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NBEO Part 2 > Iris/Lens > Flashcards

Iris/Lens Flashcards

1
Q

Iris colobomas are located?

A

Inferior nasally

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2
Q

True or false
Iris colobomas are only bilateral

A

False
They can be unilateral or bilateral

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3
Q

What is an ICL?

A

Implantable collamer lens
* corrective lens implanted behind the iris and in front of the lens without removal of crystalline lens

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4
Q

What is an RLE?

A

Refractive lens exchange
* removal of clear crystalline lens and replaced with corrective posterior chamber intraocular lens implant

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5
Q

Conductive keratoplasty is suited for what refractive error?

A

Low hyperopes (less than 3 D with 0.75 D astigmatism or less)
* surgery steepens cornea

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6
Q

Remnant of hyaloid system previously attached to lens

A

Mittendorf dot
* benign
* located on posterior aspect of crystalline lens

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7
Q

Should a patient with a subluxated lens be dilated?

A

NO!!!
* may cause lens to be dislocated into anterior chamber which can block TM leading to development of glaucoma

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8
Q

Why can’t a patient with plateau iris be dilated?

A

Dilation can cause iris root to block TM leading to angle closure

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9
Q

Peter’s anomaly

A

Failure of lens to completely detach from surface epithelium during 4-7 wks gestation.
* central corneal opacity

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10
Q

What are the three types of zonular cataracts?

A
  1. Nuclear
  2. Lamellar
  3. Capsular
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11
Q

Which zonular cataract involves only fetal or embryonic nucleus and varies densities?

A

Nuclear

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12
Q

Which zonular cataract is confined to area between nucleus and cortex?

A

Lamellar

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13
Q

Which zonular cataract affects either the posterior or anterior capsule?

A

Capsular

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14
Q

“Blue dot” cataract

A

Cerulean cataract
* lenticular periphery
* congenital cataract, doesn’t affect VA

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15
Q

Sutural cataract

A

Located within Y sutures and tends to be genetic
* bilateral and does not interfere with vision

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16
Q

What is the primary treatment for iritis?

A

A cycloplegic agent to prevent or promote breakdown of synechia

Synechia refers to adhesions that can form between the iris and other structures of the eye.

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17
Q

How does a cycloplegic agent aid in pain management for iritis?

A

By controlling pupil size and avoiding unnecessary movement of the iris muscles

Movement of the iris can be painful for patients with iritis.

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18
Q

What type of eyewear is helpful for managing associated photophobia in iritis?

A

Tinted lenses

Photophobia is light sensitivity that can occur with iritis.

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19
Q

What should be prescribed to reduce the inflammatory response in iritis?

A

A potent topical steroid

Topical steroids are used to control inflammation in various ocular conditions.

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20
Q

What is crucial to do after signs of iritis have resolved when using topical steroids?

A

Slowly taper the use of the steroid

Tapering is important to prevent rebound inflammation, which can occur if steroids are stopped abruptly.

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21
Q

When is it necessary to treat iritis with a topical antibiotic?

A

Only if there is a risk of infection due to a compromised cornea

Topical antibiotics are not routinely used in iritis unless there are specific infection concerns.

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22
Q

Initial tx for anterior uveitis

A

Homatropine BID and Pred-Forte q1h
* cycloplegic to prevent formation of synechia and control pupil size helps with light sensitivity
* potent topical steroid to reduce inflammatory response (slow taper once signs resolved to reduce risk of rebound inflammation)

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23
Q

What is iritis also known as?

A

Anterior uveitis

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24
Q

What symptoms do patients with iritis typically report?

A
  • Photophobia
  • Lacrimation
  • Pain
  • Decreased visual acuity
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25
Q

What causes iritis?

A

Inflammation of the iris or both the iris and the anterior portion of the ciliary body (iridocyclitis)

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26
Q

What are keratic precipitates?

A

Deposits on the corneal endothelium that vary in size and distribution depending upon the etiology of the iritis

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27
Q

What clinical signs may indicate iritis?

A
  • Cells and flare
  • Sluggish and slightly constricted pupils
  • Irregular pupil margins
  • Iris nodules (in granulomatous inflammation)
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28
Q

What is the difference in cell count between the anterior chamber and the vitreous chamber in iritis?

A

The number of cells in the anterior chamber should exceed the number observed in the vitreous cavity

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29
Q

What are the two categories of endogenous anterior uveitis?

A
  • Granulomatous
  • Nongranulomatous
30
Q

What are the clinical features of granulomatous anterior uveitis?

A
  • Insidious onset (occurs gradually)
  • Minimal pain
  • Mild aqueous flare
  • Minimal cells in the anterior chamber
  • Large mutton-fat keratic precipitates
  • Iris nodules

Granulomatous uveitis systemic diseases: sarcoidosis, TB, herpes zoster

31
Q

What are the typical features of non-granulomatous anterior uveitis?

A
  • Acute onset
  • Moderate amount of pain
  • Marked injection of the conjunctiva
  • Heavy cells and flare
  • Small keratic precipitates
  • Absence of iris nodules
32
Q

What is posterior uveitis associated with?

A

Inflammation of the choroid and retina posterior to the base of the vitreous

33
Q

What symptoms may patients with posterior uveitis report?

A
  • Recent onset of floaters
  • Blurred vision due to choroiditis of the macular region
34
Q

What VF defect can choroiditis of the macular region cause?

A

central scotoma

35
Q

In posterior uveitis, how do the number of vitreous cells compare to those in the anterior chamber?

A

The vitreous cells will outnumber those observed in the anterior chamber

36
Q

Which ocular surgeries increase risk of developing neovascular glaucoma in an eye with iris neovascularization?

A

Cataract surgery
Vitrectomy
* cause inflammation which can stimulate neovascularization

37
Q

Plateau Iris configuration

A

Normal central anterior chamber depth with abnormally anterior placed ciliary processes

38
Q

What is the pars plicata?

A

Portion of ciliary body that produces aqueous humor

39
Q

First line treatment for plateau iris?

A

LPI (laser peripheral iridotomy)
* to counteract possibility of pupillary block
* if LPI doesn’t keep angle open next step is argon laser peripheral iridoplasty

40
Q

What are the common s/s of oculocutaneous albinism?

A

Symptoms:
- nystagmus
- reduced vision

Signs:
- transillumination defects
- blonde fundus
- foveal hypoplasia

41
Q

What is the most likely explanation for reduced best corrected visual acuity in oculocutaneous albinism?

A

Foveal hypoplasia (under developed tissue)
* lack of foveal pit formation
* leads to reduced VA, nystagmus and poor fine-detail vision (affects reading, recognizing faces)

42
Q

Rubeosis iridis

A

Neovascularization of the iris

43
Q
A

Megalopapilla
* enlarged optic disc not associated with any other morphological anomalies

44
Q

Tx for anterior uveitis

A

Topical pred acetate 1% q1h and cyclopentolate 1% BID
* slow taper steroid depending on severity and response to treatment

45
Q

Pt with anterior uveitis tx with topical steroid comes back for follow up and his IOP increased significantly, inflammation has not resolved, what’s the best tx for lowering IOP?

A

Add Alphagan 1 gtts BID
* do NOT stop steroids, steroids need to be tapered

46
Q

32 WM

A

Familial drusen
* autosomal dominant
* harmless, small drusen, located in macular region
* VA rarely affected
Tx with amsler grid vigilance and advise pt to RTC ASAP if any changes

47
Q

Christmas tree cataract caused by?

A

Myotonic dystrophy
*muscle tissue replaced by fibrous and adipose tissue
* genetic disorder, autosomal dominant

48
Q

Rosette cataract caused by?

A

Trauma
* blunt ocular trauma
* develop months to years after trauma occurs

49
Q

Snowflake cataract caused by?

A

Diabetes
* rapid onset
*caused by elevated levels of intra-ocular glucose and lenticular sorbitol causing oxidative stress

50
Q

Sampaolesi line

A

Pigment build up on schwalbe’s line during gonioscopy
*highly indicative of pigment dispersion syndrome

51
Q

Vossius ring

A

Secondary to ocular trauma
* posterior surface of iris rubs against anterior portion of lens causing a ring of pigment
* no treatment
*considered a cataract

52
Q

Blue dot (cerulean) opacities

A

Congenital cataracts
*autosomal dominant

53
Q

What measurements are needed to determine intraocular lens power for CE?

A

Axial length (A) and corneal curvature (K)
* A’s and K’s
* 0.3 mm error in axial length = 1D error

54
Q

Anterior or posterior polar congenital cataracts can grow large and decrease vision?

A

Posterior polar congenital cataract

55
Q

Elsching pearls

A

Transparent clusters of proliferating lens cells

56
Q

Dislocated lens is up and out, caused by what?

A

Marfan’s syndrome
* autosomal dominant
* connective tissue disorder, defective zonules, cause bilateral lens dislocation up and out

57
Q

Homoystinuria lens displacement is where?

A

Down and in
* enzymatic disorder, increased levels of homocysteine in body, 90% pts will have dislocated lens by their 30’s

58
Q

What is UGH syndrome?

A

A condition occurring when a one-piece IOL is accidentally placed in the sulcus, causing the IOL haptic to rub on the underside of the iris during pupil movements.

IOL stands for intraocular lens.

59
Q

What are the symptoms of UGH syndrome?

A

Symptoms include:
* Reduced vision
* Pain
* Photophobia
* Reduced visual fields in late stages

Photophobia refers to sensitivity to light.

60
Q

What signs are associated with UGH syndrome?

A

Signs include:
* Uveitis (anterior chamber cells and flare)
* Glaucoma (increased IOP, ONH cupping, RNFL loss)
* Hyphema (blood in the anterior chamber)

IOP stands for intraocular pressure, ONH stands for optic nerve head, and RNFL stands for retinal nerve fiber layer.

61
Q

How should UGH syndrome be treated?

A

Treatment includes:
* Immobilization of the iris with a topical cycloplegic (Atropine)
* Reduction of inflammation with a topical steroid
* Decreasing IOP
* Surgery may be necessary to remove or reposition the IOL

Atropine is a medication used to dilate the pupil and immobilize the iris.

62
Q

What occurs when the corneal endothelium deteriorates across the anterior segment?

A

Contraction of the iris and secondary angle closure glaucoma

This condition most frequently occurs in women.

63
Q

What are the initial symptoms of the condition described?

A

Patients will be asymptomatic

Symptoms may develop as iris changes occur in later stages.

64
Q

What symptoms may patients complain of in later stages?

A

Blur and monocular diplopia

65
Q

What are the signs presented by patients?

A

Deep anterior chamber, ‘beaten bronze’ appearance of the corneal endothelium, corneal edema, peripheral anterior synechiae

Corneal edema is due to endothelial defects.

66
Q

What is the prognosis of Essential Iris Atrophy?

A

Worst prognosis

Characterized by severe iris thinning causing holes and a distorted/displaced pupil (corectopia).

67
Q

What characterizes Chandler Syndrome?

A

Mild iris thinning causing a distorted/displaced pupil (corectopia)

It has a better prognosis than Essential Iris Atrophy.

68
Q

What defines Iris Nevus / Cogan-Reese Syndrome?

A

Pigmented iris nodules

This condition has the best prognosis among the three types of iris changes.

69
Q

What treatment options are available for corneal edema?

A

Topical hypertonic (sodium chloride, Muro 128), severe cases may require corneal transplant

70
Q

How often should patients be followed up?

A

Every 1-3 months

71
Q

Fill in the blank: Patients may benefit from _______ treatment options.

A

[surgical]

NBEO Part 2 (20 decks)

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