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Pathophys > Eye Pathophys > Flashcards

Eye Pathophys Flashcards

1
Q

What is the basic anatomy of the sclera?

A

Thick, white, transparent at the cornea

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2
Q

What is the basic anatomy of the choroid?

A

Deeply pigmented, contains blood vessels, and the Iris is part of the choroid

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3
Q

What is the basic anatomy of the Retina?

A

Has rods and cones, converts light energy into nerve impulses

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4
Q

What is present at the Fovea centralis?

A

Only cones. This is where the greatest visual acuity occurs.

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5
Q

Which bones make up the orbit?

A 
Zygomatic
Sphenoid
Frontal
Ethmoid
Lacrimal
Palatine
Maxillary
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6
Q

Which bone making up the orbit is the thinnest and what can result from this?

A

Ethmoid- orbital cellulitis can result if infection erodes through from the sinus

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7
Q

What is the origin of the occular muscles?

A

Annulus of Zinn

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8
Q

What does the annulus of zinn encircle?

A

optic n.

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9
Q

What is characteristic of the lower canaliculus in children?

A

It’s smaller= inc risk for infection.

Massage can keep the duct open.

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10
Q

What is the mechanism for thyroid-related orbitopathy(Graves Dz)?

A

T cells secrete cytokines(TNF, interferon) which stimulates fibroblast proliferation. Fibroblasts synthesize extracellular matrix proteins to 1)inc hydrophilic glycosaminogycans (Hyaluronic acid) and 2) inc osmotic pressure= fluid accumulation.

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11
Q

What is the manifestation of thyroid related orbitopathy?

A

Proptosis
Strabismus/muscle-restriction
Exposure problems
Compressive optic neuropathy.

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12
Q

Thyroid related orbitopathy Tx?

A

Steroids
Radiation therapy
Surgical decompression (opening the orbital walls into the sinuses)

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13
Q

What are the most frequent primary tumors of the orbit?

A

Most are vascular in origin
Capillary hemangioma
Cavernous hemangioma
Lymphangioma

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14
Q

What are characteristics of capillary hemangiomas?

A

“spider”, thinner

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15
Q

What are characteristics of cavernoushemangiomas?

A

more dense/dilated

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16
Q

What is the most common primary malignancy of the orbit in children?

A

rhabdomyosarcoma

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17
Q

What is the most common metastatic tumor in children?

A

neuroblastoma- 20% develop orbit metastasis

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18
Q

Where will the gaze likely be in orbital floor fx?

A

Restricted upgaze if there is muscle entrapement

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19
Q

How critical are orbital floor fx?

A

Typically require hospitalization

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20
Q

What are the tarsal glands AKA?

A

Meibomian glands

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21
Q

What are the malignant tumors of the eyelids?

A

Basal cell carcinoma – most common
Sebaceous carcinoma
Squamous
Melanoma

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22
Q

What can occur if basal cell carcinoma is not completely removed?

A

inc risk of becoming squamous cell carcinoma

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23
Q

What causes a Chalazion?

A

chronic inflammatory lesion of the meibomian gland

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24
Q

What secretes the mucinous components of the tear film?

A

goblet cells

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25
Q

What causes conjunctivitis?

A

viral(adenovirus), bacterial, or allergic cause

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26
Q

What can result from chlamydial conjunctivitis?

A

scarring causing a dec in goblet cells leading to dec in mucin

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27
Q

Bacterial conjunctivitis Tx?

A

usually self limited in 10-14 days

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28
Q

Allergic conjunctivitis Tx?

A

antihistamines, vasoconstrictors, and steriods

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29
Q

What does conjunctiva intraepithelial neoplasia(CIN) often preceed?

A

Squamous cell tumor

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30
Q

What is the Limbus?

A

Border of the cornea and the sclera. The limbus is a common site for the occurrence of corneal epithelial neoplasm.

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31
Q

Where do lymphoidic conjunctiva tumors arise from?

A

mucosa-associated lymphoid tissue (MALT)

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32
Q

What are conjunctiva squamous papilloma and conjunctiva intraepithelial neoplasia(CIN) associated with?

A

HPV 16 and 18

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33
Q

Is the cornea vascularized?

A

No

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34
Q

What are the 5 layers of the Cornea?

A 
Epithelium
Bowmans Membrane
Stroma
Descemet's membrane
Endothelium
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35
Q

What is the anatomy of the Cornea epithelium?

A

Continuous with conj, richly innervated by CN-V1

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36
Q

What is the anatomy of the Corneal Stroma?

A

The thickest central portion (90%).

Primarily made up of Type 1 Collagen in uniformly-spaced lamellar bundles.

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37
Q

Where does copper deposition occur in Wilsons disease (Kayser-Fleischer ring)?

A

Descemet’s membrane layer of the cornea

38
Q

What is the function of the endothelial layer of the cornea?

A

pumps the water out of the cornea and keeps it clear

39
Q

Where does LASIK/Refractive surgery happens?

A

Corneal Stroma

40
Q

What is Keratitis?

A

inflammation of the cornea

41
Q

What is the most common cause of bacterial keratitis?

A

Pseudomonas

42
Q

What is the most common cause of viral keratitis?

A

HSV

43
Q

What are the signs of HSV Keratitis?

A

epithelial “dendritic” lesions

44
Q

What are the signs of Bacterial Keratitis?

A

Hypopyon

45
Q

What is Stromal dystrophy?

A

a heritable disorder resulting in abnormal tissue morphology, function, or abnormal depositions of material into the cornea.

46
Q

What is ectasia?

A

progressive deformation of the cornea

47
Q

What is the most common ectatic dystrophy?

A

Keratoconus

48
Q

What can be a complication of refractive surgery?

A

Ectasia

49
Q

ectasia Tx?

A

refer to ophthalmology

50
Q

What composes the Uvea?

A

Iris, ciliary body, and the choroid

51
Q

What is the function of the iris?

A

diaphragm for light

52
Q

What is the function of the ciliary body

A

suspends and flexdes the lens, also makes the aqueous humor

53
Q

What is the function of the choroid

A

nourishes the outer retina

54
Q

where is the angle of the uvea?

A

where the iris meets the cornea

55
Q

What is the function of the angle of the uvea?

A

regulates the outflow of aqueous humor through the canal of Schlem. This determines intraocular pressure.

56
Q

What serious systemic Dzs can uveitis be associated with?

A

arthritis, IBD, vacuities, torch syndrome

57
Q

What is commonly seen in anterior uveitis?

A

WBC’s floating in aqueous humor

58
Q

What is seen in posterior uveitis?

A

active toxoplasmosis choroiditis, old scars

59
Q

Why is the choroid a potential target site for metastasis?

A

It is highly vascularized

60
Q

What has the highest protein content in the body and what is the significance of this?

A

Lens- creates a high refractive index

61
Q

What focuses light on the retina

A

The lens in concert with the cornea

62
Q

What happens the the central fibers of the lens with aging?

A

they become sclerotic and opaque making the lens flatten with time

63
Q

What are pathogenic factors of cataracts

A

UV light, steroids, and inflammation

64
Q

What type of cells are in the retina?

A

Photoreceptors-detect light
Bipolars-transmit signal to ganglion cells
Ganglion cells- send signal by long axon through optic n.

65
Q

Which side of the optic disc do retinal arteries and veins emerge from?

A

nasal side

66
Q

Which direction do arching retinal vessels go?

A

toward the temple

67
Q

which direction do radial retinal vessels go?

A

toward the nose

68
Q

Do retinal arteries contain a muscular coat?

A

No

69
Q

What do retinal arteries drain?

A

innner retina(retinal ganglion cells and their axons and the bipolar cells)

70
Q

What drains the outer retina(rods and cones)?

A

choroidal circulation

71
Q

Where does retinal detachment occur?

A

between the retinal pigment epithelium(RPE) and photoreceptor(neurosensory) segments

72
Q

What causes Macular degeneration?

A

Bruch’s membrane damaged by deposition of drusen, allowing leaky choroidal vessels to grow into retina (exudative type).

73
Q

What causes Drusen?

A

mucoproteins and mucopolysaccarides that progressively calcify, leaving remnants of axonal transport system of degenerative retinal ganglion cells. Occurs in both wet and dry macular degeneration

74
Q

What are the 2 types of retinal detachment?

A

Tear (most common), seperation

75
Q

What are characteristics of atrophic macular degeneration?

A

Discrete deposits in the Bruch membrane(drusen)

76
Q

What are characteristics of neovascular macular degeneration?

A

Presence of angiogenic vessels originate from choroid capillaries
Penetrate Bruch membrane and may penetrate the RPE.
Vessels may leak causing macular scars.

77
Q

Neovascular macular degeneration Tx?

A

VEGF antagonists(antibodies to growth factors)

78
Q

What is characteristic of hemorrhage form of macular degeneration?

A

sudden onset of painless, blurred, or warped vision called metamorphopsia.

79
Q

What can cause microvascular Dz in the retina?

A

Dm, Sickle cell, radiation

80
Q

What occurs in the preproliferative phase of diabetic retinopathy?

A

Glu and sorbitol levels are high=Retinal blood vessels thicken= 1)dec O2 perfusion=up regulation of VEGF and 2)vessles become flimsy=microaneurysusms occure

81
Q

What occurs in the proliferative phase of diabetic retinopathy?

A

retinal angiogenesis=retina becomes thicker

82
Q

Consequences of Diabetic Retinopathy?

A

Vitreous humor detachment “posterior vitreous detachment”
May precipitate massive hemorrhage
Organization of retinal neovascular membrane may wrinkle the retina
Traction retinal detachment

83
Q

What is the best prevention of Diabetic Retinopathy?

A

blood glucose control

84
Q

Diabetic Retinopathhy Tx?

A

lasers can stop progression

85
Q

What are Roth spots

A

Cotton wool spots surrounded by hemorrhage

86
Q

If a person has chronic hypertension, what is likely to be seen on the optic disc?

A

AV nicking due to stiffened arteries

87
Q

What is the classic pediatric tumor of retina?

A

Retinoblastoma

88
Q

What causes Ischemic Neuropathy?

A

due to arteritic (Giant Cell Arteritis) or non-arteritic causes. Vessle walls become inflammed= dec diameter= dec blood supply to optic n.

89
Q

What causes Optic Neuritis?

A

Many causes, but demyelinating (Multiple Sclerosis) causes are most important

90
Q

What causes Papilledema?

A

swelling due to increased intracranial pressure

Pathophys (15 decks)

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