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Pathology > Ocular Pathology > Flashcards

Ocular Pathology Flashcards

1
Q

What is sympathetic uveitis ophtahlmia?

A

Bilateral diffuse granulomatous inflammation

T- cell mediated panuvieitis that occurs after a penetrating eye injury

Blurred vision, photophobia in the non-injured eye

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2
Q

What are mutton fat keratic precipitates?

A

Granulomatous uveitis
Collectino of epithelioid cells plus lymphocytes macrophages, multinucleated giant cells or pigment on the endothelium of the cornea

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3
Q

What are Dalen Fuch’s nodules

A

RPE inflammation with accumulation of macrophages in sympathetic uveitis

Uveal reaction to antigens localised on the RPE

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4
Q

What is phacoanaphylactic endophthalmitis?

A

Autoimmune zonal granulomatous inflammation caused by rupture of the lens capsule and consequent reaction to the lens material

May result from the breakdown of tolerance at the T cell level and formation of an antibody and antigen reaction

Macrophages an dlymphocytes enter the antioer chamber from dialted vessles in iris and ciliary body.

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5
Q

What is phacolytic glaucoma

A

Macrophages engulf lens matter and can block the AC angle leading to phacolytic glaucoma

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6
Q

What is suppurative endophthalmitis

A

Tissue necrosis with PMN leukocyte infiltration

Exogenous sources - srugical, penetrating, radiation, chemical

Endogenous - BEhcets inflammation, haematogenous spread

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7
Q

What is non-suppurative uveitis and enophthalmitis?

A

Inflammation (anteiror, intermediate or posteiorr)

Exogenous - traumatic anteiror uveitis - blunt trauma, penetrating injury inducing sterils inflammation

Endogenous - idiopathic inflammation associated with viral, bacterial infection or local ocular disease, ifnlammation associated with systemic disease

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8
Q

What is sjogren’s syndrome

A

Primary or secondary to systemic disease

Disorder of acinar glands of conuunctiva, lacrimal gland and oral mucosa

Glands destroyted by a lymphocytic infiltrate

Loss of conjunctival goblet cells leading to impaired tear secretion and dry eyes

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9
Q

What is rheumatoid eye disease?

A

Immune complex and T cell mediated mechanism
Wide spectrum of eye effects

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10
Q

What is necrotising scleritis and peripheral corneal ulceration due to?

A

Immune complex deposition which leads to complement activation, PMN infiltration, collagenase production and corneal melt

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11
Q

What is corneal melt

A

Spontaneous central-periphaerl corneal ulceration with or without infalmmaotry cell infiltrate

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12
Q

What is scleromalacia perforans

A

Thinning of the sclera and exposure of the underlying uveal tract

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13
Q

What happens in TED

A

Orbits become congested, swollena nd painful
More commonly bilateral

Dry eye due to corneal exposure, conjunctival chemosis, proptosis, eyelid retraction, lid lag, superior limbal keratopathy, diplopia, compressive optic neuropathyha

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14
Q

What is the histology in TED

A

Perivascular lymphocytic infiltration with mast cells and glucosaminoglycan accumulation within and around the EOM and fat

This progresses to fibrosis

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15
Q

What are effects of blunt trauma?

A

Separation of attachments - e.g. ciliary msucle attachemnt to scleral spur - angle recession glaucoma

Retinal oedema or commotio retinae - retinal vessel spasm producing ishcaemia and endothelial damage or interruption of axoplasmic flow in the ganglion cell processes.

Shearing of photoreceptors leading to a reactive RPE proliferation and pseudoretinitis pigmentosa

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16
Q

What wavelenghts do the cornea and lens absorb?

A

UV and blue wavelengths

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17
Q

What does laser stand for

A

Light amplication by stimualted emission of radiation

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18
Q

Why is there pigmentation around laser burns

A

RPE proliferation at edge of burn leads to pigment around white scar formed by glial cells

19
Q

What are side effects of radiation to the eye?

A

Endarteritis - infiltration of the vessel wall by inflammatory cells and proliferation of the spindle cells within the internal elastic lamina - contributes to tumour necrosis but can also lead to telangiectasia and leakage of plasma into surrounding tissue.

Dry eye due to lacrimal gland damage

Increased risk of mutations

Cataract formation

Radiation retinopathy

20
Q

Why is alkali damage worse than acid

A

Acids coagulate tissue meaning diffusion through cornea and sclera is limited

Alkali pass through easily and destroy lens, uveal tract, retina

21
Q

What are corneal dystrophies?

A

Inherited, bilateral and progressive diseases that lead to corneal opacification

Autosomal dominant with complete pentrance

22
Q

What is cogan’s microcystic dystrophy

A

Map dot fingerprint dystrophy

AD or sporadic
Onset in 2nd decade
Degeneration of cells with cyst formation leads to unstable epithelium
Histology - thickened BM, absent hemidesmosomes, fibillary materal between BM and Bowman’s layer

23
Q

What is Meesman’s dystrophy

A

Ibset in early childhood

Epithelial dystrophy - separation of cells leading to formation of loops of basement membrane and microcysts

24
Q

What dystrophy affect Bowman’s layer?

A

Reis-Buckler
Fine reticular opacity in superifical cornea - fibrous tissue between Bowman’s and epithelium

Thiel-Behnke

RB TB (Bowman’s)

25
Q

Which optic nerve head rim is thickest normally? Thinnest?

A

ISNT

Inferior thickest
Superior
Nasal
Temporal thinnest

26
Q

What dystrophies affect stroma?

A

Granular

AVellino

Lattice
Macular
Schnyder crystalline dystrophy

27
Q

What is granular dystrophy?

A

Onset early in life with white well-demarcated stromal deposits
Discrete opaque granules in the anterior corneal stroma
The anterior stroma and Bowman’s layer contain non-birefringent hyaline bodies with keratinoid

28
Q

What is Avellino dystrophy

A

Same as granular with amyloid deposite

29
Q

What is lattice dystrophy

A

Fine branching lattice lines seen in the anterior stroma with a variable amount of stromal haze

Amyloid deposits in the anterior stroma

Congo red stain - apple green birefringence with polarised light

30
Q

What type of lattice dystrophy coexists with systemic amyloidosis

A

Type 2 - onset in third decade

31
Q

What is macular dystrophy? Inheritance

A

Autosomal recessive

Onset in first decate with focal grey anterior stromal opacities in the axial region

Mucopolysaccharide granules in cytoplasm of keratocytes and in interlamellar spaces

32
Q

What is Schnyder crystalline dystrophy?

A

Associciated with systemic hypercholesterolaemia
Fine polychormatic cholesterol crystals deposited in the anterior stroma for dense corneal arcus

33
Q

What are endothelial corneal dystrophies?

A

Congenital hereditary endothelial dystrophy

Fuch’s AD endothelial dystrophy

Posterior polymorphous dystrophy

34
Q

What is CHED?

A

Primary dysfunction of corneal endothelial cells leading to corneal opacification

Descemet’s membrane exhibits fine lamination with an abnormal layer of collagen at the ultrastructural level

CHED1 - AD - second year of life

CHED2 - AR - from birth

35
Q

WHat is Fuch’s ED

A

AD
Dystrophic endothelial cells result in the formation of guttata as a result of abnormal collagen deposition on a thickened Descemet’s membrane

Reduction in number and function of cells and pump action leads to progressive corneal oedema

Persistant oedema can lead to bullous keratopathy

36
Q

What is posterior polymorphous dystrophy

A

Multilayered endothelial cells which have some features of epithelial cells e.g. microvillae

In severe diffuse disease - posterior corneal surface lined by stratified cells with prominent desmosomal attachemnts

Can lead to astigmatism and decompensation

37
Q

What is iridocorneal endothelial syndrome?

A

Unitlateral, sporadic, adults

Degenerate corneal endothelial cells surrounded by normal cells
Form blebs and can acquire microvilli on posterior surface

Abrnormal cells forma membrane over angle structures

Corneal decompensation with or without glaucoma

Associated with progressive iris stromal atrophy

38
Q

What is Chandler sydnrome?

A

Progressive Endothelial corneal sliding with normal riris

39
Q

What is Cogan Reese syndrome

A

Endothelial corneal sliding with

40
Q

What is bullous keratopathy?

A

Endothelial decompensation
Corneal oedema
Stromal and epithelial microcystic
Epithelial macrocystic oedema (bullous)

41
Q

What would be seen on examination of bullous keratopathy?

A

Stromal oedema
Descemet’s folds
Epithelial oedema
Subepithelial scarring
Corneal neovascularisation

42
Q

What are causes of bullous keratopathy?

A

FED
Intraocular surgery
Endothelial cells inflammation due to herpes
Corneal graft failure/rejection
Chronic anteiorr uveitis
Trauma

43
Q
A

Pathology (15 decks)

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