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Anterior Segment 2 > Chigbu: Immuno of Conj > Flashcards

Chigbu: Immuno of Conj Flashcards

1
Q

Does the conjunctiva epithelium contain more CD8 or CD4 T-cells?

A

CD8 T-cells

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2
Q

This effect aids in clearing away antigens, dust and cell debris found on the ocular surface.

A

Mechanical Washing Effect

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3
Q

What are the 3 proteins found in the tight junctions of the epithelial cells?

A
  1. Occludins
  2. Claudins
  3. JAMs
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4
Q

Antigens that are left behind after blinking are subject to what types of AMPs found in mucin?

A
  1. Lysozymes
  2. Lactoferrin
  3. Defensins
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5
Q

These receptors provide an external alarm system by detecting non-cells on the epithelial surface.

A

Pattern Recognition Receptors

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6
Q

TLRs are a type of PRR found on the conjunctiva and corneal epithelial layer which detect _____.

A

PAMPs

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7
Q

Lipopolysaccharide (LPS) is a PAMP of ____?

A

gram (-) bacteria

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8
Q

Peptidoglycan (PGN) is a PAMP of _____?

A

gram (+) bacteria

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9
Q

What TLR is responsible for LPS?

A

TLR 4

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10
Q

What TLR is responsible for PGN?

A

TLR 1 and 2

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11
Q

What TLR is responsible for Viral RNA and Bacterial DNA?

A

TLR 3 and 8

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12
Q

What TLR is responsible for Flagellin (pseudomonas)?

A

TLR 6

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13
Q

When PRR/TLRs engage w/ PAMPs, an immune response is initiated w/ the use of?

A
  1. AMPs
  2. Cytokines: IL-1, IL-6, TNF-a, IFN-y
  3. Chemokines
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14
Q

The conj lamina propria (2nd layer) consist of what 4 cells that form the basis of CALT?

A
  1. lymphocytes: t/b cells, NK
  2. Macrophages
  3. Mast Cells
  4. DCs
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15
Q

Plasma cells account for ___ of conjunctival lymphocyte and secrete ___?

A

20%

IgA

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16
Q

This immunoglobulin neutralizes infectious without causing inflammation bc it cannot activate complements.

A

IgA

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17
Q

Does the lamina propria contain more CD8 or CD4 T-cells?

A

Neither.

It contains equal numbers of both

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18
Q

What are the 3 cells that are conjunctival APCs?

A
  1. Langherhans
  2. DCs
  3. Macrophages
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19
Q

Where do the APCs present antigens?

A

T-cells and Conjunctival follicles

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20
Q

This is the site of localized immune processing of antigens that pass through the conj. epithelium.

A

Conjunctival follicles

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21
Q

What are follicles composed of?

A

Naive T and B cells, APCs

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22
Q

Why do follicles enlarge?

A

Enlarge in response to ocular surface infection (viral) or inflammation

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23
Q

What are the effector immune cells of the conj.?

A
  1. Mast Cells
  2. T/B cells
  3. Plasma Cells
  4. Neutrophils
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24
Q

This effector cell provides immune surveillance to the cornea while we’re sleeping

A

Neutrophils

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25
Q

Are eosinophils found on the conjunctiva?

A

NO

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26
Q

This immunoglobulin prevents binding of microbes and antigens to the epithelial surface?

A

sIgA

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27
Q

What are the main cells found in the EFFERENT arm of the CALT? In what layer of the epithelium are they found?

A

CD8 and CD4 Tcells

Basal Layer

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28
Q

What are the main cells found in the AFFERENT arm of the CALT?

A

T and B cells

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29
Q

This lymphoid tissue functions to maintain balance between immune tolerance and immune-mediated ocular surface inflammatory processes.

A

Eye Associated Lymphoid Tissue

30
Q

Does the EALT favor immune-mediated inflammation or immune tolerance?

A

Immune tolerance - provides afferent and efferent protection to ocular surface

31
Q

This arm of EALT does uptake and presentation of antigen, while also generating effector T cells. `

A

The afferent arm of EALT

32
Q

What are the main cells of the AFFERENT arm of EALT?

A

T and B-cells

33
Q

This arm of EALT is the regulator of immune tolerance?

A

Efferent Arm

34
Q

More lymphoid follicles are found where?

A
  1. upper conjunctiva
  2. tarsal plate
  3. peripheral zone (temp/nasally)
35
Q

Which infection is known to induce follicles around the limbus?

A

Trachoma (chlamydia)

36
Q

How does the CALT provide immune surveillance for the cornea?

A
  1. Windscreen when blinking

2. Generates AMPs that suppress bacterial growth when we sleep

37
Q

What 2 cells do CALT favor when upregulating factors from neutrophils to suppress bacterial growth during sleep?

A

TH2 –> activates B cells –> activates plasma cells that secrete IgA
Tregs –> activate TGF-beta (anti-inflammatory)

38
Q

What 4 effector cells does CALT generate?

A

TH1, TH2, TH17, Tregs

39
Q

Trachoma presents as what type of immune response?

A

Type 1

40
Q

Irritation, dryness or infection can damage epithelial cells and TJs causing CALT to ___?

A

Generate more proinflammatory immune cells

41
Q

Immune cells activate fibroblast which causes them to express which complement components? What do they activate?

A

Express C1, C2, C4 and HLAII

Activates C5a and C3a

42
Q

Ocular surface trauma by an epithelial defect and allows entry of an nonpathogenic antigen is known as ?

A

Ocular Allergy

43
Q

Ocular surface trauma by an epithelial defect and allows entry of an pathogenic antigen is known as ?

A

Microbial Conjunctivitis

44
Q

Allergens produce _____ which binds to ______ in conjunctival epithelium

A

protease

Protease-Activated Receptor 2 (PAR-2)

45
Q

Protease bound to PAR-2 causes what?

A

Breakdown of TJ proteins (occludins) and separates epithelial cells to allow access of the allergen into tissue

46
Q

What are the main 2 immune cells involved in allergic conjunctivitis?

A 
Mast cell (innate)
Th2 (adaptive)
47
Q

What type of immune response is allergic conjunctivitis? But, what type of hypersensitivity response is it?

A

Type 2 immune response

Type 1 hypersensitivity response

48
Q

Histidine Decarboxylase and Histaminase breaks down ____?

A

Histamine

49
Q

What drug inhibits 4. Histidine Decarboxylase and Histaminase ?

A

Alrex 0.2%

50
Q

What allergic conjunctivitis does not have eosinophils?

A

SAC

51
Q

Histamine hits H1 receptors on sensory nerve fibers and causes ___?

A

Itching

52
Q

Fibroblast DO NOT play a major role in which 2 allergies?

A

SAC and PAC

53
Q

Which ocular allergy has an innate response with TH1 and TH2 cells?

A

AKC

54
Q

In which condition will you have more eosinophils?

A

VKC and AKC

55
Q

When IL-4 induces fibroblast to produce more collagen we get what?

A

Papillary hypertrophy

56
Q

Any ulceration found in the cornea due to allergies are caused by fibroblasts producing too many __ and ___?

A

MMPs and Eosinophils

57
Q

VKC is mediated by what?

A

Th2 cells

58
Q

In VKC, ulceration is usually due to what 3 things?

A
  1. Mechanical abrasion from papillae
  2. Eosinophils
  3. MMPs
59
Q

What are the 4 presenting signs of VKC?

A
  1. Trantas Dots
  2. Papillary Hypertrophy
  3. Shield Ulcer
  4. Limbal Hypertrophy
60
Q

This VKC finding contains degenerated eosinophils and epithelial cells

A

Trantas Dots

61
Q

This VKC finding is caused by mast cells found around the limbus and can lead to PEE.

A

Limbal hypertrophy

62
Q

This VKC finding is noninfectious and is caused by mechanical rubbing.

A

Shield Ulcer

63
Q

This VKC finding presents when fibroblast become activated and undergo proliferation

A

Papillae hypertrophy

64
Q

What is the best way to manage VKC?

A

Antihistamine/MCS agent

65
Q

Where are shield ulcers found in VKC?

A

Superior 1/3 of cornea

66
Q

Dosing of Lastacaft, Pazeo and Pataday?

A

QD

67
Q

Dosing of Zatidor?

A

BID

68
Q

Dosing of Alocril?

A

BID

69
Q

Dosing of Alomide

A

QID

70
Q

FML/Lotemax/Pred Forte is used for what AC?

A

VKC

71
Q

Dosing for Lotemax

A

QID minimum

72
Q

What cell is the first responder in infectious conjunctivitis? What do they produce

A

Th1 Cells: produce IFN-y to fight pathogens

Anterior Segment 2 (14 decks)

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