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Ophthalmology > Unit 2 - The Uvea > Flashcards

Unit 2 - The Uvea Flashcards

1
Q

The uvea is the ______ layer of the eye.

A

Vascular

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2
Q

What are the two components of the uvea?

A

Anterior uvea and posterior uvea

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3
Q

What are the components of the anterior uvea?

A

Iris and ciliary body

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4
Q

What are the components of the posterior uvea?

A

Choroid

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5
Q

What is the iris made out of?

A

Smooth muscles - the constrictor is stronger than the dilator

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6
Q

What does the iris do?

A

It regulates the amount of light that reaches the retina

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7
Q

What are the zones in this photo?

A

A - Ciliary

B - Collarette

C - Pupillary

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8
Q

Where do PPMs arise from?

A

The collarette of the iris

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9
Q

What is mydriasis?

A

Dilation of the iris

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10
Q

What drugs can cause mydriasis?

A

Tropicamide

Atropine

Phenylephrine

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11
Q

What is miosis?

A

Constriction of the iris

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12
Q

What drugs can cause miosis?

A

Pilocarpine and demecarium bromide

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13
Q

What is the ciliary body made up of?

A

Smooth muscles

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14
Q

What are the functions of the ciliary body?

A

Production of aqueous humor

Suspension of the lens zonules

Accommodation

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15
Q

What is the function of aqueous humor?

A

To nourish the cornea and lens

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16
Q

What accomodation does the ciliary body provide?

A

It accomidates focus by changing lens shape

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17
Q

Relaxed ciliary muscle results in what (to the zonules and lens)?

A

Taught zonules and thin lens

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18
Q

Contracted ciliary muscle results in what (to the zonules and lens)?

A

Loose zonules and rounder lens

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19
Q

Where is the choroid locateD?

A

Between the sclera and retina

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20
Q

T/F: A choroid can be atapetal but if there is a tapetum it will be located in the ventral region of the choroid.

A

False - it will be in the dorsal region of the choroid

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21
Q

What does the tapetum look like?

A

It is a highly reflective, yellow-green-orange ‘shine

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22
Q

What does the atapetal choroid look like?

A

It is variably pigmented and usually a dark, uniform color

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23
Q

What is the blood ocular barrier? What is its purpose?

A

It is a blood aqueous barrier that prevents the leakage of protein and cells into the eye from systemic circulation

It maintains the clarity of aqueous humor

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24
Q

What happens if the blood ocular barrier is broken down?

A

It results in clinical signs of uveitis

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25
Q

What is uveitis?

A

Inflammation of the uveal tissue

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26
Q

What is anterior uveitis?

A

Inflammation of the iris and ciliary body

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27
Q

What is posterior uveitis?

A

Inflammation of the choroid

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28
Q

What is chorioretinitis?

A

Inflammation of the choroid and retina

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29
Q

What is panuveitis?

A

Inflammation of all of the ocular layers

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30
Q

What is endophthalmitis?

A

Inflammation of the intraocular contents, excluding the fibrous tunic

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31
Q

What is panophthalmitis?

A

Inflammation involving all structures of the eye, including the neural, uveal, and fibrous tunics

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32
Q

What general clinical signs and findings are associated with uveitis?

A

Blepharospasm

3rd eyelid elevation d/t enophthalmos

Rubbing at the eye

Photophobia

Epiphora

Decreased vision or blindness

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33
Q

What are the ocular surface clinical signs and findings associated with uveitis?

A

‘Red eye’ due to episcleral and conjunctival BV injection

Corneal edema - localized or diffuse

Dense peripheral corneal neovascularization

34
Q

What clinical signs and findings are associated with uveitis of the intraocular anterior segment?

A

Keratic precipitates

Aqueous flare, hypopyon, hyphema

Fibrin clots or strands

Iris hyperemia or ‘rubeosis irides’

Iris swelling or color change

Irideal hemorrhage

Peripheral anterior or posterior senechia

Dyscoria

Miosis or resistance to pharmacologic dilation

Lens subluxation

35
Q

What clinical signs and findings are consistent with intraocular posterior segment uveitis?

A

Vitreal cells

Vitreal hemorrhage

Vitreal degeneration

Subretinal exudates causing hyporeflectivity in tapetal fundus or white-yellow discoloration in nontapetal fundus

Retinal hemorrhage

Retinal detachment

Optic neuritis

36
Q

What is aqueous flare caused by?

A

Suspended protein/cells in the anterior chamber

37
Q

How do you assess aqueus flare?

A

Deliberate 90 degree exam in a dark room with intense, focal light source close to the corneal surface

38
Q

What is the normal intraocular pressure in a dog/cat?

A

10-20 mmHg

39
Q

What intraocular pressure is consistent with uveitis?

A

<10 mm Hg or low normal range

40
Q

What intraocular pressure is consistent with glaucoma?

A

> 20 mmHg

41
Q

What clinical signs are consistent with active posterior uveitis?

A

Poorly defined lesions - +/- raised

Hyporeflective lesions in the tapetum

White/grey areas in non-tapetum

Retinal detachment

42
Q

What clinical signs are associated with historic posterior uveitis?

A

Well defined lesions

Hyperreflective lesions in tapetum - +/- pigmented center

White grey areas in non-tapetum

43
Q

What are the causes of uveitis?

A

Traumatic, neoplastic, lens-induced, infectious, immune-mediated, idiopathic

44
Q

What are the primary ocular causes of uveitis?

A

Trauma - blunt or penetrating

Corneal ulceration

Intraocular neoplasia

Cataract

45
Q

T/F: Any widespread infection or metastatic neoplasia can be a systemic cause of uveitis.

A

True

46
Q

What immune mediated etiologies can result in uveitis?

A

Uveodermatologic syndrome (immune-mediated melanin attack)

Immune-mediated thrombocytopenia

Immune mediated vasculitis

Golden Retriever pigmentary uveitis - associated with ciliary cysts

47
Q

T/F: Idiopathic uveitis may be up to 75% of non-ocular causes of uveitis.

A

False - it is 50%

48
Q

What does a uveitis workup consist of?

A

Complete ocular exam

Complete physical exam

Additional diagnostic testing such as CBC, chemistry, urinalysis, LN aspirat, thoracic/abdominal imaging, ocular ultrasound +/- aspirate

49
Q

What are the keys to uveitis treatment?

A

Start treatment immediately +/- submit labwork

Topical and systemic anti-inflammatory drugs

Topical mydriatic

Address underlying cause

50
Q

What is the treatment protocol for uveitis?

A

Treat the eye aggressively at first and tehn taper medications as signs resolve

Treat 2-4 weeks

Address underlying cause

51
Q

What is the preffered topical anti-inflammatory for the treatment of uveitis?

What other options are there?

A

Preferred - 1% prednisolone acetate (steroid) QID+

Others: 0.1% dexamethasone (Neo-Poly-Dex - steriod) QID+, Diclofenac, Flurbiprofen, ketorolac, suprofen, bromfenac TID-QID

52
Q

When are topical NSAIDs preferred over steroids in uveitis treatment?

A

When there is concurrent corneal ulceration present

53
Q

What topical steroids should not be used for the treatment of uveitis? Why?

A

Hydrocortisone, betamethasone, or sodium phosphate forms because they have poor penetration

54
Q

What form of uveitis are topical NSAIDs great for?

A

They are great to prevent or treat mild lens-indued uveitis

55
Q

What systemic drugs can be used for the treatment of uveitis (general)?

A

Systemic NSAIDs or systemic corticosteriods

56
Q

What specific systemic NSAIDs can be used to treat uveitis? When are they contraindicated?

A

Drugs: Carprofen, meloxicam, firocoxib

Contraindication: Avoid if hyphema/hemorrhage

57
Q

What systemic corticosteroids are indicated for treatment of uveitis? When are they contraindicated/should take caution?

A

Drug: 0.5-1 mg/kg prednisone BID then taper

Use caution with systemic infectious disease

58
Q

What is the preferred topical mydriatic for treatment of uveitis?

A

Atropine SID-BID

59
Q

Why would you want to use a mydriatic for treatment of uveitis?

A

To reduce ciliary spasm pain

Dilation of the pupil/prevents synechia

Stabilizes blood-aqueous barrier

60
Q

In what uveitis cases is atropine contraindicated?

A

If the intraocular pressure is elevated

61
Q

What side effects are associated with atropine use?

A

GI stasis, reduced STT, cat hypersalivation

62
Q

If you don’t have atropine, what other mydriatic drug can you use in the treatment of uveitis?

A

Tropicamide TID-QID

63
Q

What systemic anti-microbial drugs can be used to treat uveitis?

A

Doxycycline 10 mg/kg PO SID x 21 days

Broad spectrum abx if bacterial disease suspected

Oral antifungals if indicated

64
Q

What are the possible sequelae to uveitis?

A

Cataract formation

Synechiation - usually posterior, iris bombe is bad

Lens luxation/subluxation

Phthisis bulbi

Secondary glaucoma

65
Q

What are the keys to uveitis management?

A

Must recognize clinical signs

Perform a thorough evaluation

Get accurate diagnosis/diagnoses

Plan appropriate treatment and start ASAP

Timely rechecks

66
Q

What are persistent pupillary membranes?

A

Embryologic membranes that usually regress by birth but have remained

67
Q

What are the types of persistent pupillary membranes?

A

Iris to Iris

Iris to lens

Iris to cornea

68
Q

How are PPM treated?

A

No treatment is needed

69
Q

What is the difference between PPMs and Synechia?

A

PPMs arise from the iris collarette to the lens, cornea, or other areas of the iris

Synechia extend from the pupillary margin of the iris to the lens to the cornea

70
Q

T/F: Uveal cysts are tumors, but they are typically benign.

A

False - they are not tumors, but they are typically benign

71
Q

How are non-problematic uveal cysts treated?

A

No treatment is usually needed but you can aspirate them or deflate them with a laser if the vision is impacted

72
Q

What type of uveal cyst is problematic? What is it associated with?

A

Ciliary-based cysts

Associated with autoimmune uveitis

73
Q

What is iris hypoplasia?

A

Thin iris tissue

74
Q

What is iris coloboma?

A

Focal absence of tissue manifesting as a hole that can occur anywhere in the iris

75
Q

In what age group is iris atrophy common in?

A

Middle-aged and older animals

76
Q

What is iris atrophy?

A

A thin iris or irregularity of the pupillary margin

It may limit pupil constriction resulting in a poor PLR and/or anisocoria in an otherwise normal eye

77
Q

What primary uveal neoplasias occur in dogs and cats? What species are they more prevalent in?

A

Ciliary body adenoma/adenocarcinoma - dog > cat

Melanocytoma/melanoma - dog > cat

Diffuse iris melanoma - cat > dog

78
Q

What should you do if you have a patient with primary uveal neoplasia?

A

Monitor the eye and intraocular pressure - they are usually benign but locally destructive

79
Q

With what primary uveal neoplasia is metastasis more common with?

A

Diffuse iris melanoma

80
Q

What is the most common metastatic uveal neoplasia?

A

Lymphoma - ‘hot’ eye but not painful

Note: A lot of neoplasia types can metastasize to the lungs, but lymphoma is the big one

Ophthalmology (13 decks)

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