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Ocular Disease > Ocular Disease: Lecture 15: Scleritis > Flashcards

Ocular Disease: Lecture 15: Scleritis Flashcards

1
Q

Scleritis

  1. What is it?
    a. 2 types
  2. More common in whom?
  3. Uni or Bi?
A
  1. Severe, Potentially sight threatening disorder
    a. Mild and Benign, or Severe and destructive
  2. Females
  3. Frequently Bilateral
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2
Q

Scleritis: Etiology

  1. % associated w/Systemic Disease?
  2. Most Common: Collagen Vascular Disease (30%) (6)
  3. 4 other diseases
A
  1. 50%
  2. RA, Ankylosing Spondylitis, SLE, Polyarteritis Nodosa, Wegener’s, Relapsing Polychondritis
  3. a. Herpes Zoster
    b. Syphilis
    c. s/p Surgery
    d. Gout
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3
Q

Scleritis

2 types, and % of time they occur?

A
  1. Anterior (98%) and Posterior (2%)
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4
Q

Anterior Scleritis

Classified in to 2 groups, each with 2 things?

A
  1. Non-Necrotizing (84%)
    a. Diffuse (40%)
    b. Nodular (44%)
  2. Necrotizing (14%)
    a. W/inflammation
    b. W/o Inflammation (Scleromalacia Perforans)
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5
Q

Anterior Scleritis: Diffuse Non-Necrotizing

  1. Benign/metastatic?
  2. When does it present?
  3. We see what w/the Sclera?
  4. Onset of what a Few days later?
    a. May radiate to what 2 locations?
    b. What does it do?
A
  1. Most BENIGN FORM
  2. 5th decade
  3. Diffuse Ocular Redness
  4. Deep ACHING PAIN
    a. to Face and Temples
    b. Wakes pt in early morning and improves throughout the day
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6
Q

Anterior Scleritis: Diffuse Non-Necrotizing

Signs

  1. Vascular Congestion and Dilation found in what 3 places?
    a. What 2 other things?

b. What else is possible?

A
  1. Conj, Episclera, and Sclera
    a. Local or diffuse and possible edema

b. maybe see a Bluish tint to the Sclera as Edema resolves

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7
Q

Anterior Scleritis: Diffuse Non-Necrotizing

Signs

  1. Seen in Anterior Chamber?
  2. Recurrence common?

Symptoms
3. What 4 things?

A
  1. Anterior Chamber Rx.
  2. Yes
  3. a. Severe BORING PAIN (radiates to orbit or head)
    b. Photophobia
    c. Red-Violet Eye
    d. Decreased Vision
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8
Q

Anterior Scleritis: Nodular Non-Necrotizing

  1. A lot of peeps have a history of what?
  2. When does it tend to present (decade)?
  3. What happens first?
  4. What 2 other things?
A
  1. of HZO
  2. 5th decade
  3. Pain usually first (then Increasing redness: Possible Focal)
  4. a. Globe Tenderness
    b. Nodule Formation
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9
Q

Anterior Scleritis: Nodular Non-Necrotizing

Signs

  1. What type of nodules do we see?
    a. Where are they found?
    b. Color?
    c. Are they movable?
    d. What could multiple nodules do?
  2. What do we see with 2.5% phenyl?
  3. What happens to the Sclera as the nodule subsides?
  4. % that Develop Necrotizing Disease?
A
  1. Single or multiple scleral nodules
    a. Interpalpebral region, 3-4 mm from the limbus
    b. Deep Blue-red Color
    c. Immobile
    d. Can Coalesce (can become ENORMOUS)
  2. No Blanch
  3. Translucent Sclera
  4. 10%
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10
Q

Anterior Scleritis: Nodular Non-Necrotizing

Symptoms

  1. Similar to what?
    a. What 3 thigns?
A
  1. to Diffuse Non-necrotizing

a. Possible pain first, Injection generally focal, nodule is tender

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11
Q

Anterior Scleritis: Necrotizing w/inflammation

  1. How aggressive is it?
    a. MOST WHAT?
  2. Onset?
  3. Uni or Bi?
  4. Associated with what?
  5. % of patients that LOSE VISION?
  6. Can result in loss of what?
A
  1. VERY
    a. MOST DESTRUCTIVE FORM of Scleritis
  2. 6th decade
  3. Bilateral 60% of the time
  4. w/Systemic Disease 60% of the time (33% mortality w/in a few years if immune disease isn’t treated)
  5. 40%
  6. In Loss of the eye
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12
Q

Anterior Scleritis: Necrotizing w/inflammation

Signs

  1. Gradual Appearance with what?
  2. What gets Severely Inflamed?
    a. May involve what?
    b. May become what?
    c. Does it Blanch with 2.5% phenyl?
  3. What is visible?
A
  1. Painful, Local, AVASCULAR PATCH
    (overlies Scleral Necrosis)
  2. Local Tissue (sclera, episclera, conj)
    a. Cornea
    b. Diffuse
    c. No
  3. Underlying Uvea is Visible.
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13
Q

Anterior Scleritis: Necrotizing w/inflammation

Symptoms

  1. SEVERE, DEEP, BORING Pain: Radiates to what?
    a. Disrupts what?
    b. Little Improvement with what?
  2. What happens to vision?
A
  1. to Jaw and Brow
    a. Sleep
    b. with analgesics
  2. Decreased
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14
Q

Anterior Scleritis: Necrotizing w/o inflammation

  1. Tends to be seen in whoom?
  2. Due to Longstanding what?
  3. Name is a MISNOMER. Why?
A
  1. Elderly Women
  2. RA
  3. Sclera rarely perforates
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15
Q

Anterior Scleritis: Necrotizing w/o inflammation

Signs

  1. What develops Near the LIMBUS with NO VASCULAR CONGESTION?
  2. What Resembles HYALINE PLAQUE?
  3. What happens to the Sclera?
A
  1. Necrotic Scleral Plaque
  2. Plaques Coalesce (and resembles this)
  3. Slow Progressive Scleral Thinning
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16
Q

Anterior Scleritis: Necrotizing w/o inflammation

Symptoms

  1. Pain?
  2. Decreased vision?
  3. Irritation?
A
  1. None
  2. None
  3. Non-specific (may suspect dry eye)
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17
Q

Anterior Scleritis: Management

Non-Necrotizing

  1. What is used orally?
  2. If it’s resistant, what is used?
A
  1. NSAIDS (indomethicin)

2. Steroids. Prednisolone (60-100 mg once daily for a week, then taper to 20mg over a 2-6 wk period)

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18
Q

Anterior Scleritis: Management

Non-Necrotizing

  1. If it’s Nonresponsive, what 3 Immunosuppressive drugs can be used?
A
  1. Methotrexate
  2. Cyclosporine
  3. Azathioprine
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19
Q

Anterior Scleritis: Management

Necrotizing

  1. Tx?
  2. Consider what if no response?
  3. What’s can be done if Perforation is possible?
A
  1. Same as Non-necrotizing, but more Difficult to manage
  2. Hospitalization and IV Corticosteroids if no response
  3. Scleral Graft
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20
Q

Anterior Scleritis: Management

Necrotizing w/o inflammation (Scleromalacia Perforans)

  1. Similar Tx to what?
  2. Is it usually needed? Why?
  3. What might need to be done?
A
  1. to Other Scleritis
  2. No. Due to Very LATE NATURE of PRESENTATION
  3. Repair/Prevent Scleral Perforation
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21
Q

Anterior Scleritis: Complications

1. What 8 things can happen?
GP3 CUPS

A
  1. G: Glaucoma
  2. P: Posterior Uveitis
  3. P: Posterior Scleritis
  4. Perforation
  5. Cataract
  6. Uveitis
  7. Peripheral Corneal Melt
  8. Stromal Keratitis
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22
Q

Anterior Scleritis: Prognosis

  1. Non-Necrotizing?
  2. Necrotizing?
A
  1. Very Good

2. Depends on ability to manage underlying disease!!!!

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23
Q

Posterior Scleritis

  1. Why is it a serious condition?
    a. USUALLY MISDIAGNOSED….leads to what?
  2. Onset before age 40, usually in whom?
  3. %of cases that are Bilateral?
  4. Presents alongside what disease in a VERY SMALL % of CASES?
  5. What can occur Rapidly?
A
  1. It can potentially cause blindness
    a. Late treatment
  2. 20-30 y/o women
  3. 35%
  4. Anterior Scleritis
  5. Blindness
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24
Q

Posterior Scleritis: Signs

  1. What is seen in 25% of cases?

List the other 6 major signs?

A
  1. Exudative RD
  2. Uveal Effusion (RD + Choroidal Detachment)
  3. Choroidal Folds (Horizontal)
  4. Subretinal Mass (yellowish brown and sometimes mistaken for a choroidal tumor)
  5. Disc Edema (can cause slight reduction of vision)
  6. Proptosis (usually VERY MILD, may be associated with ptosis)
  7. Myositis (pain w/eye movement; can cause diplopia; tender to the touch; injection around muscle insertions)
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25
Q

Posterior Scleritis: Other Signs

  1. What 4 other signs are there?
A
  1. Glaucoma Anterior rotation of CB –> Angle Closure)
  2. Periorbital Edema
  3. Chemosis
  4. Conjunctival Injection
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26
Q

Posterior Scleritis: Symptoms

  1. Pain and if so, how much?
    a. What does it Correlate more to?
  2. What happens to vision?
A
  1. Mild discomfort or pain.
    a. More to MYOSITIS rather than to severity
  2. Decreased, blurred, distorted vision. Possible Photophobia
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27
Q

Posterior Scleritis: Etiology

  1. Similar Systemic Associations as what disease?
    a. Especially in what age of patients?
A
  1. As Anterior Scleritis.
    a. if older than 55 y/o.
    * Possible that most pt’s are young and healthy….
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28
Q

Posterior Scleritis

  1. Lab workup same as what other disease?
  2. Ultrasound done to see what?
  3. What else can be done?
A
  1. as Anterior Scleritis
  2. Scleral Thickening; Scleral nodules; Separation of Tenon’s Capsule (T-Sign); Choroidal Folds; Retinal Detachments
  3. MRI/CT
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29
Q

Posterior Scleritis: Treatment

  1. Same as what?
  2. Refer for what findings?
A
  1. as Anterior Scleritis

2. Refer to manage any Retinal Findings

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30
Q

Important Systemic Conditions for Scleritis

  1. There are 4 of them
A
  1. RA
  2. Wegener Granulomatosis
  3. Relapsing Polychondritis
  4. Polyarteritis Nodosa
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31
Q

RA

  1. What disease type is it?
  2. What does it do?
  3. Seen more in whom?
  4. When does it present and as what?
  5. MOST COMMON CAUSE of WHAT EYE DISEASE?
    a. Mild RA associated with what?

b. Longstanding Severe RA associated with what?

A
  1. AI disease
  2. Symmetrical, Destructive, deforming inflammatory condition
  3. Females
  4. 3rd decade: Joint swelling
  5. of Scleritis
    a. Non-Necrotizing

b. Necrotizing

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32
Q

Wegener Granulomatosis

  1. What type of Granulomatous disorder is it?
  2. What is it exactly?
    a. Predominantly Occurs where?
  3. Happens in whom more?
  4. When does it present?
    a. With what symptoms?
  5. Associated with what?
A
  1. Idiopathic multisystem
  2. Small Vessel Vasculitis
    a. Respiratory tract and Kidneys
  3. Males
  4. 5th decade
    a. Pulmonary Symptoms
  5. Rapidly Progressive, Necrotizing, Granulomatous Scleritis
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33
Q

Relapsing Polychondritis

  1. Common?
  2. Cause?
  3. What is it?
  4. When does it present?
  5. Often associated with what 2 things?
A
  1. RARE
  2. Idiopathic
  3. Small Vessel Vasculitis of CARTILAGE, and it’s CHRONIC, RECURRENT SWELLING of CARTILAGE
  4. 5th decade
  5. Necrotizing and Non-necrotizing Scleritis (usually intractable)
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34
Q

Polyarteritis Nodosa

  1. Cause?
  2. What does it affect?
  3. Is it lethal?
  4. In whom more?
  5. What may be the first sign?
A
  1. Idiopathic Collagen Vascular Disease
  2. Medium and Small Arteries
  3. Potentially yes
  4. Males
  5. Ocular involvement. Precedes Systemic by several Years
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35
Q

Polyarteritis Nodosa

  1. When does it present?
  2. 5 Systemic Signs?
  3. 3 Ocular signs?
A
  1. 3-6th decade
  2. Arthralgia, Fever, Myalgia, Tachycardia, Weight loss
  3. a. Peripheral Ulcerative Keratitis
    b. Orbital Pseudotumor
    c. Scleritis (Aggressive and Necrotizing; Milder forms possible)
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36
Q

Iris Coloboma

  1. Common?
  2. Uni or bi?
  3. What is it essentially?
  4. Usually found where?
A
  1. Uncommon
  2. Uni or Bilateral
  3. Defective Closure of Embryonic Fissure
  4. Inferonasal
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37
Q

Iris Coloboma: Signs

  1. Segmental Absence of what?
    a. AKA what kind of pupil?
    b. Partial Coloboma may not involve what?
  2. Can be associated with what 5 other Colobomas?
A
  1. of Iris from Pupil to the Root
    a. Key hole pupil
    b. the Root
  2. a. Choroidal
    b. Ciliary Body
    c. Lens
    d. Optic Nerve
    e. Retinal Colobomas
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38
Q

Iris Coloboma

  1. Symptoms
    a. May be what?
    b. What could u see?
  2. Treatment
    a. Manage what error?
    b. Evaluate for what anomalies?

c. May need a specialized Contact Lens: why?

A
  1. a. Asymptomatic
    b. Possible Glare, halos
  2. a. Refractive Error
    b. other congenital anomalies

c. Cosmesis; and to get rid of Visual Symptoms associated w/enlarged distorted pupil

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39
Q

Persistent Pupillary Membrane

  1. What is it?
  2. MOST COMMON what?
    a. % of dark eyes?
    b. % of light eyes?
  3. What are they?
A
  1. Benign Embryonic Remnants
  2. Ocular Congenital Anomaly
    a. 80%
    b. 35%
  3. Thin iris strands: May bridge the pupil
40
Q

Persistent Pupillary Membrane: 2 Types

  1. Type 1: Only attached to what?
  2. Type 2: Attached to what?
A
  1. to the Iris

2. Iridolenticular Adhesions

41
Q

Persistent Pupillary Membrane

  1. Symptoms?
  2. Treatment?
A
  1. None

2. None needed. If troublesome strand…use a YAG Laser

42
Q

Iris Heterochromia

  1. Heterochromia Iridis
    a. Uni or bi?
    b. What is it?
  2. Heterochromia Iridum
    a. Uni or bi?
    b. What is it?
A
  1. a. Unilateral
    b. Single iris with 2 colors
  2. a. Bilateral
    b. Irises are different colors
43
Q

Iris Heterochromia: Etiology

  1. Congenital: 2 Types, and what is associated w/each type (what disease)?
A
  1. Hypochromic (Lighter)
    a. Congenital Horner’s Syndrome
    b. Waardenburg’s Syndrome
    c. Hirschsprung’s Disease
    d. Perry Romberg Hemifacial Atrophy
  2. Hyperchromic (Darker)
    a. Ocular Melanocytosis
    b. Iris Pigment Epithelium Hamartoma
44
Q

Iris Heterochromia: Etiology

  1. Acquired: 2 types and what is associated with each?
A
  1. Hypochromic
    a. Acquired Horner’s Syndrome
    b. Juvenile Xanthogranuloma
    c. Fuch’s Heterochromic iridocyclitis
    d. Stromal Atrophy
  2. Hyperchromic
    a. Siderosis
    b. Hemosiderosis
    c. Chalcosis
    d. Medication (xalation)
    e. Iris Nevus
    f. ICE Syndrome
    g. Iris Neovascularization
45
Q

Iris Heterochromia

  1. Symptoms?
  2. Treatment?
A
  1. None usually

2. None usually. If caused by Foreign body (may need to remove). If due to Uveitis (manage uveitis)

46
Q

Rubeosis Irides

  1. What is it?
  2. Due to what? (1)
    a. What is the most common cause?
    b. What 3 other conditions?
A
  1. Neovascularization of IRIS and ANGLE
  2. Ocular Ischemia
    a. Proliferative Diabetic Retinopathy MOST COMMON

b. CRV occlusion; Carotic Occlusive Disease; Other conditions that cause anterior segment ischemia or chronic inflammation

47
Q

Rubeosis Irides: Signs

  1. What looks abnormal?
    a. Usually noted at what margin?
    b. What is possible?
    c. What can cause Angle Closure glaucoma (possible)
A
  1. BV’s on Iris and Angle
    a. Pupillary Margin
    b. Spontaneous Hyphema and Angle Closure Glaucoma
    c. High IOP; ONH Cupping; NFL defects and VF defects
48
Q

Rubeosis Irides: Symptoms

  1. Often Asymptomatic if there’s no what?
  2. If there’s Angle involvement: what do we see?
A
  1. No angle involvement
  2. Neovascular Glaucoma
    a. Pain; Red Eye; Photophobia; Decreased Vision; Headache; Nausea, Vomiting
49
Q

Rubeosis Irides: Management

  1. Usually requires what?
    a. Why?
  2. Intravitreal Anti VEGF
    a. What is used?
    b. May decrease what?
    c. May perform what?
  3. Monitor for what?
    a. Difficult to manage?
A
  1. PRP
    a. to destroy ischemic tissue
  2. a. Avastin
    b. Progression
    c. Vitrectomy
  3. for Angle Closure Glaucoma
    a. Very
50
Q

Rubeosis Irides: Prognosis

  1. Well…what is it?
A
  1. Poor. usually a Chronic Progressive Disease
51
Q

Iridocorneal Dysgenesis

  1. What 3 have we already talked about?
  2. What 1 is new?
A
  1. Review: Posterior Embryotoxin, Axenfeld-Reiger Syndromes and Peter’s Anomaly
  2. Aniridia
52
Q

Aniridia

  1. Common?
  2. Uni or Bi?
  3. Abnormal Development due to what?
    a. Predisposes Pt to what?
  4. 3 Classifications of the disease?
A
  1. RARE
  2. BILATERAL
  3. It’s 2ndary to Genetic Mutation
    a. to Wilm’s Tumor (Life threatening associations)
  4. a. Autosomal Dominant
    b. Gillespie Syndrome
    c. Sporadic
53
Q

Aniridia: Classification

  1. AD
    a. % of cases?
    b. Systemic issues?
  2. Sporadic
    a. % of cases?
    b. % of developing Wilm’s Tumor?
  3. Gillespie Syndrome
    a. % of cases?
    b. Genetic association?
    c. Associated with what 2 things?
A
  1. a. 2/3rds of cases
    b. None
  2. a. 1/3 of cases
    b. 30% chance
  3. a. Less than 1% of cases
    b. AR
    c. Mental Handicap and Ataxia
54
Q

Aniridia: Presentation

  1. Birth: presents with what 2 things?
  2. Severity?
    a. 3 types
  3. What does Gonio Reveal?
  4. Lids Demonstrate what?
  5. Cornea may have what 2 things?
  6. Lens: 3 things?
  7. Retina: 3 things?
A
  1. Nystagmus and Photophobia
  2. Variable
    a. Minimally detectably (requires retroillumination); Partial and Total
  3. Rudimentary Frill of Iris tissue (even in total aniridia)
  4. MGD
  5. Chronic Dry Eye and Limbal Stem Cell Deficiency
  6. Aphakia, Cataract, and Subluxation (superiorly)
  7. a. Choroidal Coloboma
    b. Foveal Hypoplasia
    c. ONH Hypoplasia
55
Q

Aniridia and Glaucoma

  1. Occurs in what % of cases?
  2. Onset?
  3. 2ndary to what?
  4. Treatment: difficult: Why?
A
  1. 75%
  2. Late Childhood
  3. to Synechial Angle Closure
  4. Often will require surgical intervention and prognosis is guarded….
56
Q

Aniridia: Management

  1. Type of Contact Lenses?
  2. Manage what?
  3. What surgery can be performed?
  4. What 2 other things?
A
  1. Opaque (Artificial Pupil)
  2. Glaucoma
  3. Cataract surgery
  4. Lubrication and Limbal Stem Cell Transplantation
57
Q

Iridocorneal Enothelial Syndrome (ICE)

  1. Common?
  2. Uni or Bi?
  3. Genetic?
  4. Affects whom?
  5. What 3 things does it involve?
  6. Associated with what?
A
  1. Rare
  2. Unilateral
  3. Un-inherited
  4. Middle Aged Women
  5. Anterior Chamber Angle, Cornea, and Iris
  6. Glaucoma
58
Q

Iridocorneal Enothelial Syndrome (ICE)

  1. 3 overlapping classifications
    a. All have what irregular layer?
    i. Why does this happen?
  2. Differentiation difficult due to what?
  3. They include what 3 classifications?
A
  1. a. Endothelial Cell Layer
    i. Endothelium Proliferates and Migrates Across Angle onto Surface of the Iris
  2. Overlap
  3. a. Essential Iris Atrophy
    b. Changler’s Syndrome
    c. Cogan-Reese Syndrome
59
Q

Iridocorneal Enothelial Syndrome (ICE)

Essential Iris Atrophy

  1. What does the endothelium look like?
    a. Due to what?
  2. Progressive, SEVERE IRIS CHANGES, including what 4 things?
A
  1. Hammered Silver Endothelium
    a. Corneal Edema
  2. a. Corectopia
    b. Holes
    c. Thinning
    d. Pseudopolycoria
60
Q

Iridocorneal Enothelial Syndrome (ICE)

Chandler’s Syndrome

  1. Endothelium looks like what?
    a. Due to what?
  2. How bad are the Iris Changes?
    a. What happens?
A
  1. Hammered Silver Endothelium
    a. Corneal Edema
  2. Mild Iris Changes
    a. Mild to Moderate Corectopia
61
Q

Iridocorneal Enothelial Syndrome (ICE)

Cogan Reese Syndrome

  1. AKA what syndrome?
  2. Endothelium looks like what?
    a. Due to what?
  3. What is seen on Anterior Iris?
  4. Iris Atrophy is ABSENT in what % of cases?
  5. Corectopia: Severity?
A
  1. Iris Nevus Syndrome
  2. Hammered Silver Endothelium
    a. Corneal Edema
  3. Diffuse Iris or Iris Nodules on ANTERIOR IRIS
  4. in 50% of Cases (Mild in the Rest)
  5. Can be SEVERE
62
Q

Iridocorneal Enothelial Syndrome (ICE)

Glaucoma

  1. Seen in what % of cases?
  2. Due to what happening?

Treatment

  1. 3 things
A
  1. 50%
  2. Due to Synechial Angle Closure
  3. a. Medical
    b. Often Requires Filtering Shunt
    c. Traveculoplasty and Trabeculectomy rarely successful
63
Q

Iridocorneal Enothelial Syndrome (ICE)

Complications

2 Major complications?

A
  1. Glaucoma

2. Corneal Decompensation (may require Corneal Transplant)

64
Q

Iris Cysts

  1. Common?
  2. Arises from what 2 things?
  3. 2 types. (categories in each)?
A
  1. Rare
  2. Iris epithelium or Stroma
  3. a. Primary: Epithelial and Stromal
    b. Secondary: Implantation; Miotic Induced; and Parasitic
65
Q

Primary Epithelial Iris Cysts

  1. Uni or Bi?
  2. Solitary or Multiple?
  3. Globular Brown or Transparent lesions?
  4. Can be found at what 3 places?
  5. What can happen to them?
A
  1. Both
  2. Both
  3. Both
  4. Iris Root; Mid Iris Zone; Pupil Border
  5. Can become dislodged and Float Freely in Anterior Chamber or Vitreous
66
Q

Primary Epithelial Iris Cysts

  1. Generally what 2 things?
  2. Large lesion may Obstruct what?
    a. Treat with what?
A
  1. Asymptomatic and Benign
  2. Vision
    a. Argon Laser and Photocoagulation
67
Q

Primary Stromal Iris Cysts

  1. Seen when?
  2. Uni or Bi?
  3. Solitary or seen with many things?
  4. Type of wall?
  5. how long can it be dormant for?
  6. What might happen then?
    a. What 2 problems can come from this?
A
  1. 1st years of Life
  2. Unilateral
  3. Solitary
  4. Smooth Translucent Anterior Wall
  5. For Several Years
  6. May Suddenly Enlarge
    a. 2ndary Glaucoma and Corneal Decompensation
68
Q

Primary Stromal Iris Cysts

  1. May break free from what?
    a. What happens then?
  2. Most require what 2 things?
    a. What has been noted in the past?
    b. Injection of what can eliminate risk of recurrence?
A
  1. from the Iris
    a. Float freely in the Anterior Chamber
  2. Needle Aspiration or Surgical Excision
    a. Spontaneous Regression
    b. Injection of Ethanol for 60 Seconds prior to removal
69
Q

Secondary Iris Cysts

  1. Develop due to what 3 things?
A
  1. Implantation; Miotics; Parasites
70
Q

Secondary Iris Cysts: Implanted

  1. Most common what?
  2. Due to deposit of what cells?
  3. Occur after what 2 things?
A
  1. Secondary Iris Cysts
  2. Surface Epithelial Cells (Conjunctival or Corneal)
  3. Penetrating Ocular Surgery or Trauma
71
Q

Secondary Iris Cysts: Implanted

Types

  1. Pearls
    a. Type of Lesions?
    b. Type of Walls?
    c. Not connected to what?
A
  1. a. White Solid Lesion
    b. Opaque Walls
    c. Not connected to the Wound
72
Q

Secondary Iris Cysts: Implanted

Types

  1. Serous
    a. What is it?
    b. May be connected to what?
  2. Frequently Enlarge which leads to what 3 things?
  3. What may be required?
A
  1. a. Translucent, Fluid filled
    b. to wounds
  2. Corneal Edema, Glaucoma, and Uveitis
  3. Surgical Excision
73
Q

Secondary Iris Cysts: Miotics

  1. Due to Prolonged use of what?
    a. Name 2 of them
  2. Uni or Bilateral?
    a. What are they?
    b. Located at what border?
    c. Can be prevented by use of what?
A
  1. of Long Acting Miotics
    a. Pilocarpine and Physotigmine
  2. Bilateral
    a. Small, Multiple Iris Cysts
    b. At the Pupillary Border
    c. of 2.5% Phenyl
74
Q

Secondary Iris Cysts: Parasitic

  1. Common?
  2. Secondary to what?
A
  1. EXTREMELY RARE

2. Secondary to PARASITIC Infection of the IRIS

75
Q

Iris Nodules

  1. It’s a Collection of what?
  2. There are several types. (3)
A
  1. of Cells on the Iris Surface
  2. a. Brushfield Spots
    b. Lisch Nodules
    c. Inflammatory (Busacca and Koeppe)
76
Q

Iris Nodules: Brushfield Spots

  1. What does it look like?
    a. Found on what part of the iris?
  2. Associated with what Syndrome?
  3. Seen in what % of normal peeps?
A
  1. Ring of Small Whitish Gray Spots
    a. Peripheral Iris
  2. Down Syndrome
  3. 24%
77
Q

Iris Nodules: Lisch Nodules

  1. What are they?
  2. Seen after what age?
    a. In ALL Pts with what disease?
A
  1. Small, Bilateral Nevi
  2. after age 16
    a. Neurofibromatosis 1
78
Q

Iris Nodules: Inflammatory Nodules

  1. Made up of what?
  2. In in what inflammatory disease?
  3. 2 Types
A
  1. Inflammatory Debris
  2. Granulomatous Uveitis
  3. a. Busacca Nodules (Anterior Iris Surface)
    b. Koeppe Nodules (Pupillary Border)
79
Q

3 Iris Tumors?

A
  1. Iris Nevus
  2. Iris Melanoma
  3. Iris Metastatic Tumor
80
Q

Iris Nevus

  1. Proliferation of what cells and where?
  2. Solitary or not?
  3. pigmented or Non pigmented?
  4. Flat or Slightly elevated?
  5. size?
  6. normally found on what part of the Iris?
A
  1. of Melanocytes in the Superficial Iris Stroma
  2. Solitary
  3. Pigmented
  4. either
  5. Usually less than 3 mm in diameter
  6. Inferior Iris
81
Q

Iris Nevus

  1. What does it disrupt?
  2. Can cause 2 things?
  3. What can it extend into?
  4. 3 Signs of Possible Malignant Transformation?
A
  1. Normal Iris Structure
  2. Ectropion Uvea or Mild Pupil Distortion
  3. Into Trabecular Meshwork
  4. a. Diffuse Spread
    b. Prominent Vascularity
    c. Diffuse Spread
82
Q

Iris Nevus

Uncommon Variants

  1. Diffuse Nevus
    a. Flat or elevated?
    b. Distinct or indistinct Margin?
    c. Sectoral or Entire Iris involved?
    d. What does it cause?
A
  1. a. Flat
    b. With an INDISTINCT MARGIN

c. Either
d. Heterochromia

83
Q

Iris Nevus

Uncommon Variants

  1. Iris Nevus Syndrome
    a. Associated with what other syndrome?
    b. What kind of lesions are seen?
A
  1. a. Cogan Reese Syndrome

b. Numerous Small Pedunculated Lesions

84
Q

Iris Melanoma

  1. More likely seen in what color iris?
  2. Extremely Rare in what population?
  3. Males or females seen in more?
A
  1. 3x’s more likely in Light colored Iris
  2. In African American Population
  3. Equal
85
Q

Iris Melanoma: Predisposing Conditions

  1. 6 things
A
  1. Fair Skin
  2. Light Colored Eyes
  3. Numerous Cutaneous Nevi
  4. Congenital Ocular Melanocytes
  5. Nevus of Ota
  6. NF1
86
Q

Iris Melanoma

  1. When does it present?
  2. Usually starts as an Enlargement of what?
A
  1. 5th-6th decade

2. as an Enlargement of Pre-existing Iris Lesion

87
Q

Iris Melanoma: Signs

  1. Pigmented or non-pigmented nodule?
    a. Size?
    b. Thickness?
    c. Located where?
    d. What is found on them?
A
  1. Either
    a. At least 3 mm in diameter
    b. At least 1 mm thick
    c. In Inferior 1/2 of the Iris
    d. Surface Blood Vessels
88
Q

Iris Melanoma: Signs (2)

  1. What happens to the Pupil?
  2. To the Uvea?
  3. What other 2 things can happen?
A
  1. Pupil Distortion
  2. Ectropion Uvea
  3. a. Possible Localized Cataract
    b. Can Invade the Angle and Anterior Ciliary Body
89
Q

Iris Melanoma: Complications

  1. Three things
A
  1. Cataract
  2. Glaucoma
  3. Hyphema
90
Q

Iris Melanoma: Rare Variants

  1. Diffuse
    a. Progressive what?
    b. Loss of what?
  2. Tapioca Melanoma
    a. What is it?
A
  1. a. darkening of iris
    b. loss of crypts of Fuch
  2. Multiple Surface Nodules. Looks Like Tapioca Pudding
91
Q

Iris Melanoma: Treatment

  1. First thing to do?
  2. Iridectomy on what?
  3. Iridocyclectomy on what?
  4. What other 2 things can be done?
A
  1. Observe and document suspicious lesions (follow for life)
  2. On Small Tumors (Iris Reconstruction)
  3. Tumors invading the Angle
  4. a. Radiotherapy
    b. Enucleation (diffuse lesions or if radiotherapy isn’t possible)
92
Q

Iris Melanoma

  1. Prognosis
A
  1. Very good. 5% develop metastasis w/in 10 years
93
Q

Iris Metastatic Tumors

  1. Common?
  2. Tend to be what?
  3. How many lesions?
  4. Uni or Bi?
  5. What part of the iris does it affect?
  6. Growth rate?
A
  1. Rare
  2. Amelanotic
  3. Usually multiple lesions
  4. Usually Bilateral
  5. Affects Superior and Inferior Iris EQUALLY
  6. Fast Growing
94
Q

Iris Metastatic Tumors

  1. Can release cells into what?
    a. Called what?
  2. Can induce what 2 things?
  3. Most commonly seen with what cancer in:
    a. Men?
    b. Women?
A
  1. into Anterior Chamber
    a. Pseudohypopyon
  2. Anterior Uveitis and Hyphema
  3. a. Lung Cancer
    b. Breast Cancer
95
Q

Iris Metastatic Tumors

  1. Treatment? (3)
  2. Prognosis
    a. Visual?
    b. Systemic?
A
  1. Chemotherapy; Excision; Radiation Therapy
  2. a. Generally good
    b. Usually Poor

Ocular Disease (11 decks)

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