Eye Pathology part 2 Flashcards
What is a risk factor for cataracts?
Diabetes Mellitus
What is a cataract?
Opacities of the lens of the eye
AGE-related cataracts result from opacification of what part of the lens and what is it called?
Nuclear Sclerosis
– opacification of the lens nucleus
What are 2 risk factors for Glaucoma?
Age and Diabetes Mellitus
What is Glaucoma associated with?
Increased intraocular pressure
Glaucoma involves changes in what 2 things?
Changes in the visual field and in the cup of the optic nerve
Describe the normal flow of the Aqueous Humor
- Ciliary body to Posterior Chamber
- Through the pupil into the Anterior Chamber
- Draining into the Trabecular Meshwork of the Cornea
Open Angle Glaucoma
Open access to the Trabecular Meshwork
–> Increased resistance to aqueous flow
Open access to Trabecular Meshwork
- -> Increased resistance to aqueous flow
- -> Increased intraocular pressure
Open Angle Glaucoma
Angle Closure Glaucoma
Peripheral zone of the Iris adheres to Trabecular Meshwork and IMPEDES outflow of aqueous fluid
Peripheral zone of the iris adheres to the trabecular meshwork and impedes outflow of fluid
Angle Closure Glaucoma
Primary Angle Closure Glaucoma
Iris bombe – iris bows forward to block trabecular meshwork
= Fluid is stuck in the posterior chamber
Secondary Angle Closure Glaucoma
Membranes form of the iris and blocks trabecular meshwork
= Fluid is stuck in the anterior chamber/posterior chamber
Adhesions between the iris and trabecular meshwork
Anterior Synechiae
Adhesions between the iris and anterior lens surface
Posterior Synechiae
Endophthalmitis
Inflammation in vitreous humor
– if suppurative => few hours may cause irreversible retinal injury
What 3 structures make up the Uvea?
Iris
Choroid
Ciliary Body
Uveitis
Inflammation of structures of the Uvea (iris/choroid/ciliary body)
What are 3 infections that can cause Uveitis?
Pneumocystis Carinii
CMV
Toxoplasmosis
NON-infectious Uveitis and what cells infiltrate?
Sympathetic Ophthalmia
= NO plasma cells + Eosinophils
Sympathetic Ophthalmia is NON-infectious Uveitis (inflammation). It is a delayed hypersensitivity reaction that affects _____
BOTH eyes – injured and non-injured!
Melanoma and Nevi can also affect the Uvea. What other structure do they affect?
Conjunctiva
What is the most common intraocular malignancy of adults and what does it NOT have a link to?
Uveal Melanoma
– NO link to UV light!
What mutations are present with Uveal Melanoma?
GNAQ, GNAII, BAP1
If Uveal melanoma is more aggressive, where is it likely in the uvea? Also, what 3 mutations are present with Uveal Melanoma?
More aggressive - Choroid/Ciliary body
- GNAQ
- GNAII
- BAP1
What 2 types of Uveal Melanoma are there and which shape has the worse prognosis?
Spindle = fusiform Epithelioid = spherical with worse prognosis
Where is the 1st site of metastasis for Uveal Melanoma?
Liver
What are the cell attributes of Melanoma?
Large nuclei with irregular contours and RED nucleoli
Melanoma terms
- Radial growth
- Vertical growth
- Clark’s level
- Breslow thickness
- Radial growth = horizontal growth
- Vertical growth = determines behavior
- Clark’s level = anatomic level of invasion
- Breslow thickness = thickness of tumor
RPE
Retinal Pigment Epithelium
Retinal Detachment involves the separation of what 2 things?
Neurosensory Retina from RPE
Rhegmatogenous vs. NON-Rhegmatogenous Retinal Detachments
Rhegmatogenous - full thickness retinal defect
NON-Rhegmatogenous - detachment WITHOUT retinal break
Retinitis Pigmentosa
Affects the rods and cones – Hereditary (autosomal dominant = later onset)
The adult Vitreous Humor is Avascular. If it liquifies and collapses, what occurs?
Floaters
Vitreous humor liquifies and collapses
Floaters
What are 2 risk factors for Retinal Vascular Disease?
HTN
DM
With Retinal Vascular Disease, what may occur since arterioles and veins share a sheath?
With a plaque, arteriole may compress the vein where the vessels cross
With Malignant HTN, what are 2 things that can be seen?
- Macular star
2. Cytoid bodies (cotton wool spots)
What are Cytoid bodies (cotton wool spots)?
- Malignant HTN
= Mitochondria accumulate at the ends of swollen axons in nerve fiber layer
Non-Proliferative Diabetic Retinopathy
Thickened basement membrane of retinal blood vessels
– microaneurysms, exudates, edema present
Proliferative Diabetic Retinopathy
New vessels sprouting from optic nerve or retinal surface
What is the primary intraocular malignancy of childhood?
Retinoblastoma
The RB gene is on what chromosome?
13Q14
What does the normal RB gene do and then describe how Retinoblastoma may occur?
Suppresses development of Retinoblastoma
– 1 abnormal gene may help to mutate other normal gene => Retinoblastoma occurs due to loss of suppression
Where are 2 places that Retinoblastoma may spread?
Brain
Bone Marrow
What 2 histo items are present with Retinoblastoma?
- Flexner - Wintersteiner Rosettes
- Fleurette
Flexner-Wintersteiner Rosettes and what they are seen with?
- Retinoblastoma
= Photoreceptor Differentiation
Fleurettes and what they are seen with?
- Retinoblastoma
= Clusters of cells composed of rod/cone segments
Is the degree of tumor differentiation associated with prognosis with a retinoblastoma?
NO
– extraocular invasion is though
Anterior Ischemic Optic Neuropathy (AION)
Injuries varying from ischemia to infarction of the Optic Nerve
With Anterior Ischemic Optic Neuropathy, describe the end results of transient partial vs. total blood flow interruptions
Transient partial => transient vision loss
Total => infarct => permanent vision loss
Papilledema
BILATERAL optic nerve swelling
What is the end stage of the eye?
Phthisis Bulbi
