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sys path > ocular > Flashcards

ocular Flashcards

1
Q

orbit anatomy

A

= Cavity that encloses the eye
1. Bony orbit formed by fusion of 5-7 bones depending on species
* Incomplete bony orbit: Dog, cat, pig have a lateral orbital ligament
* Complete bony orbit: Horse, cow, sheep
2. Retrobulbar tissues
* Extraocular muscles, nerves, vessels, fat, lacrimal gland

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2
Q

functions of orbit

A
  • Protection and cushioning of globe
  • Conduit for vessels and nerves
    through multiple foramina
  • Attachment for extraocular muscles
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3
Q

orbital changes in volume

A
  • Exophthalmos – eye
    pushed forward, space- occupying lesions (something behind eye in orbital)
  • Neoplasia, inflammation
  • Enophthalmos – eye sinks backward
  • Dehydration, atrophy of
    orbital fat
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4
Q

eyelid function

A
  • Sensation given by cilia and vibrissae surrounding the eye
  • Meibomian gland secretions –
    lipid layer of tearfilm
  • Physical protection of eye
  • Reduction of tear evaporation
  • Distribution of tears
  • Pumping of tears down the
    nasolacrimal duct
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5
Q

Eyelid pathology

A
  • Eyelid agenesis (coloboma) usually cats
  • Blepharitis (inflammation of eyelid) Infectious, immune-mediated
  • Eyelid laceration leading to fibrosis
  • Trauma
  • Eyelid neoplasia: Meibomian gland adenoma,
    squamous cell carcinoma,
    melanocytoma
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6
Q

Blepharitis

A

-(inflammation of eyelid) Infectious, immune-mediated

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7
Q

Eyelid neoplasia

A
  • Meibomian gland adenoma,
    squamous cell carcinoma,
    melanocytoma
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8
Q
  • Bulbar conjunctiva
A
  • Conjunctival epithelium extending
    from limbus to conjunctival fornix
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9
Q
  • Palpebral conjunctiva
A
  • Conjunctival epithelium extending from eyelid margin to conjunctival fornix
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10
Q

Conjunctival physiology

A
  • Provides smooth, lubricated surface for blinking
  • Conjunctival goblet cells – secrete mucin component of tears
  • Lymphoid follicles – respond to antigens as part of immune surveillance
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11
Q

Conjunctivitis

A

-inflammation of conjunctiva
- Primary conjunctivitis in cats –
etiologies such as FHV-1,
Chlamydophila felis
* Non-specific and secondary in
most other species

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12
Q

Lacrimal “anatomy 3 layers of tear composition

A
  1. Lipid layer – produced by meibomian glands of eyelid
  2. Aqueous layer – produced by lacrimal gland (60%) and third
    eyelid gland (40%)
  3. Mucin layer – produced by conjunctival goblet cells
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13
Q

lacrimal physiology (function)

A
  • Provide optically uniform corneal
    surface
  • Flush foreign material and debris
  • Permit passage of oxygen and
    nutrients to cornea
  • Antimicrobial enzymes
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14
Q

Pathology of lacrimal system

A

-Alterations of quantity (aqueous tears) or quality (mucin, oil) affect
corneal health and clarity
* Vascularization (red)
* Keratinization
* Pigmentation (brown)
* Lackluster cornea
* Scarring
* Corneal ulceration

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15
Q

lacrimal deficiency in quantity (aqueous)

A

= keratoconjunctivitis sicca

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16
Q

lacrimal deficiency in quantity (mucin, oil)

A

= tear film quality disorder

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17
Q

Nasolacrimal pathology

A
  • Lacrimal punctal atresia
  • Supernumerary puncta
  • Nasolacrimal cysts
  • Dacryocystitis
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18
Q

corneal anatomy layers

A
  1. Epithelium (5-7 cell layers) outer layer
  2. Stroma
    * Collagen lamellae
  3. Descemet’s membrane
    * Basement membrane of endothelium
  4. Endothelium
    * One inner layer of cells
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19
Q

corneal physiology / function

A
  • Refracts light: Corneal curvature bends light rays to create focused image
  • Clear for vision!!!
  • Non-pigmented
  • Non-keratinized
  • Non-vascularized: Aqueous humor and tears provide nutrition and oxygen
  • Organized collagen lamellae
  • Dehydrated state:
  • Active pumping in endothelium via Na/K ATPase
  • Physical barrie
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20
Q

loss of corneal clarity =disease causes

A
  • Pigmentation
  • Keratinization
  • Vascularization
  • Edema
  • Cellular, lipid, mineral infiltrates
  • Corneal ulceration
  • Superficial – corneal
    epithelium only
  • Deep – corneal stromal involvement
  • Scarring
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21
Q

Corneal epithelial pathology

A
  • Epithelial hyperplasia, keratinization,
    pigmentation
  • Response to chronic inflammation
  • Superficial corneal ulceration
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22
Q

Corneal stromal pathology

A

Corneal edema – 3 mechanisms
1. Disruption of epithelium: ulcer
2. Loss of endothelial pump function
* Reduced number of endothelial cell or function
3. Leakage from newly formed vessels
* Corneal vascularization

-keratitis

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23
Q

keratitis (ulcerative and non-ulcerative)

A

-of the stromal layer of the cornea
* Inflammation – neutrophils, lymphocytes
and plasma cells
* Vascularization – vessels migrate to areas
of injury
* Corneal ulceration – takes ~4 days for vessels
to start growing, then they grow at a rate of 1 mm/day

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24
Q

Scleral/episcleral anatomy

A
  • Episclera: Loose connective tissue between conjunctiva and
    sclera
  • Sclera: Dense connective tissue between episclera and uvea
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25
Q

Scleral/episcleral function

A
  • Continuous with cornea, together comprise fibrous layer of the eye to
    provide structural support
  • Protection of intraocular structures
  • Insertion of extraocular muscles
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26
Q

Episcleritis

A

-inflammation of the episclera
* Nodular, focal, and diffuse
forms
* Superficial disease, does NOT affect deeper ocular structures
* Immune-mediated
inflammation of episclera
* Mixed inflammation – plasma cells, lymphocytes, macrophages.

27
Q

Sclera pathology

A
  • Scleral coloboma: Focal absence of sclera
  • Scleritis
  • Causes include immune-mediated, traumatic,
    infectious agents
  • Deep disease, affects deeper structures - uvea,
    retina
  • Necrotizing scleritis
  • Collagen degradation
28
Q

Uveal anatomy

A

-Uvea = Vascular tunic of the eye
-posterior uvea: choroid
-anterior uvea: iris and ciliary body

29
Q

Uveal physiology

A

Iris:
* Forms the pupil
* Sphincter muscle
constricts
* Dilator muscle dilates

Choroid:
* Blood supply to outer retina
* Contains tapetum lucidum
dorsally in the fundus
* Bright structure that increases light capture

Ciliary body:
* Produces aqueous humor
* Attachment site for zonules
that suspend the lens

30
Q

Uveal physiology - Aqueous humor production

A

Aqueous humor is produced by ciliary
body and circulates:
* posterior chamber, pupil, anterior
chamber, filtration angle, collecting
veins into systemic circulation
Function:
* Maintains intraocular pressure (IOP)
* Provides nutrition and waste removal
for lens, inner cornea

31
Q

Blood-Ocular Barriers

A

Blood-Aqueous Barrier: breakdown of BAB results in anterior uveitis

blood-retinal barrier: * Breakdown of BRB results in
posterior uveitis

32
Q

Blood-Aqueous Barrier:

A

Epithelial portion
* Tight junctions of non-pigmented
ciliary epithelium
Endothelial portion
* Tight junctions of iridal vessels
* Breakdown of BAB results in anterior uveitis

33
Q

Blood-Retinal Barrier:

A

Epithelial portion
* Tight junctions of retinal pigment
epithelium
Endothelial portion
* Tight junctions of retinal vessels
* Breakdown of BRB results in posterior uveitis

34
Q

uveal pathology

A
  • Congenital:
  • Persistent pupillary membranes =
    vascular strands of iris that failed to regress
  • Iris hypoplasia
  • Heterochromia iridis
  • Inflammation: Uveitis
  • Neoplasia:
  • Ciliary body adenoma
  • Melanocytomas and melanomas
35
Q

Uveitis

A

Uveitis = Breakdown in Blood-Ocular Barriers
-can be anterior, posterior, and panuveitis.

36
Q

Anterior Uveitis

A
  • Iridocyclitis = inflammation of iris and ciliary body
    -Protein and cellular leakage into aqueous
    humor
  • Protein – aqueous flare
  • White blood cells – hypopyon
  • Red blood cells – hyphema
  • Fibrin
  • Keratic precipitates
37
Q

Anterior uveitis sequelae

A
  • Disruption of normal nutrition and waste
    removal
  • Cornea – edema, degeneration
  • Lens – cataract, zonular breakdown
  • Adhesions and scar tissue formation inside
    the eye: Secondary glaucoma
38
Q

Posterior Uveitis

A
  • Choroiditis = inflammation of the choroid
  • Chorioretinitis = inflammation of choroid and retina
  • Tapetal hyporeflectivity:
  • Fuzzy, gray exudates within or behind retina or within vitreous
    that obstruct view of tapetum lucidum
  • Hemorrhage, retinal detachment, granulomas
39
Q

Panuveitis

A
  • BOTH anterior and posterior uveitis
    *also called Endophthalmitis
    -filled with suppurative material
40
Q

Phthisis bulbi

A

-Chronic, uncontrolled
uveitis can lead to
a small, shrunken
globe

41
Q

Uveitis caused by? two types

A
  1. Ocular disease
    * Ocular trauma (blunt, penetrating)
    * Complex corneal ulceration or laceration
    * Lens-induced (phacolytic, phacoclastic,
    lens instability)
    * Pigmentary uveitis (Golden Retriever)
    * Equine recurrent uveitis (ERU)
  2. Systemic disease
    * Infectious disease: Bacterial
    -neoplasia
    -immune-mediated disease
    -septicemia and endotoxemia.
42
Q

pigmented Melanocytic tumor of the anterior uvea

A

-uveal neoplasia
-Large, heavily pigmented
mass arising from iris and
ciliary body

43
Q

Filtration angle anatomy and function

A

Anatomy
* Iridocorneal angle = located where iris and cornea meet
* Pectinate ligaments span opening of filtration angle

Function
* Drainage of aqueous humor and return to systemic circulation

44
Q

filtration angle pathology = glaucoma

A
  • Glaucoma = Elevated intraocular pressure
    due to DECREASED drainage of aqueous humor
    -mechanisms: blockage at filtration angle, blockage at pupil (posterior synechia where iris is adhered to lens)
    -causes:
  • Congenital glaucoma = embryologic errors
  • Primary glaucoma = inherited
  • Secondary glaucoma = ocular disease
45
Q

acute glaucoma causes

A
  • Cornea:
  • Endothelial cell dysfunction → edema
  • Iris:
  • Muscle dysfunction → dilation
  • Retina and optic nerve:
  • Cellular dysfunction → temporary vision loss
46
Q

chronic glaucoma causes

A
  • Globe stretching/enlargement
    (buphthalmos)
  • Retina and optic nerve ischemia and
    oxidative stress
    : Permanent retinal ganglion cell death
  • End-stage eye
    1. Irreversible blindness
    2. Pain
47
Q

lens anatomy

A

Outer capsule:
* Anterior and posterior lens capsule

Anterior lens epithelium and lens fibers:
* Cortex = outer, newer fibers
* Nucleus = inner, older (harder) fibers

48
Q

Lens physiology

A
  • Transparent:
  • Dehydrated state
  • Avascular - obtains nutrition from
    aqueous humor
  • Biconvex:
  • Functions to bend light to
    produce a focused image on the retina
49
Q

Lens aging leads to

A
  • Nuclear sclerosis:
  • Lens fibers proliferate throughout life
  • Newer outer fibers push older inner
    fibers concentrically toward lens nucleus
  • Normal old age change
50
Q

lens pathology

A
  • Congenital – aphakia (no lens), microphakia (small lens): Embryologic errors in development
  • Lens instability – luxation,
    subluxation: Due to breakdown of zonules
51
Q

Lens instability

A
  • Zonular breakdown:
  • Primary = inherited zonular
    degeneration (Terriers)
  • Secondary:
  • Uveitis causing zonular degeneration
  • Trauma causing zonular disruption
  • Glaucoma causing zonular disruption
  • Consequence for the eye:
  • Uveitis due to microtrauma of
    unstable subluxated lens
  • Glaucoma due to disrupted aqueous
    humor outflow
52
Q
  • Cataract (white eye)
A
  • Due to protein and/or hydration changes in lens metabolism.
  • Metabolic disturbance affects lens protein and/or fluid content
  • Results in altered organization of lens fibers
  • Manifests as an opacity in the lens (cataract)
  • Causes:
  • Inherited, metabolic (diabetes), nutritional, congenital, traumatic, toxic, retinal degeneration, uveitis
  • Consequences for the eye
    1. Disrupts vision
    2. Causes inflammation due to leakage of lens proteins across intact lens capsule
  • Phacolytic uveitis – lymphocytic plasmacytic inflammation
53
Q

Phacoclastic uveitis

A
  • Penetrating lens trauma with capsule rupture:
  • Cataract with massive release of lens protein through the rent in lens capsule
  • Severe (phacoclastic) uveitis leading to glaucoma (severe)
54
Q

Vitreal Anatomy & Physiology

A
  • Composition of vitreous:
  • Water (99%)
  • Collagen fibers which serve as a skeleton for
    the gel
  • Cells (hyalocytes)
  • Hyaluronic acid
  • Maintains ocular shape
  • Maintains lens and retina in their normal
    anatomic position
  • Transmits light
55
Q

Pathology of the vitreous

A
  • Persistent hyperplastic primary vitreous
  • Vitritis
  • Vitreal hemorrhage
  • Liquefaction/Degeneration/Syneresis: due to old age or preveous vitritis
  • Asteroid Hyalosis: Suspended calcium and phospholipid concretions
    in vitreous
56
Q

Retinal anatomy

A
  • Optic cup formation
    embryologically
  • Layers appose but are not firmly attached
  • RPE and neurosensory retina detach easily
  • Retinal pigment epithelium (RPE) = one cell layer
  • Neurosensory retina = multiple layer

-space between these two layers and if unattached leads to degeneration.

57
Q

Retinal physiology

A
  • Neurosensory retina
  • Phototransduction by photoreceptors: Conversion of light energy into electrical signals
  • Blood supply and nutrients
  • Retinal pigment epithelium (RPE)
  • One cell layer thick
  • Supports retina through transport of ions, removal of waste products, and regeneration of photoreceptors
58
Q

Retinal degeneration

A
  • Retinal thinning:
  • Dorsal fundus – tapetal hyperreflectivity
  • Ventral fundus – pigment clumping and
    depigmentation
  • Retinal vascular attenuation
    -less vascular, hyperreflective, pigment clumping.
  • Causes
  • Inherited photoreceptor degenerations,
    toxicity, nutritional, glaucoma
59
Q

Retinal detachment

A
  • Separation between photoreceptor layer of retina and RPE
  • Embryologic potential space between them.
  • Acute – vision loss due to loss of contact between retina and RPE
  • Chronic – death of photoreceptors due to loss of support from RPE
  • Mechanisms of detachment
    1. Rhegmatogenous retinal detachment
  • Tears or holes in retina, expand due to liquified vitreous entering subretinal
    space
    2. Non-rhegmatogenous retinal detachment (looks like seagull Y)
  • Fluid
  • Cells
60
Q

optic nerve anatomy

A
  • Optic nerve = cranial nerve II
  • Optic nerve > Optic chiasm > optic tracts > Optic radiations > Visual cortex
61
Q

optic nerve pathology

A
  • Congenital:
  • Optic nerve hypoplasia – reduction in retinal ganglion cells
  • Optic nerve aplasia – retinal ganglion
    cells absent
  • Acquired
  • Inflammation: Optic neuritis
  • Degeneration: Optic nerve atrophy
  • Neoplasia
62
Q

Optic neuritis

A
  • Signs:
  • Optic disc may be elevated, enlarged,
    fuzzy
  • Exudates, hemorrhages of optic disc
  • Causes:
  • Immune-mediated
  • Systemic infection
  • Trauma
63
Q

Optic nerve degeneration signs and causes

A
  • Signs
  • Disc appears darker, smaller, cupped
  • Causes
  • Chronic glaucoma – loss of retinal
    ganglion cells
  • Post-optic neuritis
  • Post-traumatic

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