AED - Lumps and Bumps III - Week 3 Flashcards
Can pigmented masses be found in the uvea?
Yesd
Where does colouration of pigmented masses come from? What two layers is this found in?
Melanocytes found in connective tissue and basal layer
Define naevus.
Benign acquired pigmentation
Define melanosis and provide an alternate name. Describe what it looks like and what structure it involves.
Complexion associated melanosis
Found in dark-skinned individuals, usually flat and involved the limbus
What does ocular melanocytosis look like and is it superficial or deep?
It is grey in the deep sclera
List the 5 classifications of ocular pigmented lesions.
Naevus
Racial melanosis
Ocular melanocytosis
Primary acquired melanosis
Conjunctival melanoma
What does the classification of naevus follow?
Uses different terms in different tissue
What are conjunctival and skin naevus classified by? List them (3) and what theyre associated with.
By depth or cell type/appearance
-junctional (epithelial basal layer/stroma junction)
-intradermal (stromal)
-compound (stromal and epithelial)
What is the most common conunctival tumour?
Naevus
Are naevus consistently coloured or can they be patchy?
Can be patchy
Are naevus mobile over the conjunctiva? What does this mean?
Yes, they havent ivaded below
When do naevus typically form?
Pubescent years, 10-20 years of age
Do naevus change with pregnancy?
They can
Are naevus fast or slow growing? What percentage become malignant?
Very slow
<1% become malignant
Are naevus flat or elevated?
Flat or minor elevation
What are naevus typically close to?
Limbus
Do naevus have a rich vascular supply?
No, 1-2 feeder vessels is common, its not rich
What is present in 70% of naevus?
Cysts
Can naevus be amelanotic?
Yes, complete or partial
In which two types of naevus are biopsies done?
Junctional or compound
What should you look out for with naevus (4)?
Sudden growth
Prominent feeders
Non-bulbar site
First noticed age 20+
Is congenital melanocytosis benign or malignant?
Benign
What is the cause of congenital melanocytosis?
Increased colour of deep tissue due to excess melanosomes
What is the difference between congenital melanocytosis and naevus of ota?
If the pigment is on the eyes alone, it is congenital melanocytosis
If it includes the eye and skin, it is naevus of ota
What appearance does congenital melanocytosis have? What percentage is associated with glaucoma? What percentage develops into melanoma?
Appears deep-bluish
10% can have associated glaucoma
2-4% develop melanoma
Does congenital melanocytosis involve the conjunctiva? Is it motile?
Doesnt involve the conjunctiva so it isnt motile
Does congenital melanocytosis change appearance or appear with puberty?
Can change or appear at puberty
Is primary acquired melanosis benign or malignant?
Premalignant
In what skin colour and age groups is primary acquired melanosis common?
Middle aged, fair skinned people
Is primary acquired melanosis uni- or bilateral?
Unilateral
Is the pigment of primary acquired melanosis dense or diffuse?
Diffuse
Is primary acquired melanosis a birthmark?
No
Where on the conjunctiva can primary acquired melanosis be found? Which regions especially?
Anywhere, especially the lid margins (evert lids)
Is primary acquired melanosis flat or raised?
Flat, not usually raised
What kind of proliferation is present in primary acquired melanosis? Is it mobile over the sclera? Does it have few or many feeder vessels?
Has lateral proliferation
Is mobile over the sclera
Has minimal feeder vessels
Is primary acquired melanosis diffuse or localised?
Diffuse (localised would be a naevus)
In what 3 cases is a biopsy indicated for a primary acquired melanosis?
Diffuse lesion found at the lid margin or the limbus with corneal involvement
Expansive diffuse lesion in one eye
What is the chance of a future melanoma if there are pleomorphic cells in a primary acquired melanosis biopsy?
50%
What percentage of melanoma comes from primary acquired melanosis?
75%
Is melanoma invasive?
Yes
Is melanoma fast-growing?
Yes
Is the colouration of melanoma dense or diffuse?
Dense
Do melanoma have regular or irregular borders? What else is seen and what is it?
Irregular border
Has a small halo which is the invasive region
What appearance does a melanoma have in terms of its surface?
Raised and irregular surface like a cauliflower
What can be seen on a biopsy of melanoma?
Invasive lesion with pleomorphism and anaplasia
Is a cavernous sinus fistula acquired or congenital?
Acquired
Is kaposi’s sarcoma benign or malignant?
Malignant
What are the symptoms of kaposi’s sarcoma?
None
List two signs of kaposi’s sarcoma and where it is usually found.
Bright red vascular mass, most often inferior fornix
May give sub-conjunctival haemorrhage
In what percentage of AIDS patients does kaposi’s sarcoma occur?
25% due to immunocompromisation
What is telangiectasia and is it acquired or congenital?
Is congenital
Dilated and tortuous blood vessels in the bulbar conjunctiva
Is telangiectasia common in isolation?
Not uncommon
List 7 important associations of telangiectasia.
Fabry’s disease
Bloom’s syndrome
Diabetes
Ataxis telangiectasia
Sturge-Weber syndrome
Myeloid disorders
Anaemic disorders
List 3 signs of sturge-weber syndrome.
Congenital conjunctival or episcleral haemangioma
Episcleral or conjunctival involvement (70%)
Cutaneous port wine stain along CNV
What three things may someone with sturge-weber syndrome also have?
Choroidal haemangioma
Iris heterochromia
Glaucoma before 2yo
What sign is classic of sturge-weber syndrome?
Port wine stain
What are the four components to assessing sturge-weber syndrome?
SL with lid eversion
IOP
Gonioscopy
DFE
What should be considered for sturge-weber syndrome and why?
Referral for assessment of neurological status (intracranial haemangioma)
What does the presence of a choroidal haemangioma with sturge-weber syndrome predispose you to (2)?
Serous RD
Glaucoma
List four symptoms of cavernous sinus fistula.
Weakness
Dizziness
Whooshing noise
List 5 signs of cavernous sinus fistula.
Generalised episcleral/conjunctival blood vessel dilation and tortuousity
Elevated IOP on that eye
Orbital bruit
Lid oedema
Retinal haemorrhage
What happens with a cavernous sinus fistula? How can it happen (2)?
ICA blood fills the cavernous sinus
Can occur spontaneously or disease related (HT)
When is cavernous sinus fistulas common (2)?
After trauma or surgery
Should cavernous sinus fistulas be referred?
Yes urgently, for closure of fistula
How is cavernous sinus fistula managed (by an optometrist)?
Manage their IOP
