EYES Flashcards
displacement of the eye forward
proptosis
compartment that is closed medially, laterally, and posteriorly.
orbit
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
masses contained within the cone formed by the horizontal rectus muscle generate
axial proprtosis
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.
Proptosis (Thyroid ophthalmopathy) is caused by the accumulation of
extracellular matrix proteins and variable degrees of fibrosis in the rectus muscle.
separates the orbit from the ethmoidal sinuses.
lamina papyracea
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
also known as orbital inflammatory pseudomotor
idiopathic orbital inflammation
t or f
idiopathic orbital inflammation may be unilateral or bilateral
true
lacrimal gland (IOI)
sclerosing dacryoadenitis
extraocular muscles (IOI)
orbital myositis
Tenon capsule (IOI)
posterior scleritis
characterized histologically by chronic inflammation and variable degrees of fibrosis
Idiopathic orbital inflammation
IOI inflammatory infiltrate
lymphocytes, plasma cells, eosi
germinal centers, when present, raise the suspicion of
reactive lymphoid hyperplasia
presence of necrosis and degenerating collagen along with vasculitis
granulomatosis with polyangiitis
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.
Most frequently encountered primary neoplasms of the orbit (vascular)
capillary hemangioma (infancy and early childhood)
lympangioma
encapsulated cavernous hemangioma (adults)
encapsulated orbital masses
pleomorphic adenoma of the lacrimal gland
dermoid cyst
neurilemomma
protruding eyeball (graves disease and hyperthyroidism)
exophthalmos
abnormal enlargement of the eyeball protruding outward
secondary to glaucomatous condition or an increased IOP
Buphthalmos
Ox eye
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
impt clinical manifestations of graves dse
Axial proptosis
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.
T
(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
T
● 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
T
● 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
T or F
Corneal dystrophies are bilateral and hereditary
T
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
T
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
