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Anterior Segment > Acquired Lens Opacities > Flashcards

Acquired Lens Opacities Flashcards

1
Q

what part of the lens is a permeable, elastic membrane that is constantly reproduced?

A

capsule

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2
Q

where is the lens capsule the thickest?

A

near the equator

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3
Q

what part of the lens is made of densely packed secondary fibers?

A

lens cortex

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4
Q

what part of the lens has very little extracellular space?

A

lens cortex

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5
Q

is the lens vascular or avascular? does it have high or low oxygen pressure?

A

avascular with low oxygen pressure

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6
Q

what physiological factors impact the energy needed for protein synthesis & protection from oxidative damage?

A

highly anaerobic & lower energy production

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7
Q

damage or rupture of cell membranes in the lens results in what?

A

protein aggregation & enzyme inactivation

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8
Q

oxidative (free radical) damage causes an increase in what?

A
  • increase in soluble proteins

- increase in lens hydration

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9
Q

when new cells envelope old cells, what occurs?

A

growth in diameter & axial length

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10
Q

when new cells envelope old cells, what does it impact?

A

refractive gradient & accommodation

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11
Q

what makes diffusion difficult? what happens?

A

compact spaces of inner lens fibers → metabolites accumulate over time

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12
Q

where are the oldest cells located?

A

nuclear & inner cortical

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13
Q

what are oldest cells devoid of?

A

organelles & access to oxygen

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14
Q

what are the most common causes of complicated (secondary) cataracts?

A
  • uveitis
  • retinal detachment
  • retinitis pigmentosa
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15
Q

acquired cataracts can be associated with what skin disease?

A

atopic dermatitis

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16
Q

what metabolic etiologies most commonly cause acquired cataracts?

A
  • diabetes
  • Wilson’s disease
  • myotonic dystrophy
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17
Q

what drugs commonly cause acquired cataracts?

A
  • corticosteroids

- chlorpromazine

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18
Q

what are the 3 morphological classifications of acquired cataracts?

A
  • nuclear
  • subcapsular (anterior & posterior)
  • cortical
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19
Q

what are the 3 types of cortical cataracts?

A
  • polar
  • cuneiform: cortical spoking
  • vacuoles
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20
Q

what are the consequences of aging lens?

A
  • VA decrease → #1 cause of blindness in the world
  • refractive error change
  • increased glare
  • shallower anterior chamber
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21
Q

what do you use to measure the impact of a cataract by projecting the Snellen chart onto the retina?

A

potential acuity meter (PAM)

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22
Q

what is an alternative to the potential acuity meter?

A

potential acuity pinhole

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23
Q

what is used to assess the impact of glare on visual acuity?

A

brightness acuity test

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24
Q

nuclear cataracts are best graded with the slit lamp beam at what angle? & focused on which structure?

A

30-45 degrees to the lens

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25
Q

what grade is a nuclear sclerotic cataract that appears Brunescent?

A

grade 4

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26
Q

what grade is a nuclear sclerotic cataract that appears yellow-orange?

A

grade 3

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27
Q

when a nuclear sclerotic cataract is graded as “trace”, what color is it?

A

slight yellow

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28
Q

cortical spoking is best graded with what slit lamp technique?

A

retroillumination of the lens

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29
Q

posterior subcapsular cataracts are best graded with what slit lamp technique?

A

retroillumination of the lens

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30
Q

what would you grade a PSC that is > 3mm?

A

grade 3+

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31
Q

what size is a PSC when it is graded as PSC 2+?

A

2-3mm

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32
Q

what would you grade a PSC that is 1-2mm?

A

PSC 1+

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33
Q

what causes steady gradual changes in the lens after age 40?

A

oxidative stress

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34
Q

a homogenous increase in insoluble proteins resulting in protein aggregation & accumulation of fluorescent chromophores causes what type of acquired cataracts?

A

nuclear sclerosis

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35
Q

T/F: nuclear sclerosis is not age-related

A

false

36
Q

which age-related cataract presents as dehydration & compaction of the nucleus & nuclear yellowing due to chromophore accumulation?

A

nuclear sclerosis

37
Q

in nuclear sclerosis, what causes light scatter?

A

denaturation of proteins by free radicals

38
Q

how do nuclear sclerotic cataracts progress?

A

usually a slow, uniform progression

39
Q

what impact do nuclear sclerotic cataracts have on visual acuity?

A
  • VA reduction

- increased density & stiffness can lead to myopic shift

40
Q

which cataract typically begins in the lower nasal quadrant & as vacuoles between the lens fibers that can be transient?

A

cortical cataracts

41
Q

which age-related cataract is due to:

  • denaturation & coagulation of lens proteins
  • decreased level of amino acids & protein synthesis
  • increased hydration caused by decrease in potassium
A

cortical cataracts

42
Q

which age-related cataracts has opacification that results in cuneiform (wedge-shaped) or radial spoke-like opacities?

A

cortical cataracts

43
Q

when cortical cataracts present with vacuoles, what impact does it have on visual acuity?

A

no impact on VA

44
Q

what is a common symptom in cortical cataracts? what is it due to?

A

glare → due to light scatter

45
Q

what age-related cataract is caused by swelling of lens due to osmotic effect of aggregated insoluble proteins?

A

mature cortical cataracts

46
Q

which age-related cataract has a “mother of pearl” appearance?

A

mature cortical cataracts

47
Q

what are the sequelae of mature cortical cataracts?

A

can cause shallow anterior chamber & elevated IOP

48
Q

what age-related cataract occurs when leakage of liquified cortex results in capsular wrinkling?

A

hypermature cortical cataracts

49
Q

in a hypermature cortical cataract, what can happen as a result of the liquified cortex?

A

nucleus can sink inferiorly

50
Q

T/F: hypermature cortical cataracts can cause shallow anterior chamber & elevated IOP

A

true

51
Q

what impact do hypermature cortical cataracts have on visual acuity? how would you test their visual acuity?

A

significant VA reduction

  • hand motion
  • light perception
52
Q

what structure of the lens cannot be viewed in a dilated pupil with a hypermature cortical cataract?

A

posterior pole

53
Q

in hypermature cortical cataracts, what can occur when lens proteins leak out of the lens?

A

it can trigger a severe nongranulomatous inflammatory reaction

54
Q

in hypermature cortical cataracts, accumulation of macrophages & protein in the trabecular meshwork can lead to what?

A

glaucoma

55
Q

what type of age-related cataracts occur due to metaplastic change in epithelial cells?

A

anterior subcapsular

56
Q

in anterior subcapsular cataracts, the epithelial cells become?

A

elongated

57
Q

anterior subcapsular cataracts can also be caused by what? what is it called?

A

angle-closure attacks (glaucomflecken)

58
Q

angle-closure attacks in anterior subcapsular cataracts are caused by what?

A

necrosis of the lens epithelium

59
Q

which type of age-related cataract presents as a plaque-like opacification due to migration of adjacent epithelial cells into the damaged area?

A

anterior subcapsular cataracts

60
Q

which age-related cataract is caused by dysplastic change in the germinal epithelium? what happens to the cells?

A

posterior subcapsular

- cells become distorted, swollen & unorganized

61
Q

posterior subcapsular cataracts can be secondary to what?

A
  • diabetes
  • corticosteroid use
  • inflammation
  • retinitis pigmentosa
  • atopic dermatitis
62
Q

what impact do posterior subcapsular cataracts have on visual acuity?

A

it may affect near vision more than distance

63
Q

in diabetes, what causes an accumulation of sorbitol & leakage of water into the lens?

A

increased glucose levels

64
Q

what is also known as a christmas tree cataract?

A

myotonic dystrophy

65
Q

in cataracts caused by myotonic dystrophy, are the cataracts nasal, central, or temporal? what color are they? what structure of the lens is it present in?

A

central, polychromatic, present in the cortex

66
Q

what is also known as sunflower cataracts?

A

Wilson’s disease

67
Q

which metabolic disorder causes copper deposits in the central lens with stellate processes?

A

Wilson’s disease

68
Q

where are cataracts due to Wilson’s disease located?

A

under anterior capsule

69
Q

T/F: sunflower cataracts cannot resolve with appropriate systemic treatment of the disease

A

false

70
Q

in patients with atopic dermatitis, when would they develop cataracts?

A

2nd-4th decade

71
Q

are cataracts from atopic dermatitis unilateral or bilateral? how do they progress?

A

often bilateral & mature quickly

72
Q

what condition causes a shield cataract, commonly an anterior subcapsular plaque?

A

atopic dermatitis

73
Q

in patients with atopic dermatitis with cataracts, what is another presentation? (besides an anterior subcapsular plaque)

A

stellate posterior subcapsular opacity

74
Q

corticosteroids most commonly cause what type of cataract?

A

posterior subcapsular cataracts

75
Q

which drug induces a stellate anterior subcapsular cataract with granular deposits?

A

chlorpromazine

76
Q

what is the most common cause of unilateral cataracts in young individuals?

A

blunt trauma

77
Q

what is a pigment imprint from pupillary ruff onto anterior lens capsule called?

A

Vossius ring

78
Q

true exfoliation of the anterior lens capsule is caused by what?

A

heat (infrared radiation) trauma

79
Q

inflammation such as uveitis, retinal detachment & retinitis pigmentosa can result in which type of cataract most commonly?

A

PSC

80
Q

what is a systemic condition that results in fibrillary residue deposits?

A

pseudoexfoliation

81
Q

pseudoexfoliation increases the risk of what? & why?

A

increased risk of glaucoma due to elevated IOP

82
Q

what impact do cataracts resulting from pseudoexfoliation have on visual acuity?

A

no impact on visual acuity

83
Q

pseudoexfoliation causes enzyme degradation of zonules which leads to?

A

zonular weakness & phakodenesis

84
Q

what is the displacement of lens from its normal position?

A

ectopia lentis

85
Q

what can cause ectopia lentis?

A
  • trauma
  • Marfan syndrome
  • pseudoexfoliation syndrome
  • high myopia
86
Q

if a patient with Marfan syndrome develops ectopia lentis, where is the lens usually displaced to? is it bilateral or unilateral?

A

bilateral, superotemporal

Anterior Segment (37 decks)

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