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Ocular Disease > Ocular Disease: Lecture14: Conjuntiva > Flashcards

Ocular Disease: Lecture14: Conjuntiva Flashcards

1
Q

Conjunctiva

  1. It’s Highly Vascular: What 2 arteries supply blood to it?
  2. It has a dense lymph system. Drains to what 2 areas?
A
  1. Anterior Ciliary Arteries, and Palpebral Arteries

2. Pre-auricular and Submandibular

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2
Q

Conjunctiva: Important Findings

Discharge

  1. What 4 types of discharge are there?
A
  1. Watery (Serous), Mucous, Mucopurulent, and Purulent Discharge
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3
Q

Conjunctiva: Important Findings

Discharge: Watery (Serous)

  1. What 2 things can cause it?
  2. Mucous Discharge: What 2 things can cause it?
A
  1. Acute Viral Conjunctivitis and Acute Allergic Conjunctivitis
  2. Chronic Allergic Conjunctivitis, and Dry Eye
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4
Q

Conjunctiva: Important Findings

Discharge: Mucopurulent

  1. What 2 things can cause it?
  2. Purulent Dishcarge
    a. Moderate caused by what?
    b. Severe Caused by what?
A
  1. Acute Bacterial Conjunctivitis, and Chlamydia
  2. a. Acute Bacterial Conjunctivitis
    b. Gonococcal
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5
Q

Conjunctiva: Important Findings

  1. Hyperemia (Injection): Caused by what?
  2. Hemorrhage: Caused by what 3 things?
A
  1. Ocular Irritation
  2. a. Trauma
    b. Bacterial and Viral Conjunctivitis
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6
Q

Conjunctiva: Important Findings

Chemosis (Edema)

  1. 2 symptoms seen with it?
  2. If it’s severe, how will it present?
  3. Acute (Non-Traumautic): Caused by what?
  4. Chronic: Caused by what?
A
  1. Severe Inflammation and Translucent Swelling
  2. It will Protrude through the Lids
  3. Hypersensitivity
  4. Orbital Outflow Restrictions
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7
Q

Conjunctiva: Important Findings

Membranes

  1. 2 Types
  2. Can be due to what 5 issues?
A
  1. Pseudomembranes and True Membranes
  2. a. Bacterial Infections
    b. Gonococcal Conjunctivitis
    c. Ligneous Conjunctivitis
    d. Severe Adenoviral Conjunctivitis
    e. Stevens Johnson Syndrome
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8
Q

Conjunctiva: Important Findings

Pseudomembranes

  1. What are they?
  2. What do they “STICK” to?
  3. They can be peeled…if so, what will happen?
A
  1. Coagulated Exudates
  2. Inflamed Conjunctival Epithelium
  3. Cause Bleeding
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9
Q

Conjunctiva: Important Findings

True Membranes

  1. Involve what layers?
  2. What will it tear when you try to remove them?
A
  1. Superficial Layers

2. Tears Conjunctiva when you try to remove them.

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10
Q

Conjunctiva: Important Findings

Infiltration

  1. Due to what?
  2. What does it look like?
    a. This obscures what?
A
  1. Due to Chronic Inflammation
  2. a Whitish Clouding of the Conjunctiva
    a. the Underlying Structures
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11
Q

Conjunctiva: Important Findings

Follicles

  1. What are they?
  2. Are they a solid color or translucent?
  3. Where are they most prominent?
    a. IF they’re FOUND at the LIMBAL, what causes it?
  4. How are vessels found on them?
A
  1. Multiple, Discrete, Slightly Elevated Lesions
  2. Translucent
  3. In the FORNIX
    a. Chlamydia
  4. They Run ACROSS or AROUND them, instead of WITHIN them.
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12
Q

Conjunctiva: Important Findings

Follicles

  1. Due to what 4 infections?
  2. Normal found how in Children?
  3. Normally found how in Adults?
A
  1. a. Chlamydial Conjunctivitis
    b. Viral Conjunctivitis
    c. Medicamentosa
    d. Parinaud Oculoglandular Syndrome
  2. Small follicles in children are normal
  3. Small Follicles AT FORNICES and MARGIN of UPPER TARSAL PLATE for Adults
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13
Q

Conjunctiva: Important Findings

Papillae

  1. Found in 1 of 2 places only?
  2. Macropapillae: Size?
  3. Giant Papillae: Size?
  4. What kind of CORE do they have?
A
  1. Palpebral or Limbal Bulbar Conjunctiva
  2. Less than 1 mm
  3. Greater than 1 mm
  4. Vascular Core
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14
Q

Conjunctiva: Important Findings

Papillae

  1. Can be caused by what 7 things?
A
  1. Allergic Conjunctivitis
  2. Bacterial Conjunctivitis
  3. Chlamydial Conjunctivitis
  4. Chronic Marginal Blepharitis
  5. Contact Lens wear
  6. Floppy Eyelid Syndrome
  7. SLK
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15
Q

Conjunctiva: Important Findings

Phlyctenulosis

A

We already talked about this…see previous lecture slides!

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16
Q

Conjunctival Degenerations

4 things to know?

A
  1. Concretions
  2. Conjunctivochalasis
  3. Pinguecula (Review from last lecture)
  4. Retention Cyst (Conjunctival Inclusion Cyst)
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17
Q

Conjunctival Degenerations: Concretions

  1. How common are they?
  2. Uni or Bilateral?
  3. Associated with what 2 things?
A
  1. VERY COMMON
  2. Usually Bilateral
  3. Aging (most of the time) and Chronic Conjunctival Inflammation
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18
Q

Conjunctival Degenerations: Concretions

  1. What are they?
    a. Made up of what 2 things?
  2. Where are they found?
A
  1. Multiple Tiny Yellowish White Deposits
    a. Epithelial Debris and Keratin
  2. Subepithelial Conjunctiva (Forniceal and Inferior Palpebral)
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19
Q

Conjunctival Degenerations: Concretions

  1. What can they become?
  2. What might they ERODE?
    a. This will lead to what?
A
  1. Calcified
  2. Overlying Epithelium
    a. Ocular Irritation
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20
Q

Conjunctival Degenerations: Concretions

Treatment

  1. If Asymptomatic?
  2. If Symptomatic?
A
  1. None. Just Monitor

2. Topical Anesthetic. Remove them.

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21
Q

Conjunctival Degenerations: Conjunctivochalasis

  1. How common are they?
  2. What are they associated with? (1)
    a. They’re exacerbated by what?
A
  1. Relatively Common
  2. AGING
    a. by Posterior Lid Margin Disease
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22
Q

Conjunctival Degenerations: Conjunctivochalasis

  1. Signs: What is Noted b/w the Globe and the Lower Lid?
    a. May note staining with what?
  2. Symptoms (2/3)
A
  1. Fold of Redundant Conjunctiva
    a. Rose Bengal
  2. Epiphora (Secondary Punctal Stenosis: Mechanical Obstruction of Inferior Punctum)

and

Possible FBS on Downgaze

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23
Q

Conjunctival Degenerations: Conjunctivochalasis

Treatment

  1. What 4 things can be done to treat it?
A
  1. Lubrication
  2. Conjunctival Resection if it’s severe enough
  3. Manage Secondary Conditions (Blepharitis)
  4. Topical Steroids if it’s Inflamed
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24
Q

Conjunctival Degenerations: Conjunctival Retention Cyst (Conjunctival Inclusion Cyst)

  1. How common is it?
  2. Sign?
  3. Fluid can be what 2 things?
  4. What 2 locations of the conj is it found?
A
  1. VERY COMMON
  2. Thin walled (Translucent) fluid filled cyst
  3. Clear and Turbid
  4. Bulbar or Palpebral Conjunctiva
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25
Q

Conjunctival Degenerations: Conjunctival Retention Cyst (Conjunctival Inclusion Cyst)

  1. Symptoms?
  2. Treatment?
A
  1. Usually none. Sometimes a Cosmetic Concern

2. Usually None. You can puncture it with a Needle

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26
Q

Benign Conjunctival Lesions

  1. 5 discussed in class…
A
  1. Conjunctival Nevus
  2. Conjunctival Epithelial Melanosis
  3. Dermoid
  4. Dermolipoma
  5. Pyogenic Granuloma
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27
Q

Benign Conjunctival Lesions: Conjunctival Naevus

  1. MOST COMMON what?
  2. 1% chance that what will happen?
  3. When does it present?
A
  1. Melanocytic Conjunctival Tumor
  2. of Malignant Transformation
  3. 1st-2nd Decade
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28
Q

Benign Conjunctival Lesions: Conjunctival Naevus

Signs

  1. Type of Lesion?
    a. Where is it Located?
    b. Size?
    c. Most common locations? (3)
A
  1. Solitary, UNILATERAL, Discrete, Mildly elevated intraepithelial Lesions
    a. on Bulbar Conjunctiva
    b. Variable
    c. Caruncle, Juxtalimbal, and Plica
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29
Q

Benign Conjunctival Lesions: Conjunctival Naevus

Signs (2)

  1. Pigmentation?
  2. May have what kind of space?
  3. What can it become in children and adolescents?
A
  1. Variable. (Non-pigmented is also Possible)
  2. Cystic Spaces
  3. Pink and Congested
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30
Q

Benign Conjunctival Lesions: Conjunctival Naevus

Signs of Potential Malignancy

  1. 4 things?
A
  1. Unusual Location (Palpebral Conj or Fornix)
  2. Prominent FEEDER VESSEL
  3. Sudden Growth or Change in Pigmentation
  4. Adult Age Development
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31
Q

Benign Conjunctival Lesions: Conjunctival Naevus

Treatment?

A
  1. Excision
    a. COSMETIC is the main reason

b. Irritation
c. Suspicious Appearance

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32
Q

Benign Conjunctival Lesions: Conjunctival Dermoid

  1. How common is it?
  2. When does it appear?
  3. What is it?
  4. 2 Systemic Associations?
A
  1. Uncommon
  2. Early Childhood. (CONGENITAL)
  3. Solid Mass. Made of COLLAGENOUS TISSUE (Dermal Elements)
  4. Goldenhar Syndrome, and Linear Nevus Sebaceus of Jadassohn
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33
Q

Benign Conjunctival Lesions: Conjunctival Dermoid

Signs

  1. It’s a Subconjunctival Mass. (what 4 things does it appear like)
    a. What may protrude from it?
  2. Where is it located at? (most commonly)
    a. May encompass what?
A
  1. Smooth, Soft, Yellowish white subconjunctival mass.
    a. Hair
  2. Inferotemporal Limbus
    a. the Entire Limbus (Complex Choristoma)
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34
Q

Benign Conjunctival Lesions: Conjunctival Dermoid

Treatment

  1. Indicated for what 3 things?
  2. Small Lesion: What do u do?
  3. Large Lesion: What do you do?
A
  1. Cosmetic Reason; Chronic Irritation. Amblyopia (Astigmatism, and Involves Visual Axis)
  2. Excision
  3. Lamellar Keratosclerectomy
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35
Q

Benign Conjunctival Lesions: Dermolipoma

  1. How common is it?
  2. Uni or Bi?
  3. Presents when?
  4. Similar to what?
    a. has what tissue in it?
A
  1. Uncommon
  2. Bilateral
  3. In ADULTHOOD (Congenital)
  4. Dermoid
    a. Fatty Tissue
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36
Q

Benign Conjunctival Lesions: Dermolipoma

Signs

  1. Subconjunctival Mass….like what?
  2. Location?
    a. Can extend into what?
    b. Hard to see what?
A
  1. Soft, Movable, Yellowish-TAN Subconjunctival Mass
    a. May have hair protruding
  2. Superior Temporally Near Outer Canthus
    a. Into Superior Fornix
    b. the Posterior Limit
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37
Q

Benign Conjunctival Lesions: Dermolipoma

Important Diff Dx

  1. Prolapse of what?
    a. Can be repositioned into orbit with what?
  2. Orbital Lobe of what?
  3. What Lymphoma?
A
  1. Orbital Fat Prolapse
    a. with Pressure
  2. of Lacrimal Gland
  3. Lacrimal Gland Lymphoma
38
Q

Benign Conjunctival Lesions: Dermolipoma

Treatment

  1. Is it needed?
  2. Surgery can do what 3 things?
  3. What can be done
A
  1. No. SHOULD be AVOIDED
  2. Can Damage: Recti Muscles, Lacrimal Gland, and Levator
  3. Debulk Anterior Portion of Cosmetic Concern
39
Q

Benign Conjunctival Lesions: Pyogenic Granuloma

A

Review Slide from Previous Lecture

40
Q

Benign Conjunctival Lesions: Conjunctival Epithelial Melanosis (Racial Melanosis)

  1. How common is it?
    a. Found more in whom?
  2. Uni or Bi?
    a. Symmetric or Asymmetric?
  3. More pronounced during what?
  4. Due to INCREASED production of what?
A
  1. Common
    a. Darkly Pigmented Ethnicity
  2. Bilateral
    a. Asymmetric
  3. During Puberty
  4. Increased MELANIN Production
41
Q

Benign Conjunctival Lesions: Conjunctival Epithelial Melanosis (Racial Melanosis)

Presentation

  1. Usually when?
    a. Static by when?
A
  1. 1st couple of years

a. by early Adulthood

42
Q

Benign Conjunctival Lesions: Conjunctival Epithelial Melanosis (Racial Melanosis)

Signs

  1. 3 things about the pigmentation?
    a. Moves freely over the Surface of the Globe with what?

b. Scattered throughout what?
c. More intense at what?

A
  1. Flat, Patchy, and Brownish
    a. Palpation

b. Conjunctiva
c. the Limbus

43
Q

Benign Conjunctival Lesions: Conjunctival Epithelial Melanosis (Racial Melanosis)

Treatment

  1. Is it needed?
A
  1. No Malignant Potential, and No treatment Necessary
44
Q

Malignant or Pre-Malignant Conjunctival Lesions: Primary Acquired Melanosis (PAM)

  1. How common is it?
  2. Uni or Bi?
  3. Affects whom more?
  4. 2 types?
A
  1. RARE
  2. Unilateral
  3. Elderly fair skinned individuals
  4. a. PAM w/o Atypia
    b. PAM w/Atypia
45
Q

Malignant or Pre-Malignant Conjunctival Lesions: Primary Acquired Melanosis (PAM)

PAM w/o Atypia

  1. Benign or Malignant?
  2. Found where in the epithelium?
  3. Proliferation of what?
  4. Risk of Malignant Transformation?
A
  1. Benign
  2. Intraepithelial
  3. of Melanocytes
  4. None
46
Q

Malignant or Pre-Malignant Conjunctival Lesions: Primary Acquired Melanosis (PAM)

PAM w/Atypia

  1. Found where in Epithelium?
  2. Proliferation of what?
    a. Variable what? (2)
  3. 50% chance of what?
A
  1. Intraepithelial
  2. of Melanocytes that are PLEOMORPHIC
    a. Size and Shape
  3. of Infiltrative malignancy w/in 5 years
47
Q

Malignant or Pre-Malignant Conjunctival Lesions: Primary Acquired Melanosis (PAM)

Onset of PAM

  1. After what age?
A
  1. After age 45
48
Q

Malignant or Pre-Malignant Conjunctival Lesions: Primary Acquired Melanosis (PAM)

Signs

  1. What does it look like?
  2. Flat or Elevated?
  3. Color?
  4. Involves what 2 regions usually?
  5. Can be seen where?
  6. May do what?
  7. Sudden onset of what?
A
  1. Irregular, Unifocal or Multifocal Areas
  2. Flat
  3. Golden Brown to Dark Chocolate Colored
  4. Limbus and Interpalpebral Region
  5. On any part of Conj (Evert Lids)
  6. Expand or shrink or remain stable. Or may lighten or darken focally
  7. of Nodules = STRONG SUSPICION of MELANOMA
49
Q

Malignant or Pre-Malignant Conjunctival Lesions: Primary Acquired Melanosis (PAM)

Evaluation

  1. Best thing to do?
  2. Only way to differentiate what?
A
  1. Biopsy and histological Study

2. PAM w/ and w/o Atypia

50
Q

Malignant or Pre-Malignant Conjunctival Lesions: Primary Acquired Melanosis (PAM)

Treatment

  1. Small Lesions?
  2. Large Lesions?
A
  1. Excision

2. Incision Biopsy from Multiple Sites. If histology Shows ATYPIA: then CRYOTHERAPY or TOPICAL MITOMYCIN C

51
Q

Malignant or Pre-Malignant Conjunctival Lesions: Conjunctival Melanoma

  1. Common?
  2. % of All ocular Malignancies?
  3. 75% of cases arise from what?
  4. 20% of cases arise from what?
  5. Remaining arise from what?
A
  1. Uncommon
  2. 2%
  3. from PAM w/Atypia
  4. from Pre-existing Nevus
  5. De Nova
52
Q

Malignant or Pre-Malignant Conjunctival Lesions: Conjunctival Melanoma

Presentation

  1. What decade?
  2. Associated with what?
A
  1. 6th Decade; Rarely Earlier

2. with Dysplastic Nevus Syndrome

53
Q

Malignant or Pre-Malignant Conjunctival Lesions: Conjunctival Melanoma

Signs

  1. Type of Nodule?
    a. Type of Nevus?

b. May be Fixed to what?
c. May be located where?

A
  1. Black or Gray Vascularized Nodule
    a. De Nova Nevus
    b. to Episclera
    c. anywhere on Conjunctiva (Predilection for LIMBUS, and may extend onto the Cornea)
54
Q

Malignant or Pre-Malignant Conjunctival Lesions: Conjunctival Melanoma

Signs

  1. Type of Tumors?
    a. What do they look like?
  2. Multifocal Lesions Possible: Usually associated with what?
    a. Appear as focal Areas of what?
A
  1. Amelanotic Tumors possible
    a. Pink, Smooth, “Fish Flesh” Appearance
  2. PAM w/Atypia
    a. of Thickening and Nodularity
55
Q

Malignant or Pre-Malignant Conjunctival Lesions: Conjunctival Melanoma

Treatment

  1. Circumscribed Lesions
    a. Type of Excision?
    b. Type of therapy?
    c. Histological study…why?
  2. Diffuse Melanoma (PAM)
    a. What do they do?
A
  1. a. Wide Margin Excision
    b. Cryotherapy
    c. to see if it’s a DEEP surface extension… then you need to do Radiotherapy
  2. a. Excision of Nodules. Cryotherapy or Mitomycin C of Diffuse Area
56
Q

Malignant or Pre-Malignant Conjunctival Lesions: Conjunctival Melanoma

Treatment 2

  1. Recurrence
    a. What 2 things should be done?
  2. Exenteration DOES NOT IMPROVE what?
A
  1. a. Local resection and Radiotherapy

2. Survival rate. Reserved for very aggressive disease

57
Q

Malignant or Pre-Malignant Conjunctival Lesions: Conjunctival Melanoma

Prognosis

  1. Mortality at 5 years?
  2. Mortality at 10 years?
  3. Main sites of Metastasis? (4)
A
  1. 12%
  2. 25%
  3. Brain, Liver, Lung, Regional Lymph Nodes
58
Q

Malignant or Pre-Malignant Conjunctival Lesions: Conjunctival Melanoma

Prognosis

  1. Indications of Poorer Prognosis
    a. Tumor types?

b. Tumor Thickness greater than what?
c. what else/

A
  1. a. Multifocal Tumors; Extralimbal Tumors involving (caruncle, fornix, palpebral conj)
    b. Greater than 2 mm
    c. Recurrence, or Lymphatic or Orbital Spread
59
Q

Ocular Surface Squamous Neoplasia (OSSN)

  1. AKA? (3 things)
  2. Spectrum of Lesions
    a. Uni or bi?
    b. Progression: slow or fast?
    c. Epithelial (2)
  3. 3 forms?
A
  1. Conjunctival Intraepithelial Neoplasia (CIN); Bowen’s Disease; Conjunctival Dyskeratosis
  2. a. Unilateral
    b. Slowly Progressive
    c. Conjunctival and Corneal
  3. Benign, Premalignant, and Malignant forms
60
Q

Ocular Surface Squamous Neoplasia (OSSN)

Associated with what 5 things?

A
  1. AIDS
  2. HPV
  3. Stem Cell Therapy
  4. UV Exposure
  5. Xeroderma Pigmentosum
61
Q

Ocular Surface Squamous Neoplasia (OSSN)

Histologic Spectrum

  1. Conjunctival Epithelial Dysplasia
  2. Carcinoma in-situ
  3. Squamous Cell carcinoma.
A
  1. Dysplastic Cells in BASAL Layers of Epithelium
  2. Dysplastic Cells involving Full thickness Epithelium
  3. RARE; Invasion of Underlying Stromal Tissue
62
Q

Ocular Surface Squamous Neoplasia (OSSN)

Presentation

  1. When?
  2. What does it look like?
  3. Signs?
A
  1. Late Adulthood
  2. Ocular Irritation or Ocular Mass
  3. Variable; Clinical Differentiation b/w the 3 types UNRELIABLE!!
63
Q

Ocular Surface Squamous Neoplasia (OSSN)

Signs

  1. Irritation or Mass
    a. May involve what 2 things?
    b. Most common where?
  2. Appearance? (4)
A
  1. a. Any area of the Conj or Cornea
    b. In Interpalpebral Space at the Limbus
  2. a. Gelatinous
    b. White Leukoplakic
    c. Papillomatous
    d. Squamous Cell Carcinoma
64
Q

Ocular Surface Squamous Neoplasia (OSSN)

Signs: Appearance

  1. Gelationus
    a. type of mass?
    b. What is see on it?
  2. White Leukoplakic
    a. What is it?
A
  1. a. Jelly Like Mass
    b. Superficial Feeder Vessels
  2. a. White Plaque covering and obscuring lesion
65
Q

Ocular Surface Squamous Neoplasia (OSSN)

Signs: Appearance

  1. Papillomatous
    a. lesion looks like what?
    b. Vessels look like?
  2. Squamous Cell Carcinoma
    a. Lesion looks like what?
    b. Vessel type?
    c. May exhibit what?
    d. May involve what?
    e. What is RARE?
A
  1. a. Papilloma like lesion
    b. Corkscrew-like surface vessels
  2. a. Fleshy Pink Papillomatous Lesion
    b. Feeder Vessels
    c. Diffuse Growth (Looks like Chronic Conjunctivitis)
    d. Cornea
    e. Intraocular Extension and Metastasis is RARE
66
Q

Ocular Surface Squamous Neoplasia (OSSN)

Special Testing

  1. Ultrasonic Biomicroscopy (UBM)
    a. Determines what?
  2. Exfoliative Cytology?
  3. Impression Cytology?
A
  1. a. Depth of Lesion
  2. Scraping
  3. Cellulose Acetate Filter: Pressed onto Ocular Surface to Remove Cells
67
Q

Ocular Surface Squamous Neoplasia (OSSN)

Treatment

  1. Main thing to do?
  2. Adjunctive therapy possible: Reduce Recurrence with what 4 things?
A
  1. Excision: 2-3 mm margin
  2. a. Cryotherapy
    b. Interferon
    c. Mitomycin C
    d. 5-Fluorouracil
68
Q

Conjunctival Papilloma

  1. Common?
  2. Benign or Metastatic?
  3. Uni or Bi?
  4. Found in whom?
  5. Secondary to what Sexually transmitted disease?
  6. Infection spread from mother to child via what?
A
  1. Uncommon
  2. Benign
  3. Unilateral, but Bilateral is possible although very rare
  4. Children and young adults
  5. HPV
  6. Infected Vagina
69
Q

Conjunctival Papilloma

Signs

  1. 2 types of lesions?
    a. Most common location?
    b. 2 other locations?
  2. Solitary?
A
  1. Sessile or Pedunculated Lesion
    a. Juxtalimbal
    b. Fornix and Caruncle
  2. Multiple possible: May become Confluent
70
Q

Conjunctival Papilloma

Signs: Large Lesions

  1. May encroach on what?
  2. May cause what?
  3. May interfere with what?
A
  1. on Cornea
  2. Irritation
  3. with Lid Closure
71
Q

Conjunctival Papilloma

Symptoms

  1. Main things?
A
  1. Cosmetic

If LARGE: then IRRITATION, FBS, Lid Closure Complications

72
Q

Conjunctival Papilloma

Treatment

  1. Small Lesions: What’s needed?
  2. Large Lesions: 2 things?
  3. Recurrence: What 4 things can be done?
A
  1. Not required. May resolve spontaneously
  2. Excision; Cryotherapy to base
  3. Alpha Interferon; CO2 Laser Vaporization; Cimetidine (Tagamet); Mitomycin C
73
Q

Sclera

  1. What is it?
  2. Makes up how much of the thickness of the globe?
  3. Contains what 2 fibers types?
  4. 4 layers?
A
  1. Opaque Fibrous Outer Layer
  2. 5/6th of the thickness
  3. Collagen and Elastic
  4. Endothelium; Episclera; Lamina Fusca; Stroma
74
Q

Episclera

  1. Is it vascular?
A
  1. Highly: Anterior Ciliary Arteries
75
Q

Miscellaneous Anomalies of the Sclera/Episclera

3 of them

A

Osterogenesis Imperfecta

Ehlers-Danlos Syndrome

Scleral Hyaline Plaque

76
Q

Osterogenesis Imperfecta

  1. Genetic?
  2. Type of disease?
  3. Usually involves a Defect of what?
  4. At least 2 have Ocular Symptoms: What are they?
A
  1. AD
  2. Connective Tissue Disease
  3. of Type 1 Collagen Synthesis
  4. Type 1 and Type 2a
77
Q

Osterogenesis Imperfecta

Type 1

  1. Genetic?
  2. Ocular Signs? (3 things)
    a. Sclera?
    b. Cornea? (2)
  3. Systemic (6)
A
  1. AD
  2. a. Blue Sclera
    b. Megalocornea and Corneal Arcus
  3. a. Deafness
    b. Dental Hypoplasia
    c. Easy Breaking
    d. Few Fractures
    e. Hyperextensible Joints
    f. Little or No Deformity
78
Q

Osterogenesis Imperfecta

Type 2a

  1. Genetic?
  2. Ocular (2)
  3. Systemic (5)
A
  1. AD
  2. a. Blue Sclera
    b. Shallow Orbits
  3. a. Severe Deafness
    b. Dental Anomalies
    c. Multiple Fractures
    d. Short Limbs
    e. Death in Early Infancy (Respiratory Infection)
79
Q

Ehlers-Danlos Syndrome

  1. How common is it?
  2. Genetic?
  3. Disorder of what?
  4. Ocular Symptoms associated with what types?
A
  1. RARE
  2. AR
  3. of Collagen: Deficiency of LYSYL Hydroxylase
  4. Type 6. Type 4 (rarely)
80
Q

Ehlers-Danlos Syndrome

  1. Skin
    a. What about it?
    b. Easily what?
    c. Tendency for what?
  2. Joints
    a. What about them?
A
  1. a. Thin and Hyperelastic
    b. Easily Bruised
    c. for Papyraceous Scarring
  2. a. Hypermobile: recurrent dislocation and Frequent Falls
81
Q

Ehlers-Danlos Syndrome

  1. Cardiovascular
    a. 2 things
A
  1. Bleeding Tendency and Dissecting Aneurysms
82
Q

Ehlers-Danlos Syndrome

Ocular

  1. Sclera: what about it?
  2. Type of Folds?
  3. Cornea?
  4. Retina?
A

Fragile Sclera (globe can rupture w/minor trauma)

  1. Epicanthal Folds
  2. Microcornea; Keratoconus; Keratoglobus; Myopia; ECTOPIA LENTIS
  3. Retinal Detachment
83
Q

Scleral Hyaline Plaque

  1. AKA?
  2. Related to what?
  3. What is it?
  4. Location at Insertion of what?
  5. Benign or metastatic?
A
  1. Senile Hyaline Plaque
  2. Age related (probably)
  3. Bilateral, Oval, Dark Gray Plaques
  4. of Horizontal Recti
  5. Benign
84
Q

Episcleritis

  1. Common?
  2. Benign?
  3. Idiopathic?
  4. Recurrent?
  5. Self-limiting?
  6. 2 Types?
A
  1. Common
  2. Usually
  3. Usually
  4. Occasionally
  5. usually
  6. a. Simple Episcleritis
    b. Nodular Episcleritis
85
Q

Episcleritis

Simple Episcleritis

  1. % of all cases?
  2. Seen more in whom?
  3. Does it recur?
  4. Frequency of episodes?
A
  1. 75%
  2. Females
  3. Frequently: Same eye; Both Eyes
  4. Decreases over time (may disappear after many years)
86
Q

Episcleritis

Simple Episcleritis: Signs

  1. Hyperemia (injection)
    a. 2 ways it can present?
    b. Frequently what?
    c. Increased in severity for what?
    d. Fades when?
    e. May be what?
A
  1. a. Sectoral or Diffuse
    b. Interpalpebral
    c. for first 12 hours
    d. over 2-3 days
    e. Unilateral or Bilateral or Switch
87
Q

Episcleritis

Simple Episcleritis

  1. 2 signs?
  2. Treatment
    a. Mild?

b. More severe?

A
  1. Redness; Mild Irritation
  2. a. None
    b. Cool AT’s.

Mild Topical Steroid (FML or Lotemax qid 1-2 wks)

Oral NSAIDS: Ibuprofen 200-800mg po TID

88
Q

Episcleritis

Nodular Episcleritis

  1. % of cases?
  2. Seen more in whom?
  3. Onset type?
  4. More prolonged what?
  5. Presentation?
A
  1. 25%
  2. Females
  3. Less Acute Onset
  4. More prolonged course
  5. Red eye upon waking. Area of redness increases in size and discomfort over 2-3 days
89
Q

Episcleritis

Nodular Episcleritis

  1. 1 or more tender what?
    a. Found w/in what?
  2. Slit lamp section demonstrates what?
  3. 2.5% phenylephrine: does what?
A
  1. nodules
    a. w/in interpalpebral fissure
  2. that sclera is flat
  3. Blanches vessels; Better visualization of uninvolved sclera beneath
90
Q

Episcleritis

Nodular Episcleritis

Signs
1. Episode is what?

  1. Repeated attacks can cause what?
  2. Treatment?
A
  1. Self-limited (lasts longer than simple)
  2. Can cause permanent Vessel Dilation
  3. Same as for simple
91
Q

Episcleritis

Important differentials? (4)

A

Scleritis

Iritis

Conjunctivitis

Inflamed Pinguecula

Ocular Disease (11 decks)

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