Pathology of the Eye (Gianani) Flashcards
most common tumor of the eye?
metastasis (just like the brain)
Retinal artery occlusion
(or one of its branches)…usually due to
A) atheromatous emboli from ipsilateral internal carotid stenosis;
B) stenosis from HT, diabetes;
C) vasculitis
- infarction of entire artery (or part of)
TIA of retinal artery (or branches of) = *** “Amaurosis fugax”… “browning out” or “loss of vision” in one eye for about 10 minutes …usually caused by ipsilateral internal carotid stenosis.
Anterior ischemic optic neuropathy
neuropathy…short posterior ciliary arteries (branches of the ophthalmic artery)…supply anterior optic nerve.…occlusion results in sudden vision loss in one eye (common in patients over 50)…classic onset is upon wakening
-sometimes seen in temporal arteritis
Stye (or hordeolum)
Acute inflammation involving gland of Zeis and/or orifice of meibomian gland….Staph…usually clears in 7 days
layers of lubrication
lipid layer
aqueous layer
mucin layer
Meibomian gland creates the lipid layer
Chalazion
Meibomian gland lipogranuloma
Lipogranulomatous inflammatory reaction to sebum in tissues (endogenous “foreign body” reaction)
Secondary to obstruction of gland
Subacute to chronic and painless nodule
Epithelioid cells and giant cells surround lipid vacuoles
Usually lasts weeks to months
May become secondarily infected
Surgical therapy, antibiotics if infected
Xanthelasma Palpebratum
Soft, flat or slightly raised yellow papules and plaques
Usually more in inner canthus
Seen in hyperlipemic and normolipemic patients
Aggregates of foamy, lipid-laden histiocytes in dermis
Cosmetic surgery
Nevi
Congenital or acquired (most)
Split nevus – a form of congenital nevus of the eyelids…rare
Nests of nevus cells
- Interface of the epidermis and dermis (junctional nevus)
- Dermis and epidermis (compound)
- Only in the dermis (dermal)
Basal Cell Carcinoma
Most common eyelid malignancy
Lower lid>medial canthus>upper lid>outer canthus
Nodular, cystic, diffuse
Islands of basaloid cells with peripheral palisading, stromal desmoplasia, retraction artifact
Ulceration may or may not occur;
Pigmentation may occur, simulating a melanoma
Locally invasive, rarely metastasizes
Squamous Cell Carcinoma
Elderly fair-skinned individuals
Lower lid most common
Typically shallow ulcer surrounded by a wide, elevated, and indurated border
- Potential for local or distant metastasis
Polygonal cells with pink eosinophilic cytoplasm, nuclear atypia, infiltrating cords into dermis, dyskeratotic cells, keratin pearls.
Sebaceous Carcinoma
Elderly, more female, > Asians
Can mimic chalazion or chronic blepharoconjunctivitis
2/3rds in upper lid
Can arise from meibomian, Zeis (lash follicules) or caruncle glands
Malignant cells with foamy, lipid-laden cytoplasm, necrosis, pagetoid invasion of the skin
15% mortality, direct extension and distant metastasis (lung, liver, brain, skull)
Pinguecula
Asymptomatic, small yellowish submucosal nodule at the limbus
Adults and older patients but younger if»_space; sun exposure
Typical in tropical places
* Conjunctival equivalent of Solar Elastosis of skin
Does not extend to or invade the cornea as a pterygium
No therapy needed
Pterygium
Submucosal growth of connective tissue that * migrates into cornea
Results from actinic (UV) damage, dust, wind
Removed for cosmetic and irritation of conjunctiva reasons
* Examine histologically to rule-out squamous neoplasia
Ulcerative Keratitis
Viral: Herpes simplex - most common cause of central corneal ulcer (dendritic ulcer); herpes zoster
Bacterial: Pseudomonas aeruginosa and Staphylococcus aureus - especially associated with cosmetics or contact lenses
Mycotic: Aspergillosis, Candida, and Fusarium represent over 80% of all fungal keratitis
Parasitic: microsporidia
Amebic Keratitis
Hot tubs, contact lenses and fresh water exposure (ponds)
Acanthamoeba often presents as an irregular dendritiform epithelial keratitis, often mis-diagnosed as herpes simplex
Later progresses to a ring ulcer or less commonly as radial keratitis
Calcoflour white staining can give rapid diagnosis, confirmed by culture in special medium
- Keratoconus
Degenerative deformation of the corneal curvature
Irregular myopic astigmatism; progressive myopic astigmatism
Conical deformation of the cornea
.
Usually bilateral
Progressive visual distortion (multiple images), light sensitivity
treat: Corrective lenses, asymmetric keratotomy, or corneal transplant
is the major refractive surface of the eye.
The cornea—not the lens—is the major refractive surface of the eye. Keratoconus is an example of a condition that distorts the contour of the cornea and alters this refractive surface, producing an irregular form of astigmatism.
Munson’s sign
In Keratoconus: When patient looks down, the cones in each eye causes the lower lids to bulge
Age-related Macular degeneration
(>75 yrs. Of age)
Loss of central vision
Dry form (absence of neoangiogenesis) 10x more common Wet form (presence of neoangiogenesis)
Dry: deposits in Brush membrane and atrophy of retinal pigmented epithelium…no treatment
Wet…Tx with injection of VEGF antagonists into the vitreous of affected eye
Retinoblastoma*
Most common intraocular tumor of childhood (90% dx before age 3)
30-40% are bilateral…associated with germ line mutations.
Sporadic cases are associated with somatic mutations.
Signs/symptoms
Leukocoria, strabismus, red,
painful eye, poor vision
* Retinoblastoma gene Chr 13
(tumor suppressor)
microscopic look of retinoblastoma
Blue with rosettes
Flexner-Wintersteiner rosettes
Retinoblastoma Treatment & Prognosis
Treatment
Enucleation, Photocoagulative Ablation and Hyperthermia, Cryotherapy, Chemoreduction Therapy, External-beam Radiation, Plaque Radiotherapy (Brachytherapy)
Prognosis
Overall survival rates of 95%
Most important risk factor is extraocular extension of tumor through ON or sclera
Uveal Melanoma
Clinical risk factors for mortality
- Larger tumor size, anterior eye location, extraocular extension
Metastasis usually 2-4 years from time of diagnosis
Patients who develop metastasis (usually to the liver) generally survive less than 6 months
Sympathetic opthalmia
Non-infectious granulomatous inflammation of uvea of both eyes
Can result from trauma to one eye…retinal antigens become visible to immune system…delayed hypersensitivity reaction in the other eye (and the damaged eye)…2 weeks to many years after the injury
Treatment of uveal melanoma
Globe-conserving
- Brachytherapy (iodine 125, ruthenium 106, palladium 103)
- Charge-particle therapy
Enucleation
- Large tumor
- Orbital or optic nerve involvement
open-angle glaucoma
the aqueous humor has complete physical access to the trabecular meshwork, and the elevation in intraocular pressure results from an increased resistance to aqueous outflow in the open angle.
In primary open-angle glaucoma, the most common form of glaucoma, the angle is open, and few changes are apparent structurally.
angle-closure glaucoma
the peripheral zone of the iris adheres to the trabecular meshwork and physically impedes the egress of aqueous humor from the eye.
