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OPHTHAL > SCLERA AND UVEA > Flashcards

SCLERA AND UVEA Flashcards

1
Q

WHAT MAKES THE UVEA?

A

IRIS
CILIAR BODY
CHOROID

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2
Q

CILIARBODY AND CHOROID JUNCTION

A

choroid becomes the ciliary body from the ora serrata

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3
Q

what shape is the ciliary body as a cut section?

A

triangular

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4
Q

what are the parts present in the outer , inner and base of the triangle and whats present in the tip of the triangle?

A

outer surface - ant and post chamber angle
inner surface - ciliary process ~ pars plicata
w no process ~ pars plana
tip consists of iris
base of triangle is the suprachoroidal space and sclera

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5
Q

what are the microscopic layers of ciliary body?

A 
from out to in
#supraciliary lamina
#stroma
#ciliary muscle- longitudinal,circu,radial/obliqu fibres
#pigment epithelium
#non pigment epithelium
#internal limiting membrane
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6
Q

blood supply of the uvea?

A

short posterior ciliary artery
long posterior ciliary artery
anterior ciliary artery

venous - iris-ciliary body- chorid VORTEX VEIN- superior and inferior temporan and same nasal veins -superior and inferior ophthalmic veins

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7
Q

define anterior uveitis - the structures affected?

A

inflammaton of the uveal tissue

from the iris to the pars plicata(ciliary process containing) of ciliary body

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8
Q

clinical feature significant point of irido cyclitis?

A

more marked inflammation in iris or ciliary body

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9
Q

symptoms in acute irido cylclitis?

A

pain, photophobia,lacrimation,redness

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10
Q

what is the severity of symptoms in chronic iridocyclitis with respect to the severity of the condition?

A

minimun symptoms even when there is increased inflammation

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11
Q

eitiology of uveitis? according to mode of onset of infection

A

exogenous infection- direct invasion~ suppurative or

#endogenous infection-from someother source through blood / anything
#secondary- from adjacent structures
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12
Q

eitiology of uveitis according to infectious agents

A 
bacterial
viral 
protozoal
rickettisial
fungal
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13
Q

types of pathomechanism of infection in uveitis?

A

suppurative infections and non suppurative infections

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14
Q

non suppurative uveitis is due to?

A

granulomatous or non granulomatous origin

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15
Q

type of pain in ant uveitis?

A 
# main symptom
# throbbing and dull
#increased at night
#radiating along 5th nerve areas like forehead and scalp
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16
Q

where is the reffered pain in ant uveitis?

A

to the scalp and fore heead along the branches of 5th nerve

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17
Q

what is the characteristics of redness found in ant uveitis? and why is it produced?

A

circumcorneal congestion

due to hyperemia of the ant ciliary vessels due to hiatamines and toxins

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18
Q

what is th ereason for photophobia and blepharospasm in acute ant uveitis?

A

due to irritated 5th nerve - that is the sensory

and the 7th nerve- motor fibres ((ornicularis oculi)

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19
Q

why does lacrimation occur in ant uveitis?

A

due to irritation of the 5th nerve

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20
Q

causes of blurred vision in ant uveitis?

A 
#corneal edema 
#cilicary spasm
#cyclitic memebrane
#pupillary black
#aueous turbidity
#complicated cataract
#2* galucoma
#vitreous haze
#induced mypoia 
#associated macular edema
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21
Q

what is the pathogonomic sign in ant uveitis?

A

keratic precipitates

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22
Q

where and what is it made of and where does it mostly occur?

KERATIC PRECIPITATES

A

IN THE BACK OF CORNEA

MADE OF PROTEINACIOUS CELLULAR DEPOSIT

MOSTLY IN THE CENTER AND LOWER PART OF THE CORNEA

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23
Q

TYPES OF KERATIC PRECIPITATES?

A

1.mutton chop
2. small and medium
3 .fine/stellate kp
4. old kps

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24
Q

where is mutton chop KPs found?

A

in granulomoatous iridocyclitis

greasy and waxy
made or macrohpages and epitheloid cells
few in number

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25
Q

small and medium kps are found in?

what are they made of?

A

non granulomatous inflammation of ant uveitis

lymphocytes

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26
Q

stellate KPs are found in ?

A

Fuchs heterochromatic iridocyclitis, CMV retinitis and herpitic iritis

cover whole cornea

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27
Q

what is stellate type of keratic precipiate also known as and where are they found?

A

aka endothelial dusty , in whole cornea

in Fuchs heterochromatic iridocyclitis
cmv retinitis
and herpitic iritis

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28
Q

old keratic precipitates are found in?

A

all the other kps when they heal

shrink fade and pigmented

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29
Q

what are the signs in ant iridocyclitis?

A

lid edema

            #corneal edema
     keratic precipitates
    post corneal oppacity
#anterior chamber signs 
#iris signs 
#pupillary signs
#lens signs
#vitrous and retinal signs
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30
Q

anterior chamber signs in ant iridocyclitis?

A

aqueous cells
aqueous flare
change in ant chamber dept
change in angle of ant chamber

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31
Q

iris signs in ant uveitis?

A

loss of pattern

change in colour

IRIS NODULES

posterior synechiea

neovascularisation

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32
Q

what are posterior synechiae?

A

they are adhesions formed between the iris and the ant surface of the lens

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33
Q

what are the types of post synechia ?

A

annular type/ring type - cause iris bombe - secondary angle closure glaucoma
segmental synechia
total synechia

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34
Q

what is the earliest sign of ant uveitis?

A

aueous flare

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35
Q

what causes aueous flare?

A

in ant uveitis when there is damage to the blood vessels the cells gets into the aueous humour and when seen in slit lamp exam with an point beam of light brownian movements are observed, this is called aques flare.

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36
Q

In which condition is aqueous flare seen?

A

most marked in granulomatous ant uveitis

less in granulomatous

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37
Q

grading of aqueous flare

A 
from 0 to 4 
0 none 
1 faint
2 moderate w iris and lens details seen
3 marked and details hazy
4 intense flare (fibrin or plastic aqueous)
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38
Q

types of hypophyon seen in ant uveitis?

A

DENSE IMMOBILE - HIGH FIBRIN - HLA B27 ANT UVEITIS

COLD HYPOPHYON - BEHCETS SYNDROME - CHANGE POSITION WITH CHANGE IN HEAD POSITION

HAEMORRHAGIC - HERPETIC , TRAUMA

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39
Q

WHAT ARE IRIS NODULES

A

THEY ARE NODULES FOUND IN ANT UVEITIS, CALLED
KOEPPES NODULES - IN THE IRIS BOORDER , INITIATE POST SYNECHIAE
BUSACCA’S NODULES - LESS COMMON

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40
Q

PUPILLARY SIGNS IN ANT UVEITIS

A 
NARROW PUPIL
IRREGULAR SHAPE
ECTROPION PUPIL (elevated pupil margin)
occlusio pupillae
sluggish pupil reaction
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41
Q

what are the changes seen in the lens in ant uveitis?

A 
deposition of pigment 
exudate deposition (in acute plastic ant uveitis)
complicated cataract(
42
Q

what are the vireous changes and retinal changes in the eye due to iridocyclitis?

A

exudates and inflammatory cells

cyatoid macular edema(esp in chronic macular edema)

43
Q

what happens to the iOP in iridocyclitis? does it increase or decreace?

A

both happens or even stays normal

incREASE- due to 2 ACG
DECREASE DUE TO 1. ACUTE IRIDOCYCLITIS - SHOCK OF CILIARY BODY
2. CHRONIC IRIDOCYCLITIS- PHYTHISIS BULBI

44
Q

WHAT IS THE END RESULT OF CHRONIC IRIDOCYCLITIS

A

PHYTHISIS BULBI WHERE THE EYE BALL SHRIKS AND LOOSES VISION

45
Q

WHAT ARE THE FEATURES U NOTICE IN A PATIENT WITH ACUTE IRIDOCYCLITIS?

A 
GRADUAL ONSET OF SYMTOPMS
WATERY DISCHARGE 
PAIN - MOD AND ALONG DIV OF 5TH NERVE
VISION IS SLIGHTLY IMPAIRED
CONGESTION - OF DEEEP CILIARY VESSELS
TENDERNESS IS MARKED
PUPIL BECOMES - SMALL AND IRREGULAR
ANT CHAMBER- AQUESOU SFLARE AND DEEPER
IRIS IS MUDDY
IOP - USUALLY NORMAL
NO CLOURED HALOS
46
Q

WHAT ARE THE POINTS THAT U SHOULD KNOWS AT THE TOP OF YOURE HEAD ABOUT ANT UVEITIS?

A 
koppes nodules and bussacas nodules
keratic precipitates
aqueous flare
muddy iris
post synechiae

Inflammation of the iris and pars plicata
due to infection or autoimmune or allery systemic,
granulomatous or non granulomatous

47
Q

complications of iridocyclitis

A 
complicated cataract 
secondary glauco ma (divided into early and late)
band shaped keratopathy
choroiditis
retinitis
retinal damages 
papillitis
phthysis bulbi (3 stages)
48
Q

stages of phythisis bulbi

A

atropic changes without shrinkage
atrophy with skrinkage
with collapse of structures

49
Q

what are the drugs used to treat iridocylclitis?

A 
cycloplegic drugs
steriods
antibiotics broad spectrum
systemic steriods 
immunosuppressants
NSAIDS
50
Q

what does cycloplegis do in iridocyclitis? and an eg of it?

A 
they reduse spasm 
increase circulation
inc circulating antibiotics
decrease load of ant ciliary vessels
prevent synechiea
break formed synechiae
51
Q

why use NSAIDs and immunosuppresives?

A

use of nsaids when the steriods are contraindicated and

immunosuppresives to use when steroids dont work

52
Q

which kind of iridocyclitis is best treated with steroids?

A

non granulomatous iridocyclitis!

53
Q

physical measures used in iridocyclitis

A

dark goggles

hot fermentation

54
Q

complication treatment in iridocyclitis

A 
glaucoma during infection - 0.5% timolol
no infection - peripheral iridectomy
phythisis - enucleation
cataract - pciol CONTRAINDICATIO IS FRESH KPs
retinal detachments - vitrectomy
55
Q

what is sarcoidosis?

A

its a multi systemic disease which is granulomatous in nature

56
Q

what are the systems affected by it?

A

pulmonary
ocular lesions
hilar lymph node enlargement
skin lesions

57
Q

how many patients with sarcoidosis present with ocular manifeatations ?

A

20-50%

58
Q

what is the type of granuloma found in sarcoidosis?

A

macrophages

its an epitheloid cell granuloma

59
Q

what are the structures affected in sarcododis ocular manifestations?

A

conjuctiva ant uvea and lacrimal glands

60
Q

types os sarcoidal uvea found?

A

anterior sarcoidal
intermediate and
posteior sarcoidal

61
Q

what happens in ant uveal sarcoidal lesion?

A 
ant uveitis ~ aueous flare,
 aqueous cells,
iris nodules,
mutton fat kps,
post synechiae
62
Q

what is the kind of kPs found in sarcoidosis?

A

mutton chop, cause it is a granulomatous type of iridocyclitis

63
Q

what are the structures affected in intermediate type of sarcoidal uveitis?

A

viterous

64
Q

characteristics of sarcoidal intermediate uveitis

A

vitrous cells
snowball opacities
snow banking

65
Q

structures affected in posterior sarcoidal uveitis?

A

retina and choroid

66
Q

charateristics of post sarcoidal uveitis?

A
  1. chorodal and retinal granulomas
  2. cystoid macular edema
  3. periphlebitis retinae
  4. CANDLE WAX APPEARANCE ^
  5. punched out atrophies
67
Q

what is HEERFORDT’S SYNDROME?

A

UVEioparotid fever -

  1. bilat panuveitis
  2. painful enlarged parotids
  3. skin rashes
  4. fever
  5. malaise
68
Q

complications of sarcoidal uveitis?

A

complicated cataract
inflammatory glaucoma
cyatoid macular edema

69
Q

other ocular lesions of sarcoidosis?

A

conjuctival - sarcoidal nodules, keratoconjuctivitis sicca

lacrimal glands - enlargements

70
Q

what is MICKULICZ’S syndrome?

A

lacrimal swell with salivary gland swell in sarcoidosis

71
Q

how is sarcoidal uveitis diagnosed?

A

KVEIMS test- positive
abnorm chest x ray
serum angiotensin converting enzyme increased

72
Q

confirmation of sarcoidosis?

A

histology of biopsy from conjuctival nodules skinn and lymph nodes

73
Q

treat sarcoidal ocular disease

A 
usual as iridocyclitis
steriods 
cycloplegics 
immunosuppresives 
NSAIDS
dark goggles
hot fermentation
and complication treatment
74
Q

what is FUCH’S uveitis syndrome?

A

non granulomatous
low grade ant uveitis
early cataract
unilat and middle aged people

75
Q

is FUCH’S unilat or bilat?

A

unilateral

76
Q

clinical features of fuch’s uveitis syndrome

A 
MOTH EATEN IRIS - diffuse stromal atrophy
HETEROCHROMIA IRIS
FINE STELLATE KPs
faint aqueous flare
no post synechiae
rubeosis iridis
angle of ant neovascularization
BUT EARLY DEVELOPMENT OF CATARACT AND 2* GLAUCOMA
77
Q

WHAT IS NOT USED IN THE TREATMENT OF FUCHS AND WHY?

A

CYCLOPLEGICS NOT USED CAUSE NO POST.SYNECHIAE

78
Q

TREATMENT OF FUCHS

A

ONLY STEROIDS

79
Q

WHAT IS posner schlossman syndrome?

A

granulomatocyclitic crisis
Recurrent acute unilat increase in IOP (40 - 50 mmHg)
no post.synechiae
no shallow ant. chamber
edeoma of cornea
fine keratic precipitates in the post cornea
dilated pupil

80
Q

C.F OF posner schlossman syndrome ?

A 
recurrent 
unilar acute inc. in IOP
no shallow ant chamber 
no post synechiae
dil pupil
WHITE EYE
epitheloid edema of corne
post cornea has FINE kps
81
Q

which age group is affected by poshner schlossman syndrome?

what is the common antigen thats positive?

A

YA

HLA BW54

82
Q

TREATMENT OF POSHNER SCHLOSSMAN?

A

ANTIGLAUCOMA FOR REDUCING IOP

STEROIDS SHORT COURSE

83
Q

what is episclera?

A

episclera is the outter vasular cover of sclera proper , it has macrophages and lymphocytes

84
Q

what is the tenons capsule?

A

its a capsule covering the sclera (actually the episclera)

{and i think its only in the posterior part}

85
Q

what is episcleritis?

A

inflammation of episclera + tenons capsule over it
benign
recurrent

86
Q

who are more susceptable ?

A

women and ya age group (women) get it?

87
Q

what are the causes of (eitiology) of episcleritis?

A
  1. idiopathis
  2. systemic disease association - gout,psoriasis,rosacea,conn tissue disorder
  3. allergic - tubercular toxin(endogenous)
  4. infectious- herpes,syphiilis,lymes,TB
88
Q

PATHOLOGY OF EPISCLERITIS?

WHAT DOES IT CAUSE?

A

Localised lymphoid aggregate of episcleral tissue

EDEMA CONGESTION - CONJUCTIVA AND TENONS

89
Q

SYMPTOMS OF EPISCLERITIS?

A
  1. redness
  2. mild discomfort- GRITTY,
  3. burning and/or foreign body sensation
  4. nild photophobia or lacrimation

maybe NO DISCOMFORT AT ALL

90
Q

SIGNS OF EPISCLERITIS?

2 clinical types of it?

A

nodular and simple

simple - sectorial (mosre common) or diffuse
- engorged episc vessles big and radial under conjuctiva
nodular - pink or purple
- around which injection present 2-3mm away from limbus
-firm and tender nodule
- moves seperately without sclera or conjuctiva

91
Q

course of episcleritis?

A

self limiting but recurrent .

lasts 10 days to 3Ws.

92
Q

DD of episcleritis?

A

simple- conjuctivitis

nodular- pinguecula , foreign body swell and nodule,scleritis

93
Q

treatment of episcleritis

A 
NSAIDS
STEROIDS mild 
ARTIFICIAL TEARS
COLD COMPRESSION
SYSTEMIC NSAIDS
94
Q

WHAT IS SCLERITIS?

WHAT IS SCLERA MADE OF?

A

INFLAMMATION OF SCLERA PROPER

ITS MADE OF CONNECTIVE TISSUE AND ITS AVASCULAR LAYER

95
Q

GIVE SOME SPECIFICATIONS ABOUT SCLERITIS

A 
# MOSTLY IN ELDERLY
#FEMALES
#LESS COMMON INCIDENCE THAN EPISCLERITIS
#BUT- Can lead to vision or total eye loss if not treated properly
#MOSTLY (50%) RELATED TO SYSTEMIC CONNECTIVE TISSUE DISORDERS
96
Q

WHAT ARE 50% OF SCLERITIS ASSOCIATED WITH?

A

WITH SYSTEMIC CONNECTIVE TISSUE DISORDER

97
Q

EITIOLOGY OF SCLERITIS

A
  1. AUTOIMMUNE- SLE, ankylosis spondylosis,RhA
  2. INFECTIOS- ch stap and strep, herpes
  3. GRANULOMATOUS DISEASE- tb , leprosy , sarcoidosis
  4. IDIOPATHIC
  5. POST SURGERY
  6. METABOLIC DISORDERS - thyrotoxicosis , gout
  7. MISCELLANIOUS -bachets diseae, rosacea , chemical burns , irradiation
98
Q

what is the pathology of scleritis?

A

that of granulomatous disease
polymorphonuclear cells , macrophages , lymphocytes , plasma cells, - inside
surrounded by - multinucleated epitheloid giant cell , new vessels
vasculitis

99
Q

classify scleritis

A

auto immune and infectious

autoimmune - anterior and posterior
non necrotising
necrotising

100
Q

symptoms of scleritis

A

no or mild photophobia and lacrimation
moderate to severe pain
redness - local or diffuse
vision may reduce

101
Q

explain the character of pain in scleritis

A

deep and boring character
worse in morning and wakes up patient in the mornings
radiate to jaw and temple

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