EYES Flashcards by Quennie Ann Silverio

displacement of the eye forward

proptosis

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compartment that is closed medially, laterally, and posteriorly.

orbit

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produces a proptosis that displaces the eye inferiorly and medially because the lacrimal gland is positioned superotemporally within the orbit

sarcoidosis, lymphoma, pleomorphic adenoma, or adenoid cystic carcinoma

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masses contained within the cone formed by the horizontal rectus muscle generate

axial proprtosis

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two most common primary tumors of the optic nerve

glioma and meningioma

produce axial proptosis because the optic nerve is positioned within the muscle cone.

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Proptosis (Thyroid ophthalmopathy) is caused by the accumulation of

extracellular matrix proteins and variable degrees of fibrosis in the rectus muscle.

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separates the orbit from the ethmoidal sinuses.

lamina papyracea

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may present first in the orbit and may be confined for prolonged periods of time, or alternatively, it may involve the orbit secondarily by extension from the sinuses

Systemic conditions such as granulomatosis with polyangiitis

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also known as orbital inflammatory pseudomotor

idiopathic orbital inflammation

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t or f

idiopathic orbital inflammation may be unilateral or bilateral

true

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lacrimal gland (IOI)

sclerosing dacryoadenitis

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extraocular muscles (IOI)

orbital myositis

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Tenon capsule (IOI)

posterior scleritis

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characterized histologically by chronic inflammation and variable degrees of fibrosis

Idiopathic orbital inflammation

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IOI inflammatory infiltrate

lymphocytes, plasma cells, eosi

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germinal centers, when present, raise the suspicion of

reactive lymphoid hyperplasia

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presence of necrosis and degenerating collagen along with vasculitis

granulomatosis with polyangiitis

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IOI is typically confined to the orbit but may develop concomitantly with

sclerosing inflammation in the retroperitoneum, the mediastinum, thyroid, especially as a manifestation of Ig-4 related disease.

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Most frequently encountered primary neoplasms of the orbit (vascular)

capillary hemangioma (infancy and early childhood)
lympangioma
encapsulated cavernous hemangioma (adults)

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encapsulated orbital masses

pleomorphic adenoma of the lacrimal gland
dermoid cyst
neurilemomma

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protruding eyeball (graves disease and hyperthyroidism)

exophthalmos

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abnormal enlargement of the eyeball protruding outward

secondary to glaucomatous condition or an increased IOP

Buphthalmos

Ox eye

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the posterior displacement due to changes in the volume of the orbit relative to its contents or loss of function of the orbital muscle

enophthalmos

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impt clinical manifestations of graves dse

Axial proptosis

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most common intraocular malignancy is

metastatic tumors

primary intraocular malignancy is

melanoma

T or F Non hodgkin's lymphoma can affect the entire orbit or be confined to a specific compartment of the orbit such as lacrimal gland.

(metastases) present clinically like idiopathic orbital inflammation

metastatic prostatic carcinoma

may produce characteristic periocular ecchymoses

metastatic neuroblastoma and wilms tumor (rich vascular neoplasms)

drainage system of the sebaceous glands is obstructed by chronic inflammation at the eyelid margin

blepharitis

produced when lipid extravasate into surrounding tissue and provoke a granulomatous response

chalazion/lipogranuloma

most common malignancy of the eyelid

basal cell carcinoma

basal cell carcinoma usually affects

lower eyelid and medical canthus

called rodent ulcer

basal cell carci

tx basal cell carcinoma

removal with wide marginal incision

histo characteristic of basal cell carci

basaloid cells underneath stratified sq epith | peripheral palisading around the nest of basaloid cells, haphazard center,

may mimic chalazion or may diffusely thicken the eyelid

sebaceous carcinoma

sebaceous carcinoma may also resemble

blepharitis or ocular cicatricial pemphigoid

sebaceous carcinoma tend to spread first to the

parotid and submandibular nodule

sebaceous carcinoma has a predilection for

intraepithelial spread

kaposi sarcoma eyelid

lesion may appear to have a purple hue because the vascular lesion is embedded in the dermis

kaposi sarcoma conjunctiva

bright red

thin layer of epithelium that lines the inner surface of the eyelid and that of the cornea

Conjunctiva

tightly tethered to the tarsus and may respond to the inflammation by being thrown into minute papillary folds

palpebral conjunctiva

outer layer of the eyelid is lined by

stratified sq epithelium

palpebral conjunctiva is lined by

flattened cells, some columnar cells

conjunctiva in the fornix

pseudostrat columnar epi rich in goblet cells

primary lymphoma of the conjunctiva is most likely to develop in the

fornix (typically indolent marginal zone B-cell lymphoma)

covers the surface of the eye | nonkeratinizing stratified squamous

bulbar conjunctiva

intersection between the sclera and cornea, also marks the transition between conjunctival and corneal epithelium

Limbus

Causes reduction of goblet cells leading to decrease in surface mucin-- “dry eye”

CONJUNCTIVAL SCARRING

causes of conjunctival scarring

Chlamydia trachomatis Exposure to caustic alkali Sequela to ocular cicatricial phempigoid rxn to drugs surgery

○ May produce significant conjunctival scarring ○ Can produce blindness particularly in poor condition in underdeveloped nations because it is infectious in origin

Chlamydia trachomatis (trachoma)

● Submucosal elevations of the conjunctiva | ● Result from actinic damage (usually from chronic sun exposure)

PINGUECULA AND PTERYGIUM

● Typically originates in the conjunctiva astride the limbus ● Formed by submucosal growth of fibrovascular connective tissue that migrates onto the cornea

PTERYGIUM

T or f Pterygium does not cross the pupillary axis

● Elevation of conjunctiva producing a small nodule ● Usually stays in the sclera and does not invade cornea ● Causes uneven distribution of tear film over adjacent cornea ● Saucer-like depression (delle)

PINGUECULA

neoplasms tend to develop at the

Limbus

associated with squamous papillomas and conjunctival intraepithelial neoplasia

HPV types 16 &18

T or F commonly but seldom invade the cornea or appear in the fornix or over the palpebral conjunctiva

● Pigmented lesions in these zones represent melanomas or melanoma precursors ● contain subepithelial cysts lined by surface epithelium

conjunctival nevi

● BRAF V600 mutations

Conjunctival melanomas

preventive measure as the best treatment of conjunctival melanoma

Extirpation of its precursor lesion

``` phase of intraepithelial growth ○ Between 50% and 90% of individuals with incompletely treated develop conjunctival melanoma ```

``` Primary acquired melanosis with atypia or conjunctival melanocytic intraepithelial neoplasia (C-MIN) ```

● Consists of many collagen and contains few blood vessels and fibroblasts hence surgical wounds tend to heal poorly

sclera

○ Following episodes of scleritis | ○ High intraocular pressure

blue sclera

resulting lesion in the zone of scleral ectasia lined by uveal tissue

Staphyloma

○ Osteogenesis imperfecta ○ Heavily pigmented congenital nevus of underlying uvea, a condition known as congenital melanosis oculi

● “Blue sclera”

when accompanied by periocular | cutaneous pigmentation

nevus of Ota

Major refractive surface of the eye

CORNEA

eye is too long for its refractive power

Myopia

eye that is too short

hyperopia

- to sculpt the cornea and change its refractive properties

laser-assisted in situ keratomileusis (LASIK)

cornea layers

``` ABCDE Anterior epithelium Bowmans capsule Connective tissue Descement membrane Endothelium ```

acellular and forms an efficient barrier | against the penetration of malignant cells

bowman's capsule

``` ○ Corneal stroma ○ lacks blood vessels and lymphatics ○ Contributes to transparency and high rate of success of corneal transplantation ```

connective tissues

○ increases in thickness with age. ○ site of copper deposition in the Kayser-Fleischer ring of Wilson disease

Descemet membrane

decrease in endothelial cells or a malfunction of endothelium results in

stromal edema

bullous separation of the epithelium

Bullous scleropathy

preventing corneal | vascularization

VEGF antagonists

may accompany chronic corneal edema, inflammation, and scarring

corneal vascularization

protozoal pathogen which may cause corneal ulcerations

acanthamoeba

Dissolution of the corneal stroma may be accelerated by activation of

collagenases within corneal epithelium and stromal fibroblasts (also known as keratocytes).

Exudate and cells leaking from iris and ciliary body vessels into the anterior chamber

HYPOPYON

● Seldom contains organisms and is an example par excellence of the vascular response to acute inflammation

HYPOPYON

chronic herpes simplex keratitis may be associated with a

granulomatous | reaction involving the Descemet membrane

T or F Corneal degeneration is either unilateral or bilateral and typically nonfamilial

T or F | Corneal dystrophies are bilateral and hereditary

BAND KERATOPATHIES

calcific band keratopathy actinic band keratopathy

○ Reis-Buckler dystrophy

bowmans layer

Posterior polymorphous dystrophy

endothelium

- deposition of calcium in the Bowman layer ○ may complicate chronic uveitis, especially in individuals with chronic juvenile rheumatoid arthritis.

Calcific band keratopathy

exposure to high levels of UV light.

actinic band keratopathy

Progressive thinning and ectasia of the cornea without evidence of inflammation and vascularization

keratoconus

● Cornea is conical rather than spherical | ● Typically bilateral

keratoconus

keratoconus is associated with

Down syndrome, Marfan | syndrome and atopic disorders

histo hallmarks of keratoconus

Thinning of the cornea with breaks in the Bowman layer

``` can complicate Descemet membrane ruptures that develop secondary to extraordinary elevations of intraocular pressure in infantile glaucoma (Haab striae) ```

Acute corneal hydrops

Results from loss of endothelial cells resulting in edema and thickening of the stroma

FUCHS ENDOTHELIAL DYSTROPHY

FUCHS ENDOTHELIAL DYSTROPHY Two major clinical manifestations:

○ Stromal edema | ○ Bullous keratopathy

Stroma becomes edematous and thickens; it | acquires a ground-glass appearance

FUCHS ENDOTHELIAL DYSTROPHY

drop-like deposits of abnormal basement membrane material

guttata

number of endothelial cells may decrease following cataract

Pseudophakic bullous keratopathy

Autosomal dominant, caused by the TGFB1 gene that encodes ECM protein called keratoepithelin.

STROMAL DYSTROPHIES

Opacification of the lens nucleus (nuclear | sclerosis)

CATARACT

T or F cataract maybe congenital or acquired

Diseases associated with cataract:

``` ○ Galactosemia ○ Diabetes mellitus - very common ○ Wilson disease ○ Atopic dermatitis ○ Drugs (corticosteroids) ○ Radiation (UV) ○ Trauma ○ Intraocular disorders ```

● migration of lens epithelium posterior to the lens equator may result in _______ ● Seen better with slit lamp examination

POSTERIOR SUBCAPSULAR CATARACT

Lens cortex may liquefy nearly entirely a condition known as _________

MORGAGNIAN CATARACT