Ocular Pathology Flashcards
A. Tunics/coats:
1. Fibrous (______, ______) = ______, ______, light _______
2. Vascular - Uveal (_____, ______ _____, _______) = _______ & vascular
* Light _______, _______
* ______
* ______ removal
3. Nervous (_____, _____ nerve) = ____ and _____ signaling to brain
B. Aqueous humor, lens, vitreous humor
* Light _______
* ________ pressure
A. Tunics/coats:
1. Fibrous (corneal, sclera) = shape, protection, light refraction
2. Vascular - Uveal (iris, ciliary body, choroid) = pigmented & vascular
* Light reflection, scattering
* Nutrition
* Waste removal
3. Nervous (retina, optic nerve) = electric and chemical signaling to brain
B. Aqueous humor, lens, vitreous humor
* Light refraction
* Internal pressure
General considerations
Clinical expressions of disease
– Blindness resulting from:
* alterations in the _____, _____, _______
* damage to the _______, optic ______
* _________ lesions on the brain
– Conjunctival discharge
– Swelling and pain
- Swelling of the eyelids/conjunctiva ?
– Sensitivity to light
General considerations
Clinical expressions of disease
– Blindness resulting from:
* alterations in the cornea, lens, humors
* damage to the retina, optic nerve
* extraocular lesions on the brain
– Conjunctival discharge
– Swelling and pain
- Swelling of the eyelids/conjunctiva ?
– Sensitivity to light
General considerations
Clinical expressions of disease
– Excessive (_______) or decreased _________
– ________ of the cornea or lens
– __________
– __________
– _______________
– __________
– _________ and _________
General considerations
Clinical expressions of disease
– Excessive (epiphora) or decreased lacrimation
– Opacity of the cornea or lens
– Exophthalmos
– Proptosis
– Buphthalmos
– Enophthalmos
– Hyphema and Hypopyon
What are each of the conditions below?
Left = Bupthalmus (enlargement of the eye)
- clinical sign of glaucoma in young animals b/c in young animals, sclera is still thin so it allows the eye to increase in size.
- Not in older animals
Middle = Proptosis (more severe condition of Exopthalmus)
- Could be a fracture; anything that is a space occupying lesion in the orbit
Right = Exopthalmus (protrusion of the eye)
- immune mediated polymyositis
Cattle: very common for them to have exopthalmus secondary to bovine leukemia virus
Name the conditions pictured below:
Left = Hyphema
- Hemorrhage in anterior chamber
- Differentials: Hypertension (felline hyperthyroidism, chronic kidney disease)
Right = Hypophon
- Discoloration due to neutrophils and fibrin in anterior chamber
- Differentials: Secondary to bacterial infection or ulcer or uveitis
What condition is pictured below?
Congenital and hereditary anomaly
Condition: Microphthalmia
Teratogens (any agent that causes malformation during embryogenesis): infectious, nutritional, genetic
Defective cell signaling during organogenesis –> blindness (unilateral or bilateral)
Not common
What conditions are pictured below?
Cyclopia and synophthalmos (sub of cyclopia)
Cyclopia and synophthalmos
* Craniofacial malformations
* Classic:
* Sheep grazing on Veratrum californicum within ___ to ___ days of gestation when normally the ________ is supposed to separate; prevents separation of ______ (_______).
* Alkaloid cyclopamine and jervine
Cyclopia and synophthalmos
* Craniofacial malformations
* Classic:
* Sheep grazing on Veratrum californicum day _____ within 14 to 15 days of gestation - sepration of proecenphalos occurs; prevents separation of proencephalos (holoprosencephalos).
* Alkaloid cyclopamine and jervine
Embryonic vasculature
Staets with the arloid artery = anterior lens, iris, cornea
What condition is pictured below?
persistent pupillary membrane = failure of blood vessels to regress
- very common in cats
- regresses 2-4 weeks after birth
Name the condition below:
* ________ membrane is a vascular fetal structure that covers the _____ during
development
* Usually _______ (__-___ weeks after birth)
* ______/_________ strands across pupil
* ___-to-____
* ____-to-___
* ___-to-____
* Not ______, don’t _____ or affect vision
Persistent pupillary membrane (he said to remember this)
* Pupillary membrane is a vascular fetal structure that covers the pupil during
development
* Usually regresses (2-4 weeks after birth)
* Uveal/vascularized strands across pupil
* Iris-to-iris
* Iris-to-lens
* Iris-to-cornea
* Not painful, don’t progress or affect vision
Cornea
1. The epithelium is made up of?
2. What are the spaces below indicative of?
3. The Decements membrane is produced by?
4. The corneal epithelium and superficial stroma are suppled by?
5. The endothelium, Desements membrane and deep stroma are supplied by?
- stratified squ epi = non keratinized
- spaces are artifact, not edema
- decemet = a basemet mebrane produ ed by corneal endothelium
- epi and superfical stroma = supplied by the tear film to irrigate and provide oxygen
- stroma, desmet, endo = provided by aqueous humor
Cornea
1. What are the acute responses to injury? e.g. keratitis
- What are the Chronic responses to injury? e.g. keratitis
Cornea
1. What are the acute responses to injury? e.g. keratitis
- Edema –> neutor = acute, lymphocytic= chronic
- Inflammation - keratitis
- What are the Chronic responses to injury? e.g. keratitis
- Vascularization
- Pigmentation
- Fibrosis
What can be seen in the images below?
Right = chronic response to injury
- inflammation, vascularization, and pigmentation
Left = normal
Label the image below
See below
What can be seen in the images below?
Opacity of cornea, a lot of blood vessels.
- vascularization of cornea
Middle = pigmentation of cornea
Healing =
Keratitis = Cornea is most susceptible
1. Irritation
* Entropion = eyelid is turned ______ so ______ rub cornea and damage it , eyelid masses, particulate material
2. Desiccation (improper ________ of cornea)/exposure
* Lagophthalmos = incomplete or abnormal ______ of the eyelids (_______ breeds = _____ eyes)
* Buphthalmos (e.g., ______) can lead to _______
* Exophthalmos (e.g., orbital ______)
3. Repeated corneal ________
4. Trauma
5. Infectious (?)
6. Immune-mediated (certain k9 breeds: _____ in German Shepherd)
Keratitis = Cornea is most susceptible
1. Irritation
* Entropion = eyelid is turned inward so eyelashes rub cornea and damage it , eyelid masses, particulate material
2. Desiccation (improper lubrication of cornea)/exposure
* Lagophthalmos = incomplete or abnormal closure of the eyelids (brachycephalic breeds = bulging eyes)
* Buphthalmos (e.g., glaucoma) can lead to lagophthalmos
* Exophthalmos (e.g., orbital masses)
3. Repeated corneal ulceration
4. Trauma
5. Infectious (Bacteria, fungi, Moraxella bovis, Feline herpesvirus-1)
6. Immune-mediated (certain k9 breeds: pannus in German Shepherd)
Keratitis
Acute
* Inflammatory cells: ________ (red arrows), leading to _____
* ________ release enzymes –> Keratomalacia = “______ ulcer”; severe inflammation of _____ –> ______
* Proteases, metalloproteinases
* Endogenous (________)
* Exogenous (__________ = bacteria, fungi = ______ causes kerato)
Keratitis
Acute
* Inflammatory cells: Neutrophils (red arrows), leading to edema
* Neutrophils release enzymes –> Keratomalacia = “melting ulcer”; severe inflammation of cornea –> liquefaction
* Proteases, metalloproteinases
* Endogenous (inflammation)
* Exogenous (Pseudomonas = bacteria, fungi = proteases causes kerato)
Chronic kerattiis
* Chronic
*Cells seen on histo : ______/_____ – > inflammation
*“skin-like” (___________)
Acanthosis/melanosis/vascularization/inflammation/stromal scarring
____________ of epithelium
___________
Chronic kerattiis
* Chronic
*L/P inflammation
*“skin-like” (epidermalization)
Acanthosis/melanosis/vascularization/inflammation/stromal scarring
Hyperplasia of epithelium
pigmentation
Name the condition below:
* A.k.a. ____________
* Chronic or acute?
* Progressive or regressive?
* Unilateral or bilateral?
* _________-mediated
* _____ light lead to modification of cornea-specific antigens; Dogs that live in ___ altitude regions
* Can happen in _____ dog: ++________ _____
- Note the fleshy gray-pink superficial tissue in the ______ ______ and the ________ ______
Chronic superficial keratitis/ keratoconjunctivitis
* A.k.a. pannus
* Chronic, progressive, bilateral, immune-mediated
* UV light lead to modification of cornea-specific antigens; Dogs that live in high altitude regions
* Can happen in any dog: ++German Shepherd
- Note the fleshy gray-pink superficial tissue in the lateral limbus and the anterior cornea. There is NO ulceration (said very important). responds very well to corticosteroid therapy.
sclera is white tissue and then starts to move to center of eye.
Name the condition below:
* A.k.a. __________ ulcer, _______ ________ corneal epithelial defects (SCCED)
* ______ to _____ age of ____ dog, but seen mainly in boxers
* ____-healing (____ to heal) _______ corneal erosion (_______ or ______ by trauma).
* Poor epithelial adhesion to ______
* Histo (keratectomy):
* Non-adherent _________ epithelium
* Clefts between _________ and _______
Boxer ulcer
* A.k.a. Indolent ulcer, spontaneous chronic corneal epithelial defects (SCCED)
* Middle to older age of any dog, but seen mainly in boxers
* Non-healing (slow to heal) superficial corneal erosion (spontaneous or triggered by
trauma)
* Poor epithelial adhesion to stroma
* Histo (keratectomy):
* Non-adherent hyperplastic epithelium
* Clefts between epithelium and stroma
Name the condition below:
* Seen in what species?
* _________ cause and pathogenesis
* Proliferative or regressive?/______ lesions/_____ material
* Cytology: ______ cells, _____ cells, _______, granules…
________ mediated disease –> corticosteroids
DDx: ??
Eosinophilic keratitis
* Cats and horses
* Unknown cause and pathogenesis
* Proliferative/placoid lesions/white material
* Cytology: epithelial cells, mast cells, eosinophils, granules…
Immune mediated disease –> corticosteroids
DDx: ??
Name the condition below:
* Mainly seen in what species?
* Breed predisposition (________, ________)
* Cause _________: Hx of _______ disease: injury (________) and _______
* _______ pigmentation (______ to ______)
* ________ hyalinization (______ of stroma; can be _______ or _______ ulcer)
* Prone to __________ colonization
Corneal sequestrum
* Cats
* Breed predisposition (Persian, Siamese)
* Cause unknown: Hx of corneal disease: injury (trauma) and FeHV-1
* Stromal pigmentation (amber to black)
* Stromal hyalinization (necrosis of stroma; can be spontaneous or corneal ulcer)
* Prone to bacterial colonization
Name the condition below:
* Often __________
* _________ spp. and _______ spp. most common
* _________ wound w/ long-term ________ and/or __________
* Most common in ______ (warm and humid climate)
* Destructive, deep _____
* Ulcerative suppurative _______ with _______
*↑↑↑ ________, ______, _____
* Close to ________ Membrane (tropism)
* Exudate spillage into _______ chamber
- rupture of DM → __________
Fungal/mycotic keratitis
* Often opportunistic
* Aspergillus spp. and Fusarium spp. most common
* Corneal wound w/ long-term antibiotics and/or corticosteroids
* Most common in horses (warm and humid climate)
* Destructive, deep stroma
* Ulcerative suppurative keratitis with keratomalacia
*↑↑↑ neutrophils, necrosis, fungi
* Close to Desemans Membrane (tropism)
* Exudate spillage into anterior chamber
- rupture of DM → endophthalmitis
Name the condition below
Keratomalacia
completely obliterate the normal structure
of the cornea
Name the condition below
Necrotic tissue attracts _______
Calcific & lipid degeneration/keratopathy
* 2ary to _______ disease (_______ deposition)
- ______ accumulation in cornea is common with Metabolic disorders
- High fat diet: species?
- Dogs: conditions?
- Hyper______
Corneal degeneration
Necrotic tissue attracts calcium
Calcific & lipid degeneration/keratopathy
* 2ary to corneal disease (calcium deposition)
* lipid accumulation in cornea is common with Metabolic disorders
* High fat diet: Amphibians, reptiles, birds
* Dogs: Hyperadrenocorticism, hypothyroidism, diabetes
* Hypercalcemia
Name the condition below.
What is wrong with the frog’s eyes pictured below?
What stain is being used in the histological image on the bottom right?
Lipid keratopathy
frog only fed crickets
white = cholesterol
oil red o = lipid stains red
Name the condition below:
* Most often __________ from adjacent sites (________)
* E.g. ?
* Commonly seen in what species?
* Extension from conjunctiva or eyelid – ___ light (_____-pigmented skin)
* __________ and ________
* Dogs with _____2 keratitis
* Progression from hyperplasia => ______ => ______
* Topical ______-modulating drugs (risk factor)
Corneal neoplasms
* Most often extension from adjacent sites (conjunctiva)
* Squamous cell carcinoma (SCC)
* Horses, Cattle (Hereford), and cats
* Extension from conjunctiva or eyelid – UV light (non-pigmented skin)
* Ulceration and discharge
* Dogs with chronic keratitis
* Progression from hyperplasia => dysplasia => neoplasia
* Topical immuno-modulating drugs (risk factor)
Name the condition pictured below
Corneal Dermoid
* Congenital/Non-neoplastic/choristoma (skin on cornea)
What is pictured below?
* Is a circumscribed ________ of the ______
* Weakening/______ with _______
* _____ tissue lining (pigmented)
* Can look like ?
* Causes? anything that increases ocular ______ e.g.?
Staphyloma = circumscibed outpouch of sclera; name of clincial sign, not disease
* Is a circumscribed outpouching of the sclera
* Weakening/thinning with bulging
* Uveal tissue lining (pigmented)
* Can look like melanocytic tumors
* Causes?
* Glaucoma
* Traumatic
* Scleritis
What is pictured below?
Staphyloma
Granulomatous/Necrotizing scleritis
* Most commonly seen in what species?
* The cause is?
* Is this condition painful?
* rapidly-_________ to involve ____ sclera +/- ____ and ____
* _______ eye at risk/poor response to _____
* _______ sclera, +/- _______, _____
* robust _______ (sclera)
*What cells would you typically see in this situation?
Granulomatous/Necrotizing scleritis
* Most commonly seen in what species? Dogs
* The cause is? Idiopathic/unknown
* Painful
* rapidly-progressive to involve entire sclera +/- uvea and retina
* Contralateral eye at risk/poor response to therapy
* Thickened sclera, +/- staphyloma, uveitis
* Robust inflammation (sclera)
*Epithelioid macrophages, multinucleated giant cells and collagenolysis
What condition is pictured below?
Granulomatous/Necrotizing scleritis
What condition is pictured below?
* Most prevalent scleral disease of _____.
* Cause?
* Good response to ___________ therapy
* Is this firm or soft?
* Is this painful?
* Does this stay in place? Or can it be moved? * smooth, gray-pink mass/swelling
- Histo:
- _________ granulomas
- ABSENT _________
Nodular granulomatous episcleritis(NGE)
* Most prevalent scleral disease of dogs
* Idiopathic
* Good response to immunosuppressive therapy
* Firm, painless, moveable, smooth, gray-pink mass/swelling
* Histo:
* Discrete granulomas
* ABSENT collagenolysis
Neoplasms
Neoplasms
* _________ ___________ (most common tumor of sclera)
* _______ (no risk of ________)
* Can be quite large, extend into ______
* ++______ (what species?)
* Cats (Differentiate from extension of ____ melanoma!)
* Histo:
*Heavily ________
*Minimal _______, absent _______
Neoplasms
* Limbal melanocytoma (most common tumor of sclera)
* Benign (no risk of metastasis)
* Can be quite large, extend into cornea
* ++Dogs; labrador, golden retriever, german sheperd
* Cats (Differentiate from extension of iris melanoma!)
* Histo:
*Heavily pigmented
*Minimal atypia, absent mitoses
What is the Uvea composed of?
Iris
Ciliary body
Choroid (continuation of the ciliary body)
- mostly composed of RBCs and melanocytes.
- responds to inflammatory diseases in the eye
What is the major issue with uveitis?
- Major issue/refractory to therapy/blind, painful eye
Uveitis could be a primary infection or secondary to ?
trauma, neoplasia, glaucoma…
Anterior uveitis/Iridocyclitis is inflammation of the ?
inflammation of iris and ciliary body
Choroiditis (aka ?)
Posterior uveitis
not common and is an extension of the anterior uvea
Panuveitis is defined as?
Is this condition common or uncommon?
inflammation of iris, ciliary body and choroid
Most common presentation
Endophthalmitis is defined as?
inflammation extension to chambers
Panophthalmitis is defined as?
inflammation extends to sclera, cornea, retina
Name the condition pictured below.
What is typically observed in this condition?
Aqueous flare: proteins, fibrin, cells,
blood are observed in the ventral
anterior
cells/protein in anterior chamber, in the ventral aspect of the eye, because of gravity.
Descvribe the pathology of uveitis
—> Inflammation –> ____ Vascular permeability
* Iris => diffusion into _______ _____ => “Aqueous _____”
* Ciliary body => ______ and _____
* Swelling of ______ => edema;
* RPE => exudative retinal _______; may have leakage of fluid and cells into ______ space (space between retina and choroid). Leads to RTE; prominent retinal ______ epithelium found on histo
—> ______ exudation (“sticky”)
* Adhesive membranes (synechiae= adhesion between ____ and another structure of the eye/blocks => ______)
posterier synichia: iris adhered to _____
anterior synichia: iris adhered to ______
—> Inflammation –> ↑ Vascular permeability
* Iris => diffusion into aqueous humor => “Aqueous flare”
* Ciliary body => distension and cysts
* Swelling of Choroid => edema;
* RPE => exudative retinal detachment; may have leakage of fluid and cells into subretinoid space (space between retina and choroid). Leads to RTE; prominant retinal pigment epithelium found on histo
—> Fibrin exudation (“sticky”)
* Adhesive membranes (synechiae= adhesion between iris and another structure of the eye/blocks => glaucoma)
posterier synichia: iris adhered to lens
anterior synichia: iris adhered to cornea
Name the condition pictured below
Uveitis
cloudy b/c increased protein cells
fibrin, inflammatory reaction occurring here
yellow = precipitation of inflammatory cells in anterior chamber. Neutrophils and fibrin term = hypopnea?
Fibrin, proteinatious fluid in anterior chanmber. Iris is markedly thickined my infl cells (top arrows). Lesions there is a pupillary block. Bottom arrrows: eosino material = leakage of protein –> protein buildup. REtinal detachment as well; retina is supposed to be attached to the choroid.
Inf cells obliterate filtration angle leads to glaucoma
What can be seen in the image below?
Pictured is one of the consequences of Uveitis:
• Keratic precipitates (leukocytes + fibrin on endothelium)
What are the consequences of uveitis?
- Cornea:
* Edema (vessels / cytokines)
* Keratic precipitates (leukocytes + fibrin on endothelium) - Synechiae (anterior/posterior)
* Fibrin, granulation tissue
Other consequences of uveitis include?
- PIFMs (pre-iridal fibrovascular membranes)
* Vasogenic compounds
- Composed of _______ and _____; formed in _______ spectrum of ____. Inflmmation, seceretion of roll factors to induce this membrane which can obliterate filtration ______ leading to glaucoma. - Lens:
* Altered aqueous (“__________”) –> ________
- Avascular tissue - Retina:
* Fibrin attach to membranes can cause –> ______- __________ traction
- Subretinal exudation; leakage from ______ to _______ space, accumulation of fluid leads to ______ detachment.
- PIFMs (Pre-irthral? fibrovascular membrane)
* Vasogenic compounds
- Composed of fibroblasts adn vessels; formed in anterior spectrum of iris. Inflmmation, seceretion of roll factors to induce this membrane which can obliterate filtration angle leading to glaucoma. - Lens:
* Altered aqueous (“malnutrition”)
* Cataract
- Avascular tissue
Most nutrients that provide the nutrition of lens comes from the aquous humor. If you have changes in aqueous humor, can lead ot malnutrition of lens –> cataracts. - Retina:
* Fibrin attach to membranes can cause –> Detachment- Membranes traction
- Subretinal exudation; leakage from choroid to subretinoid spcae, acu,ulation of fluid leads to retinal detachment.
Lens-induced uveitis, caused by some lesions in the lens.
* Common in _____
* Two clinical syndromes:
1. Phacolytic
* ______ capsule
* Diffusion of soluble lens _____ (“LEAkage”)
- Mild
Lens proteins are highly antigenic because they are sequestered from _______ system;. induced _________
2. Phacoclastic
* _________ lens capsule (“BLAST”)
* Exposure of lens ______ and ____
Lens-induced uveitis, caused by some lesions in the lens.
* Common in dogs
* Two clinical syndromes:
1. Phacolytic
* Intact capsule
* Diffusion of soluble lens proteins (“LEAkage”)
- Mild
Lens proteins are highly antigenic because they are seqested from immune system;. induced inflammation
2. Phacoclastic
* Ruptured lens capsule (“BLAST”)
* Exposure of lens epithelium and fibers
What condition is pictured below?
What cells would you see on histo?
What are some common complications of this condition?
Phacolytic uveitis
* Diffuse, mild, L/P anterior uveitis
* Cataract
- b/c there is swelling and edema of lens in case of cataract; lens proteins can leak from the lens without rupturing the capsule.
* Complications
* Corneal vascularization, PIFM, synechiae, 2ary glaucoma…
Phacoclastic uveitis
1. Sudden release of lens contents into chambers
2. Ruptured capsule
* Spontaneous (e.g. intumescent cataracts)
* Trauma (blunt or penetrating)
* Dissolution by infection (e.g. encephalitozoonosis)
3. Intense lens-centered inflammation
*Suppurative/fibrinous/(pyo)granulomatous…
Phacoclastic uveitis
Shape of lens is abnormal
Severe lesions
Fiber degeneration
Necrosis
Capsule is light pink line; ruptured at bottom, leakage of lens proteins extending
- What condition is pictured below?
- This condition is very common in rabbits with?
Phacoclastic uveitis
Very common in rabbits infected with ecenphalitozooan caniliculi
What condition is pictured below?
Uveodermatologic syndrome aka Vogt–Koyanagi–Harada (VKH)-like syndrome
Uveodermatologic syndrome
* A.k.a. ?-like syndrome
* _________ disease /rapid progression/ _______
* _____ and _____ response against _______
* Canine ____ breeds (+ other breeds)
* E.g.?
* _________
* _______, ______ pigmented epithelium
* _____/hair ______
* ______ membranes
* Granulomatous choroiditis => exudative retinal ________ => diffuse uveitis/endophthalmitis
*=> PIFM => _______
• A.k.a. Vogt–Koyanagi–Harada (VKH)-like syndrome
• Autoimmune/rapid progression/bilateral
• Cellular and humoral response against melanin
• Canine Artic breeds (+ other breeds)
• Akita, Siberian Husky, Samoyed, Alaskan malamute…
• Depigmentation
• Choroid, iridociliary pigmented epithelium
• Skin/hair follicles
• Mucous membranes
• Granulomatous choroiditis => exudative retinal detachment => diffuse uveitis/endophthalmitis
•=> PIFM => glaucoma
immune mediated reaction against melanocytes, which is why you see depigmentation.
Ocular lesions usually precede mouth lesions, but usually we see both.
Uveodermatologic syndrome
What condition is pictured below?
Uveodermatologic syndrome
Granulomatous, a lot of MQ
dispersion of melanin
Feline lymphoplasmacytic uveitis
arrow = busacca nodules
Feline _____________ uveitis is the most common uveitis in cats
B. 2ary ________ very common => enucleation
C. Non-specific immune reactions
* Infectious (E.g.?.)?
*Immune-mediated ?
* So ultimately the cause is “_________”
D. Non-specific changes
* Perivascular infiltrates of _____ & ___ cells
* Mostly within ______ uvea
* Changes of ________
Feline lymphoplasmacytic uveitis
* Most common uveitis in cats
* 2ary glaucoma very common => enucleation
* Non-specific immune reactions
* Infectious (Toxo, Bartonella, FeLV, FIV…)? Immune-mediated ?
* “Idiopathic”
* Non-specific changes
* Perivascular infiltrates of lymphocytes & plasma cells
* Mostly within anterior uvea
* Changes of glaucoma
What condition is pictured below?
What do you notice about the image on the right?
Feline lymphoplasmacytic uveitis
On right, extends into iris more
]filtration angle at bottom of that, which is obstructed by inflammatory cells
- What condition is pictured below?
- What species does this effect?
- This condition is the most common cause of what two conditions?
- Equine recurrent uveitis
- Most common ocular disease in horses, 3. most common cause of blindness and cataracts
Blue eye or corneal edema seen here
Equine recurrent uveitis
* Side effects: ________ and ____
* ______-mediated disease with ________ to an infectious agent; Name the 2?
* Waxing and waning/uni-=> bilateral uveitis => ______ and _______
* Histo:
* ___________ exudation (esp. ciliary body)
* ____/_____ inflammation (anterior uvea, retina, choroid)/Lymphoid follicles
* ________-like material covering ciliary body (Stain used? )
* Ciliary epithelium w/ ________ _______ linear inclusions
Equine recurrent uveitis
* Blindness and Pain
* Immune-mediated disease with hypersensitivity to an infectious agent; Leptospira interrogans serovar Pomona
* Waxing and waning/uni-=> bilateral uveitis => glaucoma and cataract
* Histo:
* Fibrinopurulent exudation (esp. ciliary body)
* L/P inflammation (anterior uvea, retina, choroid)/Lymphoid follicles
* Amyloid-like material covering ciliary body (Congo Red+)
* Ciliary epithelium w/ cytoplasmic eosinophilic linear inclusions
white material: inflammatory cells
Vitrous is cloidy b/c of inf cells
Coronary body is thickened, on bottom right image
Cornea is edematous too (left image)
inflamnatory cellls in eiris
Equine recurrent uveitis
What type of inclusion bodies do you typically see in a case of equine recurrent uveitis?
See below
- What condition is pictured below?
- What category does this condition belong to?
- What cells would you see on histo?
- What type of exudate would you see here?
- Would you see vasculitis?
- How would you confirm your Dx?
- Feline infectious peritonitis
- Viral uveitis
- L/P or Pyogranulomatous uveitis
- Fibrinous exudate (coagulation of aqueous/vitreous)
- +/-Vasculitis (blood vessel necrosis)
- Confirmation by IHC; Antigen in cytoplasm of macrophages
FIP
Inflammation of iris
necrotizing vasculities
fibrin and infl cels in chambers of the euye
- What condition is pictured below?
- What category does this condition belong to?
- What is a rare reaction that can occur in this condition?
- Is this condition short or long lived?
- What can be seen grossly? What does it represent?
- What cells can be seen on histo?
- Would you see inclusion bodies on histo? If so, where would they be?
- Canine adenovirus-1 (infectious hepatitis)/ vaccination with live modified virus
- Viral uveitis
- Rare/type III hypersensitivity 6-7 days post vaccine
- Transient.. self-limiting
- Blue eye (Diffuse corneal edema)
6 L/P uveitis - +/- intranuclear viral inclusions in endothelial cells (blood vessels)
- What condition is pictured below? What is the etiologic agent?
- What category does this condition belong to?
- What would you see both in the eyes and throughout the body?
- Would this condition stay within the uvea? Or would it spread to other parts of the eye
- What cells would you see on histo?
- Bovine malignant catarrhal fever (MCF); Ovine herpesvirus-2
- Viral uveitis
- Vasculitis/lymphoid proliferation/necrosis
- Endophthalmitis
* Arterial fibrinoid necrosis - “Lymphoblastic”(peri)vascular infiltration (uvea, retina, +/-optic nerve)
Charqacterized by systemic vasculitis, like FIP
Main lesion of MCF: Ulcerative lesions in oral cavity, intestines, alimentary cavity; Very good differential for mucosal disease. When you have blue eye, it is most likely MCF. BVD does not have?
- What condition is pictured below?
- List the causes of this condition.
- What would you see on histology?
- Bacterial uveitis/endophthalmitis
- A. Exogenous cause: Penetrating wounds/progression from corneal ulcers
B. Endogenous cause (bacteremia/ septicemia): Foals/food animals (R. equi and strangles in horses) - Neutrophils (perivascular => stroma => chambers/subretinal space)
* Hypopyon
* +/-fibrin (fibrinopurulent endophthalmitis)
Most likely an exogenous source here
Hypopyon
pus, neutrophils filling anterior chamber of eye
- What type of disease is fungal uveitis?
- List the most common etiologic agents.
- Describe the pathogenesis of this condition.
- _______ aqueous/vitreous, exudative retinal _________
* ___________ endophthalmitis (___choroid/subretinal space)
- _______ aqueous/vitreous, exudative retinal _________
- Systemic disease
- Most common: Blastomyces dermatitidis, Cryptococcosus neoformans, Coccidioides immitis, and Histoplasma capsulatum
- Inhalation => start off with pneumonia signs, then spreads hematogenous/ extension of CNS
- Plasmoid aqueous/vitreous, exudative retinal detachment
* (Pyo)granulomatous endophthalmitis (↑choroid/subretinal space)
__________, a very common consequence of uveitis
(Pre-)iridal fibrovascular membranes (PIFMs)
PIFMs
- PIFMs occur in what situations?
- What is the Pathogenesis of PIFMs?
* ________ retina or ______ cells => _______ factors (VEGF)
* Arise as vascular ____ from iris _____ => _____ maturation
* Proliferate ______ tissue surfaces:
* Anterior and posterior iris, ciliary body (cyclitic membrane), lens
capsule, pectinate ligament
- 2ary to uveitis, retinal detachment, trauma, glaucoma, intraocular neoplasia…
- Hypoxic retina or neoplastic cells => vasogenic factors (VEGF)
* Arise as vascular buds from iris stroma => fibrous maturation
* Proliferate over tissue surfaces:
* Anterior and posterior iris, ciliary body (cyclitic membrane), lens
capsule, pectinate ligament
- Hypoxic retina or neoplastic cells => vasogenic factors (VEGF)
What are the complications of PIFMs?
*Complications: OSSI
* Outflow obstruction
* Synechiae (anterior and/or posterior)
* 2ary glaucoma
* Intraocular hemorrhage
?? = when there is ? of fibrovascular membrane, these vessels are new and tend ot leak erythrocytes so it is very common to see hemorrhage. This is called hemorrhage hyphema
- What condition is pictured below?
- A dog is pictured below. With this information, what is the name of this condition?
- Is this condition common in dogs?
- Is this condition benign or malignant?
- What part of the eye is affected?
- Uveal melanocytic neoplasia
- Canine Uveal Melanocytoma:
- Most common intraocular neoplasm
- Benign
- Anterior uvea or choroid
* Slow growth into adjacent tissue and chambers
* Tissue necrosis, distortion and secondary
changes common (mass-occupying lesion)
* ≤ 4 mitoses per 10 HPF (literature variation) –may use bleach
Canine Uveal Melanocytoma
left: uvea melnao
right: choroidd melanocytoma
- Name the condition pictured below.
- Is this condition common?
- Can arise from a __________
- Is this pigmented?
- List the anaplastic features
- Uveal melanocytic neoplasia
* Uveal (malignant) melanoma in DOGS: - Less common
- Can arise from a melanocytoma (usually anterior uvea); better to enucleate b/c?
- Usually less pigmented (or amelanotic)
* Anaplastic features (anisokaryosis, pleomorphism, large nucleoli)
* ≥ 4 mitoses per 10 HPF (usually more)
* Rare reports of metastases
Uveal melanocytic neoplasia
- Uveal melanocytic neoplasia is called what in cats?
- Is this condition common in cats?
- Progression
* ______ or ______ hyperpigmentation
* Confined to ______ surface of iris (_______)
* Coalescence over ____ or ____ + ________- FDIM (iris stroma)
* Obstruction of filtration angle => _______
* Invasion into _____ _____ and _____
- FDIM (iris stroma)
- ______ in earlier stages recommended
- Risk of metastases to?
- Uveal (malignant) melanoma in CATS:
- Feline Diffuse Iris Melanoma - Most common 1ary ocular tumor
- Progression
* Golden or brown hyperpigmentation
* Confined to anterior surface of iris (melanosis)
* Coalescence over months or years + thickening
* FDIM (iris stroma)
* Obstruction of filtration angle => glaucoma
* Invasion into ciliary body and sclera - Enucleation in earlier stages recommended
- Risk of metastases to liver, lung, kidney
What condition is pictured below?
• Feline Diffuse Iris Melanoma
What condition is pictured below?
• Feline Diffuse Iris Melanoma
FDIM
Different subtypes of melanoma
The function of the lens: great _______ power
–> Is it opaque or transparent?
* Vascular or Avascular?
* Pigmented or non-pigmented
* Does it contain water?
The function of the lens: great refractive power
* Transparent:
* Avascular
* No pigmentation
* Dehydrated (~65% water)
Lens epithelium: pumping water ____ of the lens
out
Lens - Physiology
- Metabolism:
- Glucose (______ absorption from aqueous) because it does not have its own _____ supply. This is why in cases of diabetes you see ______.
- __________ glycolysis (hexokinase pathway)
- Proteins sequestered from immune system => release => _________
*** It has to be _________ and in proper ______ (zonular _________)
Lens - Physiology
- Metabolism:
- Glucose (passive absorption from aqueous) because it
does not have its own blood supply. This is why in cases of diabetes you see cataracts - Anaerobic glycolysis (hexokinase pathway)
- Proteins sequestered from immune system => release =>
inflammation
*** It has to be transparent and in proper location
(zonular ligaments)
Lens here is in aposition held by the ?
Zonular ligament, an exte4nsion of the ciliary body
Lens - Histology
* Capsule: the capsule is secreted by lens epithelial cells
* Epithelial cells:
* Cuboidal to columnar
* Only anterior
* Form lens fibers
What condition is pictured below?
_______ changes
* ______/______ sclerosis (inner lens fibers _________):
* Not true lens _______ (_______ at pupil)
* May affect ____
- Senile cataract:
- Cortical ______ changes
- _______
- May affect _____ (usually ______)
- Aging changes
* Nuclear/lenticular sclerosis (inner lens fibers condense):
* Not true lens opacity (haziness at pupil)
* May affect vision
- Senile cataract:
- Cortical cataractous changes
- Opacity
- May affect vision (usually progressive)
- What condition is pictured below?
- What parts of the eye are affected?
- What is the age of onset?
- How is this condition classified?
- Cataract
- Pathologic opacification (fibers and/or capsule)
* Varied classification: - Onset (congenital/juvenile or developmental/senile)
- Progressive
Classified based on extent (incipient, immature, mature, hypermature)
- These samples were taken from a patient with?
- What is the smaller arrow in the bottom photo pointing to?
- What is the larger arrow in the bottom photo pointing to?
- What else can be seen in this photo?
- Cataracts -Histopathology
- Morgagnian globules (smaller arrow):
* Smooth hyalinized spheres of denatured proteins
* Lysis of lens fiber cell membranes - Bladder cells (larger arrow):
* Swollen nucleated lens epithelial cells - Mineralization
* Capsular wrinkling:
* Cortical liquefaction of hypermature cataract
Cataracts -Etiologies
ALL:
1. Anything that causes decrease in _____ of Aqueous Humor
- ______ _____ (most common cause of cataracts in cats)
- Congenital disorders (seen at ____)
- _______
DOGS:
- Systemic metabolic disease (Diabetes Mellitus) –> _____ taken up by lens, increasing uptake of _____
- ______ disease
- Hereditary/ Juvenile _____ (most common cause of ______ in dogs, seen at ____ age)
OTHER:
- Infectious (___________ in rabbits)
- Inherited:
- Dogs/congenital or later onset
Cataracts -Etiologies
ALL:
- Anything that causes decrease in quality of Aqueous Humor
- Anterior uveitis (most common cause of cataracts in cats)
- Congenital disorders (seen at birth)
- Trauma
DOGS:
- Systemic metabolic disease (Diabetes Mellitus) Glucose taken up by lens, increasing uptake of water
- Retinal disease
- Hereditary/ Juvenile cataracts (most common cause of cataracts in dogs, seen at early age)
OTHER:
- Infectious (E. cuniculi in rabbits)
* Inherited:
* Dogs/congenital or later onset
A rabbit is pictured below. What is wrong with its eye? What is the etiology?
What is the pathogenesis?
Cataracts -Etiologies
* Primary infection:
* Encephalitozoon cuniculi (rabbits)
* Active penetration and proliferation within the lens
* Lens fibers destruction => phacoclastic uveitis
- What is seen in the picture below?
- Separation of ____ from _____ attachment
- The luxation can be?
- This condition often leads to?
- Is this condition primary or secondary? Which is more common?
- Lens Luxation
- Separation of lens from zonular attachment
- Anterior, Posterior
- Often leads to glaucoma
- Primary vs. Secondary (more common)
Examples of Secondary lens luxation
* Chronic intraocular inflammation => _______ disruption
* Chronic glaucoma => ________
* _________ cataract
* _______ degeneration of _____ ligaments
* _______
Secondary lens luxation
* Chronic intraocular inflammation => zonules disruption
* Chronic glaucoma => buphthalmos
* Hypermature cataract
* Senile degeneration of zonular ligaments
* Trauma
What is pictured below?
Secondary lens luxation?
Glaucoma - overview
* Elevation of the intraocular pressure (IOP)
* Degenerative changes (optic nerve, retinal ganglion cells -RGC)
* Caused by altered aqueous circulation
* Varied causes between species
* Painful and blind eye
* Enucleation very common
Healthy normotensive eye
Complications
* ↑IOP
* Deformation of optic nerve axons
* Degeneration and death of retinal ganglion cell layer
* progression to atrophy of all retinal layers
* Stagnation of aqueous flow
* Impaired nutrition and waste removal
Morphologic changes associated with glaucoma
* ___________
- Younger > older (___elasticity)
* ________ onto fibrous tunic
* Thinning of _____ and _____
* ________
* Angle _______
* Lens _______
Morphologic changes associated with glaucoma
* Buphthalmos
- Younger > older (↑elasticity)
* Pressure onto fibrous tunic
* Thinning of sclera and choroid
* Staphyloma
* Angle recession
* Lens luxation
Morphologic changes
1. Cornea: exposure _______
2. Lens
* _______ (stagnant aqueous)
* ___________
3. Retina
* Loss of ______ and ____
Morphologic changes
1. Cornea: exposure keratitis
2. Lens
* Cataract (stagnant aqueous)
* Luxation
3. Retina
* Loss of axons and RGC
Morphologic changes
* Optic nerve
* Cupping of optic disc
* Direct pressure
* Axonal loss and collapse
Glaucoma Classification
1. Primary
- Secondary
- Goniodysgenesis, * Open angle glaucoma
- Neovascular
* Pigmentary
* Pupillary block
* Lens luxation
* Neoplasia
- Neovascular
- Name the condition pictured below.
- What category is this condition under?
- Is this condition common?
- What is this condition characterized by?
- What is the age of onset?
- No _______ or _______ 1ary ocular disease
- Which eyes are at risk?
- Goniodysgenesis
- Primary Glaucoma
- Most common 1ary glaucoma
- Dysplasia of ciliary cleft and/or trabecular meshwork (TM)
- Dogs/presumed inheritance/middle age (~6yo or older)
- No previous or concurrent 1ary ocular disease
- Both eyes at risk!
Goniodysgenesis - Histopathology
* Solid iris-like sheet of uveal stroma from iris base to DM
Secondary glaucoma
* Neovascular (PIFM)
* Investigate inciting causes
* Chronic uveitis, neoplasms…
Secondary glaucoma
1. Posterior synechia –> ?
2. Lens luxation
- Cause or consequence of ________
3. Tumors
* Direct obstruction of the _______ angle
* ____ (esp. _________ tumors)
Secondary glaucoma
1. Posterior synechia –> Pupillary block
2. Lens luxation
- Cause or consequence of glaucoma
3. Tumors
* Direct obstruction of the filtration angle
* PIFM (esp. Iridociliary tumors)
What conditions leads to Glaucoma in cats?
- Chronic lymphoplasmacytic uveitis
- Diffuse iris melanoma: Filtration angle obliteration by neoplastic cells
- Intraocular hemorrhage (hypertension)
Retinal atrophy
* Glaucoma
* degeneration/loss of ganglion cells to full thickness
Retinal detachment can be caused by:
1. Exudative
* _________, _______
* ____/______ in subretinal space
2. ________ injury (________)
Retinal detachment
1. Exudative
* Chorioretinitis, trauma
* Fluid/exudate in subretinal space
2. Hypoxic injury (hypertension)
histo on bottom left: RPE hypertrophy (“tombstoning”)
Systemic hypertension
* ___________ __________ (often 1st clinical clue)
* Dogs: _____-stage ______ disease, _________
* Cats: ______-stage ______ disease, ___________
- Hemorrhage, ________ detachment
- Arteriolar lesions:
- _______ change
- __________
- Medial _________
Systemic hypertension
* Hypertensive retinopathy (often 1st clinical clue)
* Dogs: End-stage renal disease, pheochromocytomas
* Cats: End-stage renal disease, hyperthyroidism
* Hemorrhage, retinal detachment
* Arteriolar lesions:
* Fibrinoid change
* Arteriosclerosis
* Medial hypertrophy
Ocular trauma
* Contusive (blunt)/penetrating/perforating
* Laceration with sharp structures
* Cat claw, foreign bodies…
* Risk of implanting infectious organisms
* Hemorrhage within the AC? Hyphema
* Common among enucleations
* Glaucoma, neoplasia, trauma
Ocular trauma- Intraocular changes
Lens
* Phacoclasticuveitis/endophthalmitis
- Lens rupture (blunt, penetrating or perforating)
* Cats –potential for intraocular sarcoma
* Traumatic (sub)luxation (severe trauma)
Lens
* Phacoclasticuveitis/endophthalmitis
- Lens rupture (blunt, penetrating or perforating)
* Cats –potential for intraocular sarcoma
* Traumatic (sub)luxation (severe trauma)
Post-traumatic ocular sarcoma (PTOS)
* Seen in what species?
* Prior hx of _______ disease
- Months to years (avg. ____ years)
* Almost all have ______ capsule rupture
* Highly _______ and ______ (_______ are rare)
* ___________ ________ in cats
- _______ recurrence common if infiltrates the orbit
* Spindle cell (______ _____ cell origin)
*Osteosarcoma/chondrosarcoma
Post-traumatic ocular sarcoma (PTOS)
* Cats & rabbits
* Prior hx of ocular disease
*Months to years (avg. 7 years)
* Almost all have lens capsule rupture
* Highly Infiltrative and aggressive (metastasis are rare)
* Prophylactic enucleation in cats
* Local recurrence common if infiltrates the orbit
* Spindle cell (lens epithelial cell origin)
*Osteosarcoma/chondrosarcoma
Eyelid, conjunctiva, orbit
* Entropion = inward turning of the lower eyelid (Top dog)
* Ectropion = outward turning of the lower eyelid (Basset Hound)
* Breed / genetic
* Keratitis and conjunctivitis common
Eyelid, conjunctiva, orbit
* Entropion = inward turning of the lower eyelid
* Ectropion = outward turning of the lower eyelid
* Breed / genetic
* Keratitis and conjunctivitis common
Eyelid - inflammation
* ________ = (lipogranuloma)
* Commonly seen in what species?
* Inflammation in response to ________gland secretion
* Freq. associated with ______
* _____ to _____ nodule(s) at eyelid _____
Eyelid - inflammation
* Chalazion (lipogranuloma)
* Dogs
* Inflammation in response to Meibomian gland secretion
* Freq. associated with adenomas
* Yellow to white nodule(s) at eyelid margin
Eyelid - Tumors
1. What are the common eyelid tumors in Dogs?
- What are the common eyelid tumors in Cats?
- Meibomian gland adenomas > melanocytomas > papillomas
- SCC
Eyelid - Tumors
* What is the Most common eyelid neoplasm of dogs?
- Often associated ______ (=__________ inflammation)
- Meibomian gland adenoma
Single or multiple/(non)pigmented
- Often associated chalazion (=lipogranulomatous inflammation)
What condition is pictured below?
- Melanocytomas (benign)
*Pedunculated or papillary
Eyelid - Tumors
* Squamous cell carcinoma
* Horses, ruminants (<conjunctiva), cats
* Nonpigmented/thin-haired sites (↓protection against UV light)
* Ulcers, crusts, hemorrhage
* Slow progression (months-years)
* Actinic keratosis => SCC in situ => Invasive SCC
Conjunctiva - overview
* Mucous membrane
* Squamous epithelium + goblet cells
* Normal bacterial, fungal, viral flora
* Lamina propria w/ lymphoid cells
Infectious conjunctivitis
* Feline herpesvirus-1
* Keratoconjunctivitis
* Latent infection => recurrence => lymphocytic conjunctivitis
* Chlamydia
* C. felis(cats), C. pecorum (small ruminants, koalas…)
* Serous => purulent discharge
Infectious conjunctivitis
* Moraxella spp. (infectious keratoconjunctivitis/“pinkeye”)
- Non-pigmented/UV light
- Hereford
- Transmited by flyes
Neoplasia
* SCC (common in horses)
* Similar features as eyelid SCC
* Eyelid = erosive
* Conjunctiva = friable proliferative salmon-pink lesions
* May also grow in plaques (in situ)
* Melanocytic
* Dogs/Conjunctiva = most are malignant!
* Recurrence common
Orbit - Neoplasia
* Any orbital tissue may become neoplastic
* Osteo(sarco)ma, fibro(sarco)ma, lipo(sarco)ma,
hemangio(sarco)ma, lymphoma (BLV)…
* EXOPHTHALMOS
*Meningioma
* Most common 1ary orbital neoplasm in dogs
* Many species
* Origin: arachnoid meningoepithelial cells
* Exophthalmos, blind eye
* Conical thickening/growth around ON
*Histo
*Chondroid, osseous, myxomatous metaplasia
Lacrimal glands - Neoplasms
* Not very common
* Adenomas, adenocarcinomas, SCC
* Can mimic prolapse (common)
Eye anatomy
* Tunics/coats:
* Fibrous (corneal, sclera) = shape, protection, light refraction
* Vascular - Uveal (iris, ciliary body, choroid) = pigmented & vascular
* Light reflection, scattering
* Nutrition
* Waste removal
* Nervous (retina, optic nerve) = electric and chemical signaling to brain
* Aqueous humor, lens, vitreous humor
* Light refraction
* Internal pressure
Chronic kerattiis
Acanthosis/melanosis/vascularization/inflammation/stromal scarring
Uvea
Iris
Ciliary body
Choroid
Corneal sequestrum
* Cats
* Breed predisposition (Persian, Siamese)
* Cause unknown: Hx of corneal disease: injury (trauma) and FeHV-1
* Stromal pigmentation (amber to black)
* Stromal hyalinization (necrosis)
* Prone to bacterial colonization
Corneal degeneration
Calcific & lipid degeneration/keratopathy
* 2ary to corneal disease (calcium deposition)
* Metabolic disorders
* High fat diet: Amphibians, reptiles, birds
* Hyperadrenocorticism, hypothyroidism, diabetes
* Hypercalcemia
Neoplasms
* Limbal melanocytoma
* Benign
* Can be quite large, extend into cornea
* ++Dogs
* Cats (Differentiate from extension of iris melanoma!)
* Histo:
*Heavily pigmented
*Minimal atypia, absent mitoses
