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Year 2 Ophthalmology > Immunology > Flashcards

Immunology Flashcards

1
Q

In terms of innate immunity what does the eye have?

A

Very little
No physical barrier and very exposed
Does have some reflex, chemical and immune cell defences.

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2
Q

What physical properties does the eye have?

A

Tears
Anti-adhesive mucous layer
Blink reflex

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3
Q

What chemical defensive properties does the eye have?

A

Lysosomes - gram -ve
Lactoferrin - gram +ve
Secretory IgA

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4
Q

What immune cells could be found on the eye?

A

Neutrophils - follow via chemotaxis release free radicals
Macrophages - phagocytosis help trigger adaptive immunity
Conjunctival mast cells

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5
Q

What is the main APC found on the cornea?

A

Langerhaans cells

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6
Q

What makes Langerhaan cells effective APC?

A

Rich in MHC II molecules

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7
Q

Where can langerhaan cells be found in their greatest density?

A

Coreoscleral limbus

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8
Q

What is special about the conjunctiva?

A

Only area with lymphatic drainage.

Specialised endothelial vessels for regulation of lymphoid cells.

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9
Q

What immune cells can be found diffusely through the conjunctiva?

A

CD4+ CD8+ T cells

IgA secreting plasma cells

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10
Q

What lymphatic tissue is found in the conjunctiva?

A

MALT - Mucosa Associated Lymphoid Tissue

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11
Q

What cells are found physiologically within MALT tissue?

A

Macrophages
Langerhaans
Mast cells

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12
Q

If for example eosinophils where found within MALT tissue what does this indicate?

A

They have been recruited by the immune system as a result of an infection/stimulation.

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13
Q

Why does the cornea and the sclera have a down regulated immune environment?

A

There is no vascular or lymphatic system so immune cells aren’t brought in.
Relative lack of APC’s
Reduced MHC I and no MHC II

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14
Q

What immune cells are found within the lacrimal glands?

A

IgA secretory plasma cells

CD8+ T cells

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15
Q

Why is the vitreous fluid and the uvea a down regulated immune environment?

A

Blood ocular barrier

Relative lack of APC

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16
Q

What is immune privilege?

A

Ability to tolerate the introduction of antigens without the initiation of an inflammatory response.

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17
Q

Where else within the body is immune privilege present?

A

Testes
Placenta
Brain
CNS

18
Q

What else occurs within the ocular environment that leads to immune privilege?

A

Immunosuppressant molecules are produced

Inhibitory cell surface molecules released.

19
Q

What does ACAID stand for?

A

Anterior Chamber Associated Immune Deviation

20
Q

What is ACAID?

A

Active process by which the introduction of a foreign antigen into the ocular environment induces a systemic tolerance to the antigen?

21
Q

What is the main aim of ACAID?

A

Protects the eye from a inflammatory response either systemically or locally.

22
Q

What is sympathetic ophthalmia?

A

Rare bilateral granulomatous uveitis due to trauma or surgery to one eye.

23
Q

What is the pathology behind sympathetic ophthalmia?

A

An autoimmune reaction due to antigens released during trauma.

24
Q

Following the trauma what happens in sympathetic ophthalmia?

A

Antigens released are taken via the lymphatic system to the lymph nodes.
T- Cells are activated and travel to the eye within the blood.
First wave to travel is CD4+
Second wave is infiltrative CD8+ T cells

25
Q

What is the injured eye called in sympathetic ophthalmia?

A

Exciting

26
Q

What is the non injured eye called in sympathetic ophthalmia?

A

Sympathising

27
Q

List the types of hypersensitivity reactions there are

A

Type 1 Immediate hypersensitivity
Type 2 Direct Cell Kiling
Type 3 Immune Complex
Type 4 Delayed Type hypersensitivity.

28
Q

What mediates Type I hypersensitivity?

A

IgE Mediated - Allergic reactions

29
Q

Give a type I hypersensitivity reaction relevant to ophthalmology?

A

Acute Allergic Conjunctivitis - Hayfever

30
Q

What is the clinical picture of someone with acute allergic conjunctivitis?

A

Puffy itchy belly like eyes

Chemosis- oedema of the conjunctiva

31
Q

What is the treatment for someone with acute allergic conjunctivitis ?

A

Allergen avoidance

Anti histamine

32
Q

What mediates type II hypersensitivity ?

A

Complement System (Membrane Attack Complex)

33
Q

Give an example of a Type II hypersensitivity reaction?

A

Ocular Cicatricial Pemphigoid

34
Q

What is the clinical picture of someone with Ocular Cicatricial pemphigoid?

A

Blistering and scarring of mucosa, not limited to the conjunctiva can be seen systemically.

35
Q

What mediates Type III hypersensitivity ?

A

Immune complexes

36
Q

Give an example of a Type III hypersensitivity reaction?

A

Autoimmune Corneal Melting

37
Q

What does the eye of someone with autoimmune corneal melting look like?

A

Cornea is degraded often opaque

Perforation would be indicated by outbulging of material.

38
Q

What mediates Type IV hypersensitivity ?

A

T cells

39
Q

Give an example of Type IV hypersensitivity reaction?

A

Corneal Graft rejection

40
Q

What is the clinical picture of someone with corneal graft rejection?

A

Vascularisation of the host cornea possibly reaching the donor tissue.

41
Q

Why are corneal grafts usually successful?

A

Reduced MHC I and II
Cornea lacks lymph and blood supply
Centre of the cornea has a low density of langerhaan cells

42
Q

What side affects do steroids carry within the eye?

A

Cataracts

Glaucoma

Year 2 Ophthalmology (10 decks)

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