ophtha-uvea Flashcards
3 parts of uvea
- Choroid
- Ciliary body
- Iris
Pigmented vascular middle coat of the eye extending from optic disc to pupil
Uvea
Posterior uvea
Choroid
Anterior uvea
Iris and ciliary body
Choroid is supplied by
10-20 short ciliary a. (A branch of ophthalmic a)
Anterior uvea is supplied by
2 long ciliary a (branch of ophthalmic a)
Choroid layers of blood vessels
- Outer layer of large veins leading to vortex veins (haller)
- Middle layer of medium veins and some arterioles (sattler)
- Inner layer of choriocapillaries
The blood vessels layers are limited by 2 membranes, externally by ____ and internally by ____
Externally by suprachoroid
Internally by Bruch’s membrane
Anterior uvea has 2 circumferential arterial network
- Major arterial circle of ciliary body and part of ant choroid
- Minor arterial circle of iris
Embryological origin of uvea
Mesodermal in origin from tissues surrounding primary optic vesicle
Embryological origin of ciliary body and iris
Have Neuro ectodermal components
It provides nourishment for pigment epith and outer layer of retina
Choroid
Secretes aqueous humor and controls accommodation
Ciliary body
Regulates size of pupil
Iris
T/f: choroid has tendency to be isolated as well as macula
True. Because of segmental arrangement of choriocapillaries
Least severe inflammatory reaction
Iris.
Has limited bld supply and few stromal cells
More severe inflammatory reaction
Ciliary body.
Hs greater number of blood vessels and cells
Most severe inflammatory reaction
Choroid.
Has marked vascularity
Pigment proliferation depends on amt of pigment. What has least pigmentation and greatest pigmentation?
Iris has least pigmentation.
Ciliary body more.
Choroid most.
Purulent or non purulent inflammation: caused by bacteria or fungus
Purulent inflammation
Suppuration in uvea, retina and vitreous setting up
Endophthalmitis
Accumulation of leukocytes in anterior chamber
Hypopyon
Endo or exogenous type of purulent inflammation:
Initially vitreous opacities
Endogenous type
Endo or exogenous type of purulent inflammation:
Initially hypopyon
Exogenous type
When there is pain in purulent inflammation which occurs during the first week in endogenous type and much later in exogenous type
Glaucoma
In glaucoma, there is pain in purulent inflammation which occurs during ___ endogenous type and____ in exogenous type
In glaucoma, there is pain in purulent inflammation which occurs during 1st wk in endogenous type and much later in exogenous type
First sign in fungus purulent inflammation
Hypopyon
When infection extends to sclera and orbital struc producing proptosis, chemosis and limitation of ocular movement
Panophthalmitis
Panophthalmitis is characterized by
Proptosis
Chemosis
Limitation of ocular movement
Most common microorganism in bacterial purulent inflammation
Staph aureus
P. Aeruginosa
Proteus
Coli form bacillus
Most common microorganism in fungal purulent inflammation
Aspergillus Candida Sporotrichium Cephalosporum Cryptococcus Actinomyces
If condition in purulent inflammation does not improve in 4 days…
Vitrectomy (evacuation of vitreous)
Non purulent inflammation
Uveitis
S&s of uveitis
Ciliary injection Fibrin in anterior chamber Small irreg pupil Pupillary membrane Vitreous opacities Choroids exudation
Signs seen in uveitis with the aid of magnifying loupe or bio microscope (slit lamp)
Keratic precipitate
Deposition of cells on post surface of cornea
Aqueous flare or trnaslucency caused by increased albumin, aqueous cells, Koeppe’s and Bussaca’s pseudonodules
Iris true nodule and stromal granuloma
Post synechiae or adhesion between iris and cataract cells
Adhesion between iris and cataract cells
Synechiae
Cause of uveitis common in Western Europe and America
Toxoplasmosis
Cause of uveitis common in Asia and Eastern Europe
TB
Cause of uveitis common in Middle East and japan
Viruses
Cause of uveitis common in central US
Histoplasmosis
T/f: uveitis by itself does not cause blindness
True
T/f. Uveitis is a recurring condition
True
Usual known cause of endogenous uveitis. Bacterial
TB Leprosy Syphilis Strep and staph Klebsiella Meningococcus Gonococcus Coliform bacilli
Usual known cause of endogenous uveitis. Viral
Herpes simplex Herpes zoster Measles Mumps Lymphogranuloma venerum Cytomegalic inclusion bodies
Usual known cause of endogenous uveitis. Fungal
Blastomyces Monilia Coccidiodomyces Cryptococcus Histoplasma
Usual known cause of endogenous uveitis. Protozoan
Amoeba
Toxoplasma
Usual known cause of endogenous uveitis. Nematode
Hookworm
Ascaris
Type of uveitis caused by introduction of inert substances, the composition of living organism, or whole dead organism into the eye
Non granulomatous uveitis
Type of uveitis caused by live microorganism invading the eye
Granulomatous uveitis
Non-granulomatous/granulomatous uveitis.
Onset
Non Granulomatous: acute
Granulomatous. Chronic
Non-granulomatous/granulomatous uveitis.
Course
Non granulomatous. Self-limiting (1-2wks)
Granulomatous. Protracted with remission
Non-granulomatous/granulomatous uveitis.
Ciliary injection
NG. Severe
G. Mild
Non-granulomatous/granulomatous uveitis.
Pain
NG. Present
G. None
Non-granulomatous/granulomatous uveitis.
Residual damage
NG. None or very slightly
G. Always and marked
Non-granulomatous/granulomatous uveitis.
Keratin precipitates
NG. Small, pin-point
G. Big and greasy
Non-granulomatous/granulomatous uveitis.
Aqueous
NG. Cells plenty
G. Cells few
Non-granulomatous/granulomatous uveitis.
Nodules
NG. None
G. Frequent
Non-granulomatous/granulomatous uveitis.
Posterior synechiae
NG. Very thin
G. Heavy and hard to break
Non-granulomatous/granulomatous uveitis.
Vitreous opacities
NG. Thin with few cells
G. Heavy with plenty cells
Non-granulomatous/granulomatous uveitis.
Retinal edema
NG. Generalized
G. Localized over choroid all exudates
Non-granulomatous/granulomatous uveitis.
Choroidal exudates
NG. None
G. Large
Non-granulomatous/granulomatous uveitis.
Pigmentation
NG. None
G. Prominent at borders of chordal exudates
Reflex pupillary dilation
Mydriasis
The principles of treatment of uveitis can be resolved into
- Mydriasis
- Anti-inflammation
- Specific therapy
Beneficial effects of mydriasis
Breaks post synechiae (which is responsible for 75% of complications that end up in blindness) Reduces volume of iris, consequently decongesting the iris mechanically (which diminishes the vascular exudation of inflammatory cells) Reduces pain (cycloplegic effects)
Mydriasis is done within ____ otherwise synechiae will remain permanent
Done within first 7-10 d
Mydriasis solutions
Soln of atropine 1%
Phenylephrine 10%
Scopolamine 1%
For 1-3 times/d
If there is consistent and prolonged Mydriasis, give
Sub conjunctival injection 0.5mL
Anti-inflammation by locally applied steroid utilized in anterior uveitis. Local suspension, ointments , subconj, succinate ans subconj acetate is given every … To obtain adequate therapeutic level in aqueous.
Local suspension. 1-3 hrs
Ointment. 6-8 hrs
Subconj succinate. 3 d
Subconj acetate. 2 wks
Specific type of uveitis that has protean manifestation.
TB uveitis
TB uveitis affects both ant and post uvea?
Yes
Charac by acute ant uveitis with greasy kp, and pseudo or true iris nodule or circumscribed irreg choroidal exudates
TB uveitis
Does TB uveitis has tendency for recurrence?
Yes
Usual form of foci of infection
Ant uveitis with fine kp and cells and post synechiae
Most common org causing foci of infection
B-streptococcus hemolyticus
Most common org causing foci of infection in Philippines
Alpha strep
Specific type of uveitis charac with spontaneous or traumatic rupture of lens capsule
Lens-induced uveitis
Specific type of uveitis with acute ant uveitis with greasy kp, and post granulomatous uveitis
Lens-induced uveitis
Specific type of uveitis charac by acute ant uveitis with fibrin in anterior chamber I. Young asso with collagen disease
Rheumatoid disease
Virus that cause ant non-granulomatous type
Herpes simplex
Herpes zoster
Mumps
Lymphogranuloma venerum
Virus that cause posterior -granulomatous type
Cytomegalic inclusion body
3 types of uveitis believed to be viral in etiology
- Behcet’s disease
- Harada’s disease
- Vogt-Koyanagi disease
Behcet’s disease
Appearance of ant uveitis
Hypopyon
Aphthous ulcer on mouth, tongue and genitalia
Bilat post uveitis with retinal detachment in young
Harada’s disease
Similar with harada’s disease but ends up with an ant granulomatous uveitis with accompanying vitiligo, poliosis, alopecia, dysacusia
Vogt-kayanagi disease
Special type of uveitis wc is an autoimmune disease with bilateral granulomatous uveitis which follows a perforating ocular injury affecting ciliary body in one eye.
Sympathetic ophthalmia.
Special type of uveitis with post choroidal exudate
Toxoplasmosis
To destroy cyst containing trophozoites which when released are responsible for recurrence
Photo coagulation
Special type of uveitis confined to ant segment as granulomatous uveitis with whitish nodule in surface of iris
Leprosy
Treatment for leprosy
Sulfone drugs (promin, promizole)
Common cause of larvae migran syndrome
Larval hookworm and ascaris in dogs and cats
Special type of uveitis with mild ant or post granulomatous uveitis and violent post uveitis with endophthalmitis
Larvae migran syndrome
Endophthalmitis may end up into phthisis
Yes
Special type of uveitis with ant granulomatous uveitis ans appears as macular edema
Amoeba
Special type of uveitis charac by small peripheral exudates with hemorrhage that ends up as sharply demarcated punched-out scars
Histoplasmosis
Special type of uveitis as acute ant granulomatous uveitis with gelatinous exudate and crystals in ant chamber
Gout
Gout attack lasts for ____ leaving come residual post synechiae, pupillary membrane and and later in bans keratopathy
4-10 d
Absence of iris
Aniridia
In Aniridia, the structure behind the cornea is
Black
In Aniridia, what is present behind the limbus
Iris tag
Usual complaint in Aniridia
Photophobia
Difference in color of iridis of 2 eyes
Heterochromia
In hereditary type of heterochromia. the light/dark colored type is abnormal.
Light colored eye because if thinning of iris stroma
In acquired type of heterochromia. the light/dark colored type is abnormal.
Darker eye because of pigment proliferation.
It usually follows uveal inflammation
In heterochromia, when aging, these 3 appears
Glaucoma
Uveitis
Cataract
Portions of iris, ciliary body, choroid or whole uvea is affected. It is charac by failure of optic cup to close completely during fetal life
COLOBOMA
COLOBOMA is located inferiorly/superiorly
Inferiorly
Accompanied by adjacent notching of lens and Astigmatic refractive errors
Ciliary body coloboma
Choroidal absence which may be partial or total where only macula is left.
With bight blindness but central vision is retained.
Choroideremia