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Ophthamology > uvea > Flashcards

uvea Flashcards

1
Q

function of uveal tract

A

vascular supply

light regulation

blood aqueous barrier

accomodation

formation of aqueous humor

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2
Q

nonpigmented epithelium of the ciliary body

A

epithelial portion of BAB-tight junctions

formation of aqueous

active aqueous production

bicarbonate

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3
Q

heterochromia iridis

A

>1 color in 1 iris or between 2 irides in 1 animal

often concurrent coat color dilution

usually incidental

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4
Q

persistsent pupillary membranes

A

remnants of embryonic vasculature

airse from iris collarette

usually resorbed by 6 weeks of age

iris to iris-incidental

iris to lens-cataract

iris to cornea-corneal opacity

no therapy

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5
Q

Merle ocular dysgenesis

A

associated with Merle gene

Dachshund, collie, australian shepherd, great dane

heterochromia iridic

iris hypoplasia

iris coloboma-chunk of iris missing

corectopia-pupil in wrong spot

no tx

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6
Q

Uveal cysts

A

arise from pigmented epithelium of iris and/or ciliary body

spontaneous in formation or in response to inflammation

free floating or anchored

main r/o: melanoma

Dx by characertistic appearance, transillumination

usually incidental

usually no tx

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7
Q

iris atrophy

A

age related thinning of the iris-moth eaten appearance, scalloped pupillary margin

diminished PLRs

dyscoria

no therapy

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8
Q

Primary uveal neoplasia

A

cats & horses-Melanoma

dogs-melanocytic neoplasia

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9
Q

feline diffuse iris melanoma

A

insidious hyperpigmentation of the iris face

r/o: benign melanosis/nevus

could be metastasis from liver, lungs, regional LNs

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10
Q

differentiating between feline diffuse iris melanoma and benign melanosis/nevus

A

raised from iris surface-Purkinje 2 image raised

rapid spread

distortion of thickening of iris

interference with pupil shape or function

extension into sclera

associated uveitis or glaucoma

extent of hyperpigmentation

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11
Q

feline diffuse iris melanoma tx

A

continued monitoring-take photo

laser photocoagulation-small lesions only could disperse neoplastic cells

enucleation:histopath

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12
Q

Canine uveal melanocytic neoplasia

A

usually in anterior uvea

DDx: uveal cyst, limbal melanoma

Dx: transillumination, U/S, gonioscopy

Tx: monitor with photos, laser photocoagulation-small, enucleation-histopath

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13
Q

secondary uveal neoplasia

A

lymphosarcoma

DDx: uveitis

clin sxs: uveitis, nodules on iris, diffuse thickening of iris, destruction of iridal architecture

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14
Q

uveal neoplasia: tx

A

primary-sector iridectomy, laser ablation, enucleation

secondary: chemotherapy, enucleation

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15
Q

blood ocular barriers

A

prevent movement of porteins, low-molecular weight solutes into the eye

tight junctions

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16
Q

Uveitis

A

inflammation of the vascular tunic of the eye

breakdown of the blood-ocular barrier

protein and inflammatory cells present

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17
Q

anterior uveitis

A

iris and/or ciliary body

iridocyclitis, iritis, cyclitis

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18
Q

posterior uveitis

A

choroid

choroiditis, chorioretinitis

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19
Q

panuveitis

A

anterior and posterior uveitis

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20
Q

endophthalmitis

A

panuveitis and inflammation of the ocular cavities

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21
Q

panophthalmitis

A

all tunics of eye inflamed

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22
Q

clinical signs of anterior uveitis

A

non-specific signs: blepharospasm, elevated third eyelid, epiphora

more specific sxs: episcleral injection, deep corneal vascularization, corneal edema, aqueous flare, miosis, hypopyon, keratic precipitates, hyphema, iris swelling congestion, anterior chamber fibrin, rubeosis iridis, iris color change, iris hemorrhage

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23
Q

does absence of aqueous flare rule out uveitis?

A

no!

24
Q

aqueous flare

A

aka Tyndall phenomenon, plasmoid aqueous

cells, proteins, inflammatory debris within aqueous reflect light

light beam traversing the anterior chamber-connecting Purkinje images 1 and 2

presence of flare=anterior uveitis

25
Q

miosis

A

restriction of the pupil

also resistance to pharmacologic dilation

26
Q

hypopyon

A

white cells in the anterior chamber

27
Q

keratic precipitates

A

inflammatory debris on corneal endothelium

found on posterior side of purkinje image 1

like a scar

28
Q

hyphema

A

blood in anterior chamber

29
Q

clinical signs of posterior uveitis

A

vitreous opacities, tapetal hyporeflectivity, retinal hemorrhage, altered pigmentation of nontapetal fundus, retinal detachment

30
Q

tapetal hyporeflectivity

A

indicates active lesion

cells or fluid obscuring view of tapetum

31
Q

diagnosis of uveitis

A

clinical hx: red eye, cloudy eye, squinting, tearing, visual deficits, blindness, signs of systemic dz

hypotony (<10 mmHg)

32
Q

diagnostic work up

A

first: complete PE, CBC, Chem23, UA, FIV/FeLV test
second: thoracic/abdominal rads, abdominal u/s, LN aspirates, ocular u/s, aqueous or vitreous aspirates, histopath

33
Q

potential etiologies

A

immune-mediated/idiopathic, neoplastic, infectious

pretty much anything

34
Q

idiopathic

A

most common “cause”

dx of exclusion

more likely to be unilateral vs bilateral

35
Q

systemic disease etiology

A

more likely bilateral than unilateral

36
Q

lens induced uveitis

A

T cell tolerance to low levels of lens antigen

increased exposure to antigen overwhelms this tolerance

antigen in anterior chamger incites intraocular inflammation

pacolytic uveitis vs phacoclastic uveitis

cataract removal

37
Q

phacolytic uveitis

A

slow leakage of lens protein

most obvious with hypermature/resorbing cataract

chronic, low grade inflammation

38
Q

phacoclastic uveitis

A

sudden release of lens protein

secondary to penetraing ocular trauma, lens rupture

rapid progression, severe inflammation

39
Q

Golden retriever uveitis

A

pigmentary uveitis of golden retrievers

unknown pathogenesis

average age 8.6 years

Characteristics: uveal cyst formation, increased iris melanin, melanin deposition on lens capsule (radial), Glaucoma, cataract

dx: clinical appearance

no effective treatment/anti-inflammatories

leads to blindness and glaucoma

40
Q

FeLV/FIV

A

FeLV itself doesn’t cause uveitis

secondary to superinfection, lymphoma, anemia, spastic pupil syndrome

FIV-Direct viral tissue damage, superinfection

41
Q

FIP

A

ocular lesions more common in dry form

granuloma formation, vasculitis, immune complex deposition

“mutton fat” keratic precipitates

42
Q

Canine distemper virus

A

chorioretinits +/- optic neuritis

43
Q

therapy for uveitis

A

treat underlying cause, address inflammation, address pain, minimize sequelae

abx-topical if ulcer present, systemic if uveitis caused by infection

44
Q

anti-inflammatory therapy

A

very important

topical if anterior only

need systemic if posterior involved

Corticosteroids, NSAIDs, Other immunomodulating drugs

45
Q

Topical corticosteroids

A

first choice for anterior uveitis

predniolone acetate, dexamethasone

NOT hydrocortisone

CI if corneal ulcer is present

high dose at first then taper off

caution in small dogs, cats and diabetics

46
Q

systemic corticosteroids

A

prednisone, prednisolone

anti-inflammatory to immunosuppressant doses-gradually taper

can be used wtih topical meds

can be used in the presence of corneal ulcer

first r/o infectious dz

do not use with NSAIDs

47
Q

Topical NSAIDs

A

diclofenac, flurbiprofen, nepafenac

may be used alone or with topical and/or sytemic corticosteroids

frequency of use depends on severity of inflammation

problems: decrease aqueous outflow, incite collagenolysis, inhibit platelet aggregation, systemic absorption

caution in cats, small dogs, concurrent renal disease

48
Q

Systemic NSAIDs

A

Carprofen, meloxicam, tepoxalin, etc

may be used toa ugemtn topical medication

may be used with infectious disease

do not use with systemic corticosteroids

49
Q

pain management

A

anti-inflammatory therapy

mydriatic/cycloplegic therapy (atropine)

50
Q

atropine

A

parasympathetic/anticholinergic

stabilizes blood-aqueous barrier

onset 30-60 mins; slowed with inflammation

use lowest dose required to achieve mydriasis

Cycloplegic-paralysis of ciliary body

decreases formation of posterior synechia

CI if glaucoma present, KCS

may cause profuse salivation

51
Q

patient monitoring

A

recheck 1 weeks after dx

check IOP, severity of aqueous flare, appearance of clinical signs

52
Q

Synechia

A

anterior-cornea to iris

posterior-iris to lens

arise from pupillary zone or peripheral ciliary zone

53
Q

Sequelae of uveitis

A

synechia

iris atrophy

cataract

lens luxation

Glaucoma

iris bombe

phthisis bulbi

chorioretinal scarring

54
Q

iris bombe

A

360 degrees posterior synechia

prevent movement of aqueous from posterio chamber to anterior chammber

narrows idiocorneal angle

elevation of IOP

55
Q

Chorioretinal scarring

A

tapetal hyperreflectivity with pigment clumping

Ophthamology (3 decks)

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