Exam 2: Eye - Clinical and Pathology (summarys and pictures from DSA) Flashcards
Name some conditions related to the following region of the eye:
Orbit
Proptosis/Exophthalmos (Graves Disease)
inflammation
tumors
Name some conditions related to the following region of the eye:
Eyelid
Inflammations/Infections (Sty, Chalazion, Xanthelesma)
Tumors (Basal Cell Carcinoma, Sebaceous Carcinoma)
Name some conditions related to the following region of the eye:
Conjunctiva
Inflammations/Infections (e.g. Trachoma)
Degenerative (Pterygium, Pinnecula)
Neoplasms
Name some conditions related to the following region of the eye:
Sclera
Collagen Disorders
Name some conditions related to the following region of the eye:
Cornea
Inflammation/Infection (including HSV, Amebiasis)
Dystrophies (Fuchs)
Degenerations (Keratoconus)
Name some conditions related to the following region of the eye:
Anterior Segment
Glaucoma (Open-, Closed-angle)
Cataracts
Inflammation
Name some conditions related to the following region of the eye:
Uvea
Inflammation** (Uveitis – Sarcoidosis, Sympathetic Ophthalmia), **Neoplasms (Melanoma)
Name some conditions related to the following region of the eye:
Vitreous
Retinitis* (infections)
Retinoblastoma*
*vitreous as well as the retina
Name some conditions related to the following region of the eye:
Retina
Degenerations (Macular Degeneration)
Retinitis (Retinitis Pigmentosa)
Vascular (Hypertensive and Diabetic Retinopathy)
Neoplasms (Retinoblastoma, Melanoma)
Name some conditions related to the following region of the eye:
Optic Nerve
- Papilledema (swelling of optic nerve/disc with increased intracranial pressure)
- Optic Neuritis (demyelination - MS)
- Tumors (Optic glioma – NF2)
- Ischemia – Anterior Ischemic Optic Neuropathy (Similar to stroke)
- Glaucomatous nerve damage (See glaucoma) - cupping
- Leber hereditary optic neuropathy (Mitochondrial inheritance)
Name some conditions related to the following region of the eye:
End-stage eye
Phthis bulbi
Name some conditions related to the following region of the eye:
Systemic Diseases
- MANY systemic diseases affect the eye
- Can be a strong push towards diagnosis
• Examples
Sarcoidosis
Sjögren Disease – lacrimal glands
Infections
Endocrine disorders
Hypertension
Diabetes
Key facts and info for:
Thyroid Ophthalmopathy (Graves disease)
- The accumulation of GAG (principally hyaluronic acid) causes a change in osmotic pressure, which in turn leads to a fluid accumulation, muscle swelling, and an increase in pressure within the orbit.
- These changes, together with retroorbital adipogenesis, displace the eyeball forward and can also interfere with the function of the extraocular muscles and the venous drainage of the orbits
- GAG secretion by fibroblasts is increased by thyroid-stimulating antibodies and activated T cell cytokines such as tumor necrosis factor (TNF) alpha and interferon gamma (implying that both B and T cell activation are important parts of this immunopathology)
What condition would you consider with this image and buzz words:
- The accumulation of GAG (principally hyaluronic acid)
- increase in pressure within the orbit
- retroorbital adipogenesis
- displace the eyeball forward
- B and T cell activation
Thyroid Ophthalmopathy (Graves disease)
- The accumulation of GAG (principally hyaluronic acid) causes a change in osmotic pressure, which in turn leads to a fluid accumulation, muscle swelling, and an increase in pressure within the orbit.
- These changes, together with retroorbital adipogenesis, displace the eyeball forward and can also interfere with the function of the extraocular muscles and the venous drainage of the orbits
- GAG secretion by fibroblasts is increased by thyroid-stimulating antibodies and activated T cell cytokines such as tumor necrosis factor (TNF) alpha and interferon gamma (implying that both B and T cell activation are important parts of this immunopathology)
Key facts and info for:
Sty or Hordeolum
- In the eyelid region
- acute inflammatory** involving **hair follicles or sebaceous/apocrine glands
Key facts and info for:
Xanthelasma
- In the eyelid region
- yellow plaques
• nasal aspect often
• associated with hyperlipidemia (in young)
Key facts and info for:
Chalazion
- In the eyelid region
- granulomatous
- around meibomian glands or glands of Zeis (sebaceous glands)
Key facts and info for:
Neoplasms
(In the eyelid region)
- In the eyelid region
- Basal cell carcinoma – Most common
• Sebaceous carcinoma – Arise in sebaceous glands
• Other - Kaposi sarcoma
What condition would you consider with this image and buzz words:
- eyelid shows ectropion
- cornea shows neovascularization
- foamy cytoplasm
- clear cytoplasm
Sebaceous Carcinoma
- (Left image) Pagetoid* spread of sebaceous carcinoma. Neoplastic cells with foamy cytoplasm are detected within the epidermis.
- Sebaceous cell carcinoma of the left lower eyelid. (Right Top image) The patient’s left lower eyelid shows ectropion**, and the cornea shows neovascularization.
- (Right Bottom) mild expansion of the conjunctival epithelium due to infiltration by single or small groups of malignant sebaceous cells with large, hyperchromatic nuclei and occasional mitoses. These display little clear cytoplasm reminiscent of sebaceous differentiation
* Pagetoid refers to this spread of neoplastic cells within the epidermis
** ectropion: a condition, typically a consequence of advanced age, in which the eyelid is turned outward away from the eyeball
Key facts and info for:
Chlamydia** – **Trachoma
- In the Conjunctiva
- Caused by Chlamydia trachomatis infection that is transmitted through flies
- Epithelial cell inclusions
- Chronic inflammation results in follicles and scarring
What condition would you consider with this image and buzz words:
- infection
- flies
- follicles and scarring
Conjunctiva - Trachoma
- Repeated infection with Chlamydia trachomatis ( transmitted through flies) causes chronic inflammation
- resulting in follicles (Panel A) and scarring (Panel B), in the form of white lines, bands, or sheets, in the tarsal conjunctiva of the upper eyelid and causing eyelashes to turn inward and abrade the cornea (Panel C).
Key facts and info for:
Pinguecula
- In the Conjunctiva
- Degenerative (actinic* lesions)
- Does not invade cornea
- Yellowish area of thickening
- Elastosis
*actinic: refers to damage resulting from sun exposure. This part of the eye is on the outside and can be easily damaged by the sunlight.
Key facts and info for:
Pterygium
- In the Conjunctiva
- Degenerative (actinic* lesions)
- Fibrovascular tissue migrates onto cornea
- White
*actinic: refers to damage resulting from sun exposure. This part of the eye is on the outside and can be easily damaged by the sunlight.
Key facts and info for:
Inflammations
(In the cornea region)
- In the Cornea
- keratitis and ulcers (e.g. contact lens complications)
- Bacterial, Fungal, Viral (HSV, herpes zoster),
- Helminth (Onchocerciasis “Loa Loa”, River Blindness); Transmitted by blackflies. Fluffy opacities in cornea and conjunctiva (degenerating microfilariae.
- Protozoal – amoebic (contact lens)
Key facts and info for:
Fuchs Endothelial Dystrophy
• In the Cornea
• Dystrophies** – Hereditary, _Non_inflammatory**
• Loss of endothelial cells
• Stromal edema and bullous keratopathy
Key facts and info for:
Keratoconus
• In the Cornea
• Degeneration** – **Nonfamilial
- Thinning and fibrosis of cornea with breaks in Bowman layer.
- Leads to distortion of cornea and visual problems
- Thinning of cornea leads to astigmatism
• often hard to correct
Key facts and info for:
Glaucoma (Open angle)
• In the Anterior Segment
• unimpeded flowofaqueous humor into anglewith increased resistancetooutflow**into**Canal of Schlemm
• Primary
Some due to defects in gene coding for myocilin
• Secondary
Particles clog trabecular meshwork (tumors, RBC, lens fragments)
Increase in episclerial pressure secondary to surface ocular vascular malformations (Sturge Weber)
• Pathophysiology/Consequence
Glaucomatous retinopathy with cupping of optic nerve head and nasal displacement of retinal vessels
Optic atrophy – Loss of axons and ganglion cells
* Image: shows cupping of optic nerve head in glaucoma. This is secondary to axonal degeneration and subsequent loss of axons
Key facts and info for:
Glaucoma (Closed angle)
• In the Anterior Segment
• Blockage of angle prevent flow into angle and then through trabecular meshwork into Canal of Schlemm.
• Primary
shallow anterior chamber (especially with pupil dilation)
• Secondary
can be due to development of membranes which contract and close angle – vessels (neovascularization), tumors, surgery
• Pathophysiology/Consequence
Glaucomatous retinopathy with cupping of optic nerve head and nasal displacement of retinal vessels
Optic atrophy – Loss of axons and ganglion cells
* Image: In angle-closure glaucoma, the aqueous humor is physically blocked from the canal of Schlemm. This can be due to a pupillary block or to a neovascular membrane.
Key facts and info for:
Cataract
• In the Anterior Segment
• Lens opacities interfere with vision
• Systemic diseases can have increases in cataracts (i.e. association with cataract)
- Galactosemia, Diabetes, Wilson, Atopic dermatitis, Drugs (steroids), Radiation, Trachoma
- Age-related (senile)
- Debris from cataract may subsequently obstruct flow of aqueous humor
- When necessary, the affected lens can be replaced by a plastic lens
Key facts and info for:
Uveitis
• In the Uvea (choroid and stroma of ciliary body and iris; vascular layer)
• Infectious
e.g. pneumocystis, toxoplasmosis, MAI
• Noninfectious
Sympathetic ophthalmia – often with penetrating injury which leads to protrusion of uveal tract followed by uveal tract inflammation in injured and opposite eye (via antibodies)
Granulomatous (sarcoid)
Key facts and info for:
Neoplasms
(In the Uvea region)
• In the Uvea (choroid and stroma of ciliary body and iris; vascular layer)
• Nevi and Melanoma (Fig 29-15)
• Metastases (no lymphatics)
In pictures:
Uveal melanoma (Melanomas are often pigmented)
A, Fundus photograph from an individual with a relatively flat pigmented lesion of the choroid near the optic disc.
B, Fundus photograph of the same individual several years later; the tumor has grown and has ruptured through the Bruch membrane.
C, Gross photograph of a choroidal melanoma that has ruptured the Bruch membrane. The overlying retina is detached.
D, Epithelioid melanoma cells associated with an adverse outcome.
Key facts and info for:
Macular Degeneration
• In the Retina
• Center of macula is point of greatest visual acuity. Macular degeneration affects this region and visual acuity. Peripheral vision is often maintained.
• Most common cause of irreversible visual morbidity
• Many have genetic basis – mutations of CFH gene that codes for complement factor H or other mutations
• Changes in underlying retinal pigment epithelium (including BM), and innermost layer of choroid vasculature (choriocapillaris) affect retinal health
• Types
Dry – deposits of degraded material in Bruch’s membrane (drusen) and geographic atrophy of retinal pigment epithelium
Wet** – **follows dry with angiogenesis leading to leakage and scars
Key facts and info for:
Retinitis (infections)
• In the Retina/Vitreous
• Toxoplasmosis
Key facts and info for:
Retinoblastoma
• In the Retina/Vitreous
• Rb gene; inherited (often bilateral) vs. sporadic forms
- small blue-cell tumor
- Malignant
* Image: A, Gross photograph of retinoblastoma. B, Tumor cells appear viable when in proximity to blood vessels, but necrosis is seen as the distance from the vessel increases. Dystrophic calcification (dark arrow) is present in the zones of tumor necrosis. Flexner-Wintersteiner rosettes—arrangements of a single layer of tumor cells around an apparent “lumen”—are seen throughout the tumor, and one such rosette is indicated by the white arrow.
What condition would you consider with this image and buzz words:
- bilateral
- small blue-cell tumor
- Malignant
- Dystrophic calcification
- Flexner-Wintersteiner rosettes
Retinoblastoma
• Rb gene; inherited (often bilateral) vs. sporadic forms
- small blue-cell tumor
- Malignant
* Image: A, Gross photograph of retinoblastoma. B, Tumor cells appear viable when in proximity to blood vessels, but necrosis is seen as the distance from the vessel increases. Dystrophic calcification (dark arrow) is present in the zones of tumor necrosis. Flexner-Wintersteiner rosettes—arrangements of a single layer of tumor cells around an apparent “lumen”—are seen throughout the tumor, and one such rosette is indicated by the white arrow.
Key facts and info for:
Hypertensive Retinopathy
• In the Retina
• HTN leads to arteriosclerosis
Arteriolar wall is thickened with narrowed lumen
Compression of vein at crossing points
Changes in appearance of vessel (Copper-wire, Silver-wire)
• Malignant hypertension leads to vascular damage
Hemorrhage, Exudates
Cotton wool spots (Infarcts of choroid and retina; Axonal damage and accumulation of mitochondria in swollen axons)
Damage to retinal pigment epithelium – detachment
What condition would you consider with this image and buzz words:
- Copper-wire
- Silver-wire
- Hemorrhage, Exudates
- Cotton wool spots
Hypertensive Retinopathy
• In the Retina
• HTN leads to arteriosclerosis
Arteriolar wall is thickened with narrowed lumen
Compression of vein at crossing points
Changes in appearance of vessel (Copper-wire, Silver-wire)
• Malignant hypertension leads to vascular damage
Hemorrhage, Exudates
Cotton wool spots (Infarcts of choroid and retina; Axonal damage and accumulation of mitochondria in swollen axons)
Damage to retinal pigment epithelium – detachment
Key facts and info for:
Diabetes
• Cataracts
• basement membrane thickening in ciliary body
• Retinal vasculopathy
* image: The ciliary body in chronic diabetes mellitus, PAS stain. Note the massive thickening of the basement membrane of the ciliary body epithelia, reminiscent of changes in the mesangium of the renal glomerulus.
Key facts and info for:
Diabetic Retinopathy
Retinal vasculopathy
1) Background (preproliferative)
Thickening of basement membrane; can be seen in the ciliary body
Loss of pericytes and then capillary endothelial cells (apoptosis)
Microaneurysms and dot intraretinal hemorrhages
Leakage: Macular edema** (breakdown of blood-retinal barrier) and **hard exudates; Hemorrhagic exudates; Cotton – wool spots
2) Proliferative (VEGF)
Neovascularization of retina: Hemorrhages (posterior vitreous detachment); Traction retinal detachment
Neovascularization of iris: Glaucoma
Newly formed blood vessels are the target of laser therapy
What condition would you consider with this image and buzz words:
- Thickening of basement membrane
- Microaneurysms
• Cotton – wool spots
• Neovascularization of retina or iris
Scene viewed by a person with diabetic retinopathy (vs. normal).
The areas with loss of vision are secondary to the diabetic vascular changes.
Name some conditions related to the following region of the eye:
Optic Nerve
- Papilledema (swelling of optic nerve/disc with increased intracranial pressure)
- Optic Neuritis (demyelination - MS)
- Tumors (Optic glioma – NF2)
- Ischemia – Anterior Ischemic Optic Neuropathy (Similar to stroke)
- Glaucomatous nerve damage (See glaucoma) - cupping
- Leber hereditary optic neuropathy (Mitochondrial inheritance)
Name some conditions related to the following region of the eye:
Optic Glioma
• Seen in childhood
• Association with NF1
• Mostly low-grade astrocytomas
* image: Optic nerve glioma. B, Optic nerve glioma seen on axial computed tomography (CT) scan. Although the tumor is clearly seen on the CT scan, magnetic resonance imaging is preferred to monitor for extension of tumor into brain. C, Histopathologic appearance of a low-grade astrocytoma of the optic nerve.
Name some conditions related to the following region of the eye:
End-Stage - Phthisis Bulbi
• Severe damage to eye can result in end-stage eye (phthisis bulbi)
• Can be result of different insults and conditions (e.g. trauma, inflammation, chronic detachments, etc.).
• End-stage eye is shrunken and internally disorganized.
