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Ophthalmology > Anterior Chamber/Uvea > Flashcards

Anterior Chamber/Uvea Flashcards

1
Q

constriction of the pupil

A

miosis

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2
Q

if you see miosis, what should be on your short list of rule outs

A

uveitis

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3
Q

abnormally shaped iris,
most commonly observed with posterior synechia

A

Dyscoria

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4
Q

Dyscoria is most commonly observed with

A

posterior synechia

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5
Q

adhesion of the iris to the lens or the cornea

A

synechia

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6
Q

adhesion of the iris to the lens

A

posterior synechia

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7
Q

adhesion of the iris to the cornea

A

anterior synechia

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8
Q

a 360 degree posterior synechia where the aqueous humor becomes entrapped within the posterior chamber which causes the iris to bulge forward like a donut

A

iris bombe

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9
Q

blood that settles within the anterior chamber
common with uveitis and indicative of a large breakdown in the blood ocular barrier

A

hyphema

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10
Q

decreased intaocular pressure
consistent with acute uveitis

A

hypotony

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10
Q

paralysis of the ciliary body.
induced by atropine and useful at alleviating pain from uveitis (ciliary body spasm)

A

cycloplegia

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11
Q

everything that is anterior to the vitreous (cornea, anterior chamber, posterior chamber, iris, lens, lens zonules, ciliary body)

A

anterior segment

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12
Q

everything that is behind the lens and zonules (vitreous, retina, choroid, optic nerve)

A

posterior segment

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13
Q

the anterior chamber is the _______ *

A

space between the cornea and iris

filled with aqueous humor

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14
Q

what is the anterior chamber filled with

A

aqueous humor

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15
Q

the space between the iris and the lens

A

posterior chamber

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16
Q

the posterior chamber is the space between the

A

iris and lens

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17
Q

What makes up the anterior vs posterior uvea

A

Anterior Uvea: Iris and Ciliary body

Posterior Uvea: Choroid

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18
Q

What structures are a part of the uvea

A

Iris
Ciliary body
Choroid

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19
Q

what produces aqueous humor

A

ciliary body epithelium

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20
Q

What are the functions of the ciliary body

A

1) Produces aqueous humor
2) where lens zonules arise
3) Ciliary muscle contraction results in visual accommodation via changing tension on the lens
4) Vascular structure

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21
Q

cilary body processes are called

A

pars plicata

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22
Q

What is the flow of aqueous humor *

A

1) Ciliary body
2) Posterior chamber
3) Pupil
4) Anterior chamber
5) Iridocorneal angle
6) Venous circulation

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23
Q

Where does aqueous humor drain out of

A

Iridocorneal angle

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24
Q

what test allows you to look at the iridocorneal angle to see if it is ipen or closed

A

gonioscopy - pectinate ligament (PL) spans the ICA (should have a lot of holes)

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25
Q

Gonioscopy evaluates the

A

drainage angle

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26
Q

What are the 3 structures of the iris

A

1) Sphincter muscle (parasympathetic)
2) Dilator muscle (sympathetic)
3) Major arterial circle- very vascular

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27
Q

What happens in mydriasis

A

iris dilators contract
constrictors relax

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28
Q

what happens in miosis

A

iris constrictors contrast
dilators rleax

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29
Q

What are the different zones of the iris

A

1) Ciliary zones (most peripheral)
2) Iris collarette (can have some vascular reminants- persistent pupillary membranes)
3) Pupillary zone - often darker

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30
Q

heterochromia iridis

A

two different colored iris (within one eye)

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31
Q

What is the purpose of the blood-ocular barrier

A

the blood-aqueous barrier prevents passage of protein and cells into the anterior chamber
allows clear media for vision

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32
Q

disruption of the blood-aqeuous barrier =

A

uveitis

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33
Q

inflammation of the iris and ciliary body

A

anterior uveitis (Iridocyclitis)

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34
Q

Iridocyclitis

A

inflammation of the iris and ciliary body (anterior uveitis)

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35
Q

Inflammation of the choroid

A

posterior uveitis (choroiditis)

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36
Q

inflammation of the entire uvea (iridoyclitis and choroiditis)

A

panuveitis

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37
Q

inflammation of the entire uvea and intraocular contents

A

endophthalmitis

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38
Q

inflammation of all ocular and intraocular structures including the slcera

A

panophthalmitis

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39
Q

What are the clinical signs of uveitis *

A

Non-specific:
-Epiphora
-Blepharospasm
-Photophobia
-Red eye - ciliary flush (deep blood vessels) or episcleral injection
-Corneal edema- angle is blocked w inflammatory cells in the anterior chamber

Specific:
-Miosis: due to inflammation driven by prostaglandins causing iris sphincter muscle constriction (give atropine)
-Aqueous flare: Increased protein in aqeuous humor - eye looks cloudy
-Keratic Precipitates: cellular and fibrinous deposits on inner cornea (WBCs adhered to endothelium)
-Hypopyon
-Hyphema
-Fibrin
-Lipid
-Lymphoid nodules (cats)

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40
Q

How can you get corneal edema with uveitis

A

angle is blocked w inflammatory cells in the anterior chamber

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41
Q

Why do you see miosis with uveitis *

A

due to inflammation driven by prostaglandins causing iris sphincter muscle constriction-
iris has prostaglandin receptors

need to give atrophine to paralyze the muscle and stop the spasm

lots of pain from ciliary body spasm

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42
Q

What is aqeuous flare *

A

Aqueous humor that has increased protein and cells due to the breakdown in blood aqeuous barrier (leaky anterior uveal tract)

scatters light and makes the eye look cloudy

43
Q

What is the best way to examine for aqeuous flare

A

slit beam at the front side of cornea and looking at the side -> shouldnt catch the beam

44
Q

cellular and fibrinous deposits on the inner cornea -> WBCs adhered to the endothelium
sign of uveitis

A

keratic precipitates

45
Q

neutrophils in the anterior chamber, settles at the bottom of anterior chamber
sign of uveitis

A

hypopyon

46
Q

When might you see fibrin in the anterior chamber

A

common in cats and horses

treat with tissue-plasminogen activator (TPA)

47
Q

when might you see lipid in the anterior chamber

A

Uveitis with Hypertriglyceridemia
1) Mini Schnauzer
2) Cushing’s
3) Diabetes Mellitus

48
Q

How do you get rid of fibrin in the eye, common in cats and horses

A

inject treat with tissue-plasminogen activator (TPA)
should go away in minutes

49
Q

With uveitis, how does intraocular pressure change

A

decreases

50
Q

What is the pathogenesis of anterior uveitis

A

1) cell damage in iris or ciliary body
2) release of arachadonic acid
3) formation of leukotrienes and prostaglandins
4) breakdown of blood-aqueous barrier (blood-ocular barrier)

51
Q

Exogenous causes of anterior uveitis (ie trauma and corneal ulcers) are unilateral or bilateral

While endogenous causes (ie infectious, neoplastic, immune mediated, idiopathic) are

A

unilateral (exogenous)

bilateral (endogenous)

52
Q

What typically causes canine infectious uveitis (typically bilateral) **

A

Algal: Prototheca

Bacterial: Borrelia*, Brucella, Leptospirosis, Septicemia

Fungal*: Blasto, Coccidiodes, Crypto, Histo

Parasitic: Dirofiliria (ocular larval migrans), Dipteran fly larva (ophthalmomyiasis interna)

Protozoan: Toxoplasma, Leishmania

Rickettsial*: Erhlichia, Rickettsia

Viral: Adenovirus, distemper

53
Q

what are common causes of canine non-infectious uveitis (unilateral or bilateral) *

A
  • Most common cause in dogs and cats

Immune mediated: Cataracts, IMHA, ITP, uveodermatologic syndrome, vasculitis

Idiopathic: Metabolic (systemic hypertension, coagulopathy, hyperlipidemia)
Neoplasic
Trauma
Scleritis, drug induced (miotics), radiation therapy

54
Q

What are common causes of feline uveitis *

A

Bacterial: Bartonella (cat scratch fever)

Fungal: Crypto, Histo, Blasto, Coccidiodes

Parasitic: Diptera (ophthalmomyiasis interna)

Protozoan: Toxoplasma

Viral FIV, FeLV, FIP, Herpes

Noninfectious/Idiopathic **most common (65% of cases): Systemic hypertension or Neoplasia (LSA or melanoma)

55
Q

65% of uveitis cases in the cat and dog are

A

idiopathic

56
Q

What are the 4 F’s ad T of feline uveitis causes

A

FeLV
FIV
FIP
Fungal
Toxoplasma

57
Q

If hyphema is present, what should you do? **

A

Coagulation panel

if cats (systolic blood pressure too)

58
Q

Uveitis work up

A

travel history
PE
CBC
Chem
Urinalysis
Thoracic radiographs
Tick titers (4DX)
Fungal titers by geography
Coagulation panel (if hyphema)
blood pressure (cat)

59
Q

Ocular centesis

A

an aqeuous humor centesis which is important for your work up of anterior uveitis
-cytology
-culture
-titers (toxo and lepto)
-PCR- FIP

60
Q

What is a common etiology of anterior uveitis in horses (aside from trauma)

A

Equine recurrent uveitis (ERU)

-immune mediated disorders

61
Q

What are common etiologies of anterior uveitis in cows (other than trauma)

A

infectious
-MCF, IBK (by causing corneal ulcer)

septicemia

62
Q

What are the signs of anterior uveitis **

A

1) Ocular discahrge (serous, mucous, mucopurulent)
2) Enophthalmos- retraction of globe from pain and raising of the third eyelid
3) Blepharospasm
4) Red eye- conjunctival and episcleral vascular injection
5) Corneal edema: decrease function of endothelial cells - blue color to cornea due to diffuse edema
6) Corneal Neovascularization: irritation of corneal endothelium ,typically deep vessels
7) Anterior Chamber changes: flare, cells, fibrin, hyphema, keratic precipitates)
8) Iris changes: miosis in acute cases due to ciliary body/iris muscle spasm, sluggish pupillary light response, hyperemia and thickening

63
Q

What iris changes are seen with anterior uveitis

A

-miosis in acute cases due to ciliary body/iris muscle spasm
-sluggish pupillary light response
-hyperemia and thickening

64
Q

What changes to the anterior chamber is seen with anterior uveitis

A

flare, cells, fibrin, hyphema, keratic precipitates

65
Q

iris hyperpigmentation is seen with

A

chronic uveitis

66
Q

What are signs of chronic anterior uveitis

A

1) Iris hyperpigmentation
2) Synechia
Anterior: iris to cornea
Posteiror: iris to lens capsule
3) Decreased intraocular pressure

67
Q

When is anterior synechia typically seen

A

corneal perforation - pressure loss
iris comes forward to plug the whole

IRIS to CORNEA

68
Q

When is posterior synchechia typically seen

A

Uveitis- when iris inflammed becomes sticky and attaches to the lens
IRIS to LENS

causing dyscoria and pigment migration onto lens capsule and changes to pupil appearance

69
Q

diffuse posterior synchechia and build up of aqeuous humor posterior to iris

A

iris bombe

70
Q

what can iris bombe lead to

A

glaucoma if the fluid is not draining properly

71
Q

What drug can you give to move iris so it doesnt form a posterior synchechia

A

atropine

72
Q

What is a great way to monitor repsonse to therapy with uveitis

A

Measuring IOP

73
Q

What is normal IOP

A

10-20mmHg dog/cat
20-30mmHg horse

74
Q

How do you treat uveitis **

A

1) Get rid of antigen
2) Nonspecific therapy: stop inflammation, control pain, prevent sequelae
-Glucocorticocoritcoids- systemic or topical or subconjuctival
-NSAID
-Immune suppressant: azathioprine, cyclosporine, mycophenolate

75
Q

What is a good topical glucocorticoid for anterior uveitis

A

1% prednisolone acetate - good cornea penetration

76
Q

What anti-inflammatories should you do for anterior uveitis *

A

Glucocorticoids
1) Systemic- prednisone, prednisolone
2) topical- 1% prednisolone acetate (3-4 times a day then taper)
3) Subconjunctival- triamcinolone (always consider the cause and potential for corneal ulceration)

NSAID
1) Topical- diclofenac, ketorolac, flurbiprofen
2) Systemic- flunixin, phenylbutazone, carprofen, meloxicam, firocoxib

Immune suppressants
1) Systemic- azathioprine, cyclosprine, mycophenolate

77
Q

Aside form NSAIDs, What should you do to relieve pain in anterior uveitis *****

A

Parasympatholytic
1% atropine sulfate **
1% tropicamide

-Mydriasis: prevent posterior synechia (exercises iris)
-Cycloplegia: relieves ciliary spasm

78
Q

Anterior uveitis sequela

A

synechia
iris color change
cataract
secondary glaucoma (most common sequela to uveitis)

79
Q

most common sequela to uveitis

A

secondary glaucoma

80
Q

Uveodermatologic Syndrome (VKH) typically occurs in what breeds

A

young adult
Akitas, Samoyeds, Siberian husky

81
Q

What are the clinical signs of Uveodermatologic Syndrome (VKH)

A

-Anterior and/or Posterior Uveitis (typically bilateral)
-Depigmentation of Skin and Hair (poliosis and vitiligo)

82
Q

What is the pathogenesis of Uveodermatologic Syndrome (VKH)

A

immune mediated attack on melanocytes

83
Q

How do you diagnose Uveodermatologic Syndrome (VKH)

A

clinical appearance
biopsy

84
Q

How do you treat Uveodermatologic Syndrome (VKH)

A

systemic immune suppression

prognosis for vision is guarded to poor due to chronic, severe uveitis and sequela

85
Q

How might you see lens induced uveitis

A

lens is immune privileged
lens proteins are antigenic
proteins leaked during cataract formation
-usually mild ut can be severe

tx: topical anti-inflamamtories and/or lens removal

86
Q

Most common cause of blindness of horse due to secondary glaucoma and cataract formation

A

Equine Recurrent Uveitis

“Moon blindness”
immune mediated disease

87
Q

Equine Recurrent Uveitis is common in what breeds

A

Appaloosas more likely to be effected (anterior uveitis)

German warmbloods (posterior uveitis)

88
Q

Equine Recurrent Uveitis is primarily immune mediated but what infectious cause might initiate it

A

Leptospira

89
Q

What causes persistent pupillary membranes

A

incomplete absorption of embryonic vascular tissue and mesenchymal strands
originate at the iris collarette
congenital
unilateral or biliteral

90
Q

persistent pupillary membranes typically regress by

A

prior to opening of the eyelids at 2 weeks of age in the dog and cat

91
Q

persistent pupillary membranes originate at the

A

iris collarette
1) Iris to iris
2) iris to lens
3) iris to cornea

92
Q

persistent pupillary membranes can be secondary to what in cats

A

in-utero FHV-1 infection

93
Q

persistent pupillary membranes often contact the corneal endothelium causing white opacities known as

A

leukomas

doesnt keep the cornea well hydrated, reuslts in corneal edema

94
Q

persistent pupillary membranes can contact the anterior capsule causing

A

focal cataracts
-leave pigment on the anterior lens capsule

95
Q

where do iris cysts occur *

A

from posterior pigment of iris
may be attached at pupil margin (cats)
may become free floating (dogs)

96
Q

What might cause fly biting behavior in dogs

A

iris cysts

97
Q

What are consequences of iris cysts

A

1) fly biting behavior
2) block filtration angle- glaucoma

98
Q

How do you diagnose iris cysts *

A

1) Transilluminate - differentiate from iris melanoma
2) Ultrasound probe

99
Q

In horses, iris cysts arise from

A

corpora nigra
-laser off

99
Q

How do you treat iris cysts *

A

often not necessary unless the cysts cause secondary issues such as secondary changes, increased intraocular pressure

laser off

100
Q

T/F: most intraocular tumors of dogs are benign

A

true - iris melanoma/melanocytoma are usually benign

but ciliary body adenoma/adenocarcinoma are malignant but slow to metastasize- often causes secondary glaucoma

101
Q

In dogs, what intraocular tumor is malignant

A

ciliary body adenoma/adenocarcinoma are malignant but slow to metastasize- often causes secondary glaucoma

102
Q

Cat anterior uvea melanoma ***

A

focal - may be slowly progressive

more aggressive in cats (than in dogs)

Feline Diffuse Iris Melanoma- metastasis to liver and lung, slowly progressive
Iris thickening, dyschoria

103
Q

What should you do if you noticed a brown marking on the iris of the cat

A

take a photo and re-evaluate in 3 months
melanoma is slow growing
but eventually can become diffuse causing flotating pigment, iris thickening, dyscoria and potentially metastasis to liver and lung
“ Feline Diffuse Iris Melanoma”

-can always laser off smaller

104
Q

normal aging atrophy of pupil margin and/or iris stroma

A

iris atrophy

Ophthalmology (7 decks)

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