Chapter 29: The Eye Flashcards
Describe the Graves orbitopathy associated with Thyroid disease
Enlargement of EOMs with nongranulomatous inflammation, increased glycosaminoglycans and endomysial fibrosis
Note that the tendons of extraocular muscles and adipose are not inflamed
Systemic disease associated with granulomatous uveitis and sympathetic ophthalmia
Sarcoid
Most common malignant tumor of periocular skin
Basal cell carcinoma
A unilateral keratoconjunctivitis unresponsive to therapy and stained positive with Oil Red O on frozen tissue may indicate what type of malignancy?
Sebaceous carcinoma
Most common intraocular tumor in adults due to metastasis to eye
Melanoma
[uveal melanoma is most common primary intraocular tumor in adults]
Oncogenes associated with uveal melanoma
GNAQ
GNA11
Uveal melanoma tends to first metastasize to what organ?
Liver
Difference between open-angle and closed-angle glaucoma
Open: complete open access to trabecular meshwork; increased resistance to aqueous outflow —> increased IOP
Closed: peripheral zone of iris adheres to trabecular meshwork and physical impedes outflow of fluid
Gene mutations associated with primary vs. secondary open-angle glaucoma
Primary = MYOC in adults, some adults with OPTN
Secondary = LOX1 gene
Consequences of diabetic retinopathy — nonproliferative vs. proliferative type
Nonproliferative = hemorrhages and macular edema
Proliferative = traction on retina
Condition with age of onset around 75; may stem from excess complement activity and/or environmental factors such as smoking or intense light exposure
Macular degeneration
Inherited retinal degeneration characterized by painless progressive vision loss
Retinitis pigmentosa
Submucosal elevations in the conjunctiva as a result of actinic damage in sun exposed regions
Pterygium (migrates onto cornea)
Pinguecula (does not invade cornea)
Immune complex depositions within sclera may occur in ________ causing necrotizing scleritis
Rheumatoid arthritis
Most common form of glaucoma
Primary open angle glaucoma
Most common type of secondary open-angle glaucoma
Pseudoexfoliation glaucoma
In intraocular inflammation, vessels in the ciliary body and iris become leaky, allowing cells and exudate to accumulate in the anterior chamber, causing what condition(s)?
Endopthalmitis and panophthalmitis
A _________ can extend onto the cornea but does not cross the pupillary axis; it may induce mild astigmatism to affect vision
Pterygium
A _______ does not impinge upon the corean, but it does affect tear distribution - potentially causing focal dehydration and corneal depression (delle)
Pinguecula
Most common cause of corneal dendritic ulcers
Herpes simplex virus infection
Patients with ______ are typically not candidates for LASIK surgery because the marked corneal thinning with breaks in the Bowman layer gives their corneas a conical shape
Keratoconus
______ deficiency can lead to keratomalacia and eventual blindness if not treated
Vitamin A
Inherited corneal stromal dystrophy has several forms, and most are autosomal dominant. However, the most severe form is _____ _____, which is autosomal recessive and is essentially a form of mucopolysaccharidosis confined to the cornea in which keratan sulfate is deposited
Macular dystrophy
What ocular complication is most likely to develop in the setting of chronic glucocorticoid therapy?
Cataracts
In some older individuals with ______, the iris is displaced forward to narrow the angle at the anterior chamber, obstructing flow of aqueous humor, so-called primary angle-closure glaucoma
Hyperopia
Mutations in the ____ and ____ genes may account for some cases of primary open-angle glaucoma
MYOC; OPTN
Increased resistance to outflow of aquous humor into the _____ canal is typical of primary open-angle glaucoma, which occurs in individuals with _____
Schlemm; myopia
Unusual but devastating form of uveitis that can complicate penetrating ocular trauma; results from release of sequestered Ag from one eye that causes an immune response with inflammatory reaction in the opposite eye
Sympathetic ophthalmia
Granulomatous uveitis is often seen in the context of what condition?
Sarcoidosis
Condition of the eye characterized by capillary micro-aneurysms, cotton-wool spots, arteriolar hyalinization, and more severe changes of proliferative retinopathy with neovascularization
Diabetic retinopathy
Condition made up of a variety of inherited abnormalities that produce a waxy pallor of the optic disc
Retinitis pigmentosa
Complication of premature birth that results from oxygen toxicity to the immature retinal vasculature, leading to neovascularization of the retina with growth into the vitreous
Retrolental fibroplasia
What complication is often seen in the eyes of those with sickle cell anemia?
Preretinal, intraretinal, and subretinal hemorrhages
Fundoscopic exam shows a cherry-red appearance of the foveola, whereas the remaining retina remains pale. What might cause this (other than Tay sachs), particularly in someone with heart disease?
Thromboembolization from diseased heart to central retinal artery — causing diffuse retinal infarct that obscures underlying vascular choroid, except where the retina is thinner in the fovea, so it appears red compared to surrounding pale retina
Tay sachs is an autosomal recessive IEM due to deficiency of what enzyme?
Hexosaminidase A (one ofthe GM2 gangliosidoses)
Leads to lysosomal storage of intermediate metabolites in retinal ganglion cells and neocortical neruons
A majority of age related macular degeneration cases may be related to inherited mutations in the ____ gene, made worse through environmental exposures like cigarette smoke
CFH (complement factor H)
What condition is described by the following:
Night blindness caused by loss of rod photoreceptors is early symptom. Later, the cone photoreceptors also begin to degenerate, producing blindness
Retinitis pigmentosa
Histologically characterized by clustering of small basophilic cuboidal or short columnar cells around a central lumen, sometimes called Flexner-Wintersteiner rosettes
Retinoblastoma
_____ is associated with increased IOP, but instead of papilledema it shows the opposite: optic cup excavation
Glaucoma
[the increased IOP with glaucoma is thought to cause the loss of nerve fibers, resulting in the characteristic cupped excavation of the optic disc]
