

maybe Bartonella

57
Q

classifications of non infectious uveitis?

A

metabolic
immune mediated
trauma
lens associated

58
Q

what are metabolic causes of uveitis?

A

hyper lipidemia -> aqueous fills up with lipid -> eye looks very milky

diabetic - cataract related / lens induced uveitis

59
Q

common immune mediated cause of uveitis?

A

uveodermatologic syndrome

targets pigmented cells - many loc w/in uveal tract

60
Q

2 types of lens associated uveitis?

A

phacolytic - protrusion across intact lens capsule

phacyclastic - lens capsule rupture

61
Q

2 types of traumatic causes of uveitis?

A

blunt or piercing

ulcerative keratitis

62
Q

Dx of uveitis?

A 
complete PE
blood work (cbc, chem)
urinalysis
chest x rays
abdominal x rays
lnn aspirates
abdominal u/s
infectious dz testing
63
Q

after etiologic dx of uveitis is made, what next?

A

control inflammation
px undesirable sequelae
relieve pain

64
Q

Tx of uveitis?

A

Tx 1* cause, if an etiologic cause is made

specific abx, chemotherapy, remove lens / foreign material, Tx of ulcerative keratitis

65
Q

presumptive tx of uveitis in cats:

A

clindamycin (anti-toxoplasma)

anti fungal

66
Q

presumptive tx of uveitis in dogs:

A

doxycycline (anti rickettsial)

anti fungal

67
Q

drugs to control inflammation in Tx of uveitis?

3 classes and some examples in each

A

corticosteroids - topical, systemic, sub conjunctival

NSAIDs - topical, systemic

immuno suppressive agents - cyclosporine, azathioprine

68
Q

what 2 classes of drugs should NOT be used together in the Tx of uveitis?

A

systemic NSAIDs and steroids

69
Q

contra indications to corticosteroid use?

A

ulcerative keratitis - NO topicals

deep mycotic dz - NO systemics

70
Q

concerns with topical corticosteroid use?

A

2* infections
inhibits wound healing
systemic absorption

71
Q

concerns with systemic corticosteroid use?

A

immunosuppression

adrenocortical suppression

72
Q

t/f

the best treatment for an ulcer is topical steroids

A

false

never give topical steroids if an ulcer

73
Q

what is solubility of a corticosteroid?

potency?

A

solubility: acetate and alcohol forms more lipid soluble than phosphate forms; relates to penetration of the drug into a tissue
potency: the extend of the anti-inflammatory effect, irrespective of penetration

74
Q

high lipid solubility of a steroid means better penetration into which tissue layer?

A

corneal epithelium

75
Q

the addition of what to a molecule enhances the anti inflammatory activity?

i.e. improves potency

A

fluoride and methyl molecules

76
Q

t/f

a more potent corticosteroid is just as good as a more soluble steroid, if given at higher doses

A

false

a more potent drug will do NO good if it cannot penetrate the target tissue

77
Q

what corticosteroids are very lipid soluble, therefore penetrate tissues well?

this is effective in the Tx of what?

A

prednisolone acetate

anterior uveitis

78
Q

common NSAIDs used to treat uveitis?

for what type of uveitis are systemic NSAIDs necessary?

A

carprofen
meloxican

necessary for posterior uveitis

79
Q

t/f

topical NSAIDs are often used along with topical steroids

A

true

80
Q

what are two examples of commonly used topical NSAIDs?

A

didofenac sodium

flurbiprofen sodium

81
Q

what is the 1* indication for topical NDAID use in uveitis?

A

anterior uveitis

82
Q

concerns of the use of NSAIDs in Tx of uveitis?

A

hyphema

glaucoma

83
Q

indications for systemic NDAIDs?

A
  • adjunct to topical Tx of anterior uveitis

- ocular discomfort

84
Q

concerns with systemic NSAIDs in tx of uveitis?

A

dry eye (KCS)
renal
GI
hematologic

85
Q

what drugs are used in the Tx of uveitis to Px undesirable sequelae?

A
  • anti glaucoma drugs

- mydriatics / cycloplegics

86
Q

2 classes of mydriatics / cycloplegics used in Tx of uveitis?

functions?

contraindications?

A
  • anti cholinergics [atropine, tropicamide]
  • adrenergics [phenylephrine hydrochloride]
  • eliminates ciliary spasm / pain
  • dilates pupil and Px synechia
  • stabilizes blood aqueous barrier
  • contraindicated in glaucoma or if tear deficiency
87
Q

what medications can be used to relieve pain in the Tx of uveitis?

A
  • mydriatics/cycloplegics
  • anti-inflammatory agents
  • dark environment - stall or eye mask - eliminates photophobia
  • analgesics if needed: butorphanol, morphine, tramadol, oxymorphone, hydromorphone

IP 11 Ophthalmology (13 decks)

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