anomalies Flashcards
anterior megalophthalmos
assoc
findings
assoc: marfans
mucolipidosis type II
Apert’s syndrome
cornea plana
chromosome 12
assoc: sclerocornea, angle closure glaucoma
K 20-30 (equal to sclera)
path: diffuse scarring/vascularization of stroma, thick epi, absent Bowman’s, thin descemets
Megalocornea
newborn with horizontal diameter > 12mm
X-linked
M>F (9:1)
Assoc: Marfan’s, alport’s, down’s syndrome, craniosynostosis
Findings: weak zonules, large cornea, sublxated lens, ectopic pupil
Microcornea
less than 9 mm
AD or sporadic, arrested development at 5 mo
dwarfism
Ehlers-danlos syndrome
Findings: hyperopic, cataract or coloboma, PHPV, glaucoma - angle closure or open angle
axenfeld’s anomaly
AD posterior embryotoxon iris processes to scleral spur 50% develop glaucoma FOXC1, PAX6, REIG1, REIG2
Alagille’s Syndrome
axenfeld’s (posteior embryotoxon with iris strands to SS)
Pus pigmentary retinopathy, esotropia, corectopia
Systemic: absent deep tendon reflexes
absent facies
pulmonic valve stenosis
chrom 20p12 - ERG and EOG abnormal
Reiger’s anomaly
axenfelds (posterior embryotoxon + iris strands to SS) + iris hypoplasia with holes
50% develop glaucoma
RIEG1, REIG2, FOXC1, PAX6
Reiger’s syndrome
Reiger’s anomaly (axenfelds + iris hypoplasia + holes)
With mental retardation
dental, craniofacial, GU skeletal abnormalities also
Peter’s anomaly
central corneal leukoma (defect in Descemet’s membrane)
absence of endothelium
iris adhesions with lens involvement
also - cardiac, craniofacia, skeletal abnormalities
mostly sporadic
80% bilateral
PAX6 (11p13), PTX2, CYP1B1, FOXC1
Differential for cloudy cornea
STUMPED Sclerocornea Trauma - tears in Descemet's membrane Ulcer Metabolic Peter's anomaly Edema (CHEDS) Dermoids Also: CHSD, rubella, poserior keratocouns, congenital corneal staphyloma
CHED - congenital hereditary endothelial dystrophy
CHED1
CHED2
rare
bilateral corneal clouding
chromosome 20p
CHED 1- AR (2 yo, pain, tearing, photophobia, progressive)
CHED 2 - AR - more common, at birth, nystagmus, no pain/tearing, nonprogressive
Congeital hereditary stromal dystrophy
rare AD nonprogressive clear peripherally, no edema can cause strabismus, nystagmus, ambylopia
dermoid
solid, yellow-white choristoma
25% bilateral
Assoc: Goldenhar’s syndrome, linear sebaceous nevus syndrome
limbal - inferior temporal (most common)
complications: astigmatism, ambylopia
Aniridia
types, genetics, associations
hereditary or sporadic PAX6
AN1 - AD (2/3) only have eye involvement
AN 2 - sporadic (1/3) - associated with Wilm’s tumor and WAGR (wilms, aniridia, GU abnml, mental retardation
AN 3 - AR - Gillespie’s syndrome - mental retardation and ataxia
Gillespie syndrome
AR
Aniridia (2% of cases)
mental retardation
ataxia
Aniridia - associations
foveal and optic nerve hypoplasia glaucoma (30-50%) cataracts (50-80%) nystagmus photophobia amblyopia limbal stem cell deficiency
PAX6 (11p13)
iris coloboma
location and associations
most commonly inferiornasal
assoc: Goldenhar’s syndrome, CHARGE, trisomy 13,18,22, chrom 18 deletion, Klinefelter’s syndrome, Turner’s syndrome, Meckel’s syndrome, basal cell nevus syndrome, linear sebaceous nevus syndrome
Ectropion uveae
Congenital iris ectropion syndrome
ectropion of posterior pigment epithelium onto anterior surface of the iris
Assoc: NF and Prader-Willi
unilateral, high iris insertion, angle dysgenesis, glaucoma, smooth crypt-less iris
corectopia
Dyscoria
displacement of pupil
assoc: axenfeld-reiger syndrome, iridocorneal endothelial syndrome uveitis, trauma
abnormally shaped pupil
assoc: PS, axenfeld-reiger syndrome, ectopia lentis et pupillae
Brushfield’s spots
Lisch Nodules
in 85% of down syndrome pts
focal areas of iris stromal hyperplasia surrounded by relative hypoplasia
NF-1
neural crest hamartomas
increase in frequency and number with age
JXG
histiocytic proliferation
yellow-tan nodules
spontaneous hyphemas with iris involvement
rarely have orbital granulomas
often regress by age 5
Path: proliferation of histiocytes with Touton giant cells
Mittendorf’s dot
white opacity on posterior lens
remnant of tunica vasculosa lentis where hyaloid artery is inserted
Lenticonus
cone-shaped lens abnormalities
Anterior - bilateral M>F
Alport’s (anterior lenticonus, nerphritis, deafness)
Posterior - unilateral, F>M, more common
microspherophakia
small, spherical lens
bilateral
sonules visable
pupillary block can occur - tx is cycloplegic
Assoc: Weill-marchesani, Alport’s syndrome, congenital rubella, peter’s anomaly
Optic nerve hypoplasia
small disc vessels exit centrally double ring sign APD amblyopia nystagmus
need: MRI and endocrine work-up
Associations with optic nerve hypoplasia
maternal diabetes, anticonvulsants, alcohol, LSD, quinine
Midline brain defects
Pituitary dysfunction
aniridia
CHARGE
Demorsier’s syndrome (septo-optic dysplasia)
De Morsier’s syndrome
= septo-optic dysplasia
bilateral ON hypoplasia
midline CNS anomalies (absent septum pellucidum)
pituitary/hypothalamus deficiency
Optic Pit
Congenital vs Aquired
unilateral
depression in ON with peripapillary RPE changes
inferior-temporal most common
40-45% develop serous RD or macular retinoschisis