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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?

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
miosis
restriction of the pupil also resistance to pharmacologic dilation
26
hypopyon
white cells in the anterior chamber
27
keratic precipitates
inflammatory debris on corneal endothelium found on posterior side of purkinje image 1 like a scar
28
hyphema
blood in anterior chamber
29
clinical signs of posterior uveitis
vitreous opacities, tapetal hyporeflectivity, retinal hemorrhage, altered pigmentation of nontapetal fundus, retinal detachment
30
tapetal hyporeflectivity
indicates active lesion cells or fluid obscuring view of tapetum
31
diagnosis of uveitis
clinical hx: red eye, cloudy eye, squinting, tearing, visual deficits, blindness, signs of systemic dz hypotony (\<10 mmHg)
32
diagnostic work up
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
potential etiologies
immune-mediated/idiopathic, neoplastic, infectious pretty much anything
34
idiopathic
most common "cause" dx of exclusion more likely to be unilateral vs bilateral
35
systemic disease etiology
more likely bilateral than unilateral
36
lens induced uveitis
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
phacolytic uveitis
slow leakage of lens protein most obvious with hypermature/resorbing cataract chronic, low grade inflammation
38
phacoclastic uveitis
sudden release of lens protein secondary to penetraing ocular trauma, lens rupture rapid progression, severe inflammation
39
Golden retriever uveitis
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
FeLV/FIV
FeLV itself doesn't cause uveitis secondary to superinfection, lymphoma, anemia, spastic pupil syndrome FIV-Direct viral tissue damage, superinfection
41
FIP
ocular lesions more common in dry form granuloma formation, vasculitis, immune complex deposition "mutton fat" keratic precipitates
42
Canine distemper virus
chorioretinits +/- optic neuritis
43
therapy for uveitis
treat underlying cause, address inflammation, address pain, minimize sequelae abx-topical if ulcer present, systemic if uveitis caused by infection
44
anti-inflammatory therapy
very important topical if anterior only need systemic if posterior involved Corticosteroids, NSAIDs, Other immunomodulating drugs
45
Topical corticosteroids
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
systemic corticosteroids
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
Topical NSAIDs
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
Systemic NSAIDs
Carprofen, meloxicam, tepoxalin, etc may be used toa ugemtn topical medication may be used with infectious disease do not use with systemic corticosteroids
49
pain management
anti-inflammatory therapy mydriatic/cycloplegic therapy (atropine)
50
atropine
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
patient monitoring
recheck 1 weeks after dx check IOP, severity of aqueous flare, appearance of clinical signs
52
Synechia
anterior-cornea to iris posterior-iris to lens arise from pupillary zone or peripheral ciliary zone
53
Sequelae of uveitis
synechia iris atrophy cataract lens luxation Glaucoma iris bombe phthisis bulbi chorioretinal scarring
54
iris bombe
360 degrees posterior synechia prevent movement of aqueous from posterio chamber to anterior chammber narrows idiocorneal angle elevation of IOP
55
Chorioretinal scarring
tapetal hyperreflectivity with pigment clumping

Ophthamology (3 decks)

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