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CLO > Uvea Pathologies > Flashcards

Uvea Pathologies Flashcards

1
Q

Iris Naevi: Aetiology (1)

A

Physiological change in pigmentation composed of small spindle and dendritic naeval cells

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2
Q

Iris Naevi: Signs (4)

A

Can be flat or raised

Avascular

Superficial layers only

Rarely distorts surroundings

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3
Q

Iris Naevi: Management (1)

A

Monitor for changes

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4
Q

Iris Naevi: Symptoms (1)

A

Cosmetic only

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5
Q

Iris Melanoma: Aetiology (4)

A

Can be primary from a secondary metastasis

Accounts for 5-10% of uveal tract melanoma

Ask history & family history

Primary tumours have low metastasis risk

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6
Q

Iris Melanoma: Signs (6)

A

Raised

Replaces Iris stroma

Variable pigmentation- frequently dark brown

Visible intrinsic tumour vessels

Commonly located at pupil margin

Distorts pupil

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7
Q

Iris Melanoma: Symptoms (4)

A

Usually none

May affect vision if interacts with pupil or cross visual axis

Can shed pigment

Block anterior angle - causing secondary glaucoma

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8
Q

Iris Melanoma: Management (3)

A

Refer within 2/52

Long-standing can be routinely referred

Urgent if increases IOPs

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9
Q

Iris Coloboma: Aetiology (1)

A

Congenital abnormalities associated with poor macula development

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10
Q

Iris Coloboma: Signs (1)

A

Part of the Iris missing

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11
Q

Iris Coloboma: CL related management (2)

A

Cosmetic

Hand painted lens with opaque backing

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12
Q

Aniridia: Aetiology (2)

A

Congenital

Traumatic

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13
Q

Aniridia: Signs (3)

A

Majority or entire Iris is missing

Nystagmus may be present

Amblyopia

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14
Q

Aniridia: CL related Management (3)

A

Cosmetic

Hand painted lens with Iris and opaque backing (prevents light scatter)

Scleral lenses may be fitted

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15
Q

Albinism: Aetiology (2)

A

Congenital

Can be just ocular of full albinism

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16
Q

Albinism: Signs/Symptoms (6)

A

High refractive error

Associated with high astigmatism

Nystagmus

Reduced VAs

Photophobia

Pale skin, hair, iris due to lack of pigment

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17
Q

Albinism: CL related management (5)

A

Cosmetic contact lens

Hand painted with opaque backing

Nystagmus can reduce with improved VAs and feedback loop

Magnification can be lost with contact lenses

UV block important

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18
Q

Fixed Dilated Pupil: Aetiology (4)

A

Unilateral or bilateral

Many causes, including blunt trauma and anterior uveitis

Neurological causes usually involve CNIII and accompany ptosis

Acute glaucoma may cause mydriasis

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19
Q

Fixed Dilated Pupil: Signs/Symptoms/Management (1)

A

Will vary depending on the cause

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20
Q

Choroid Naevi: Aetiology (2)

A

Often congenital

Pigment changes in the choroid

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21
Q

Choroid Naevi: Signs (2)

A

Always flat

Slate grey in colour

22
Q

Choroid Naevi: Symptoms (1)

A

Typically asymptomatic

23
Q

Choroid Naevi: Management (2)

A

Monitor for changes (growth and visual symptoms)

Can develop into malignant melanoma

24
Q

Choroid Melanoma: Aetiology (3)

A

Most common primary malignant intraocular tumour

More common in caucasians ages 55-75

Systemic metastasis occurs in 40% of patients

25
Q

Choroid Melanoma: Signs (3)

A

Slate grey in colour (similar to Naevi)

Concerning when raised

Overlaying vessels are pushed forward

26
Q

Choroid Melanoma: Symptoms (4)

A

Can be asymptomatic

Can experience photopsia (flashes) as neural retina is pulled

Metamorphopsia (distorted vision) as retina pulled out of place

Vision loss if more severe

27
Q

Choroid Melanoma: Management (2)

A

Consider retinal detachment first with symptoms - refer for dilated examination same day or next

Once ruled out retinal detachment, refer routinely

28
Q

Uveitis: Structures it involves (4)

A

Iritis (anterior uveitis) - iris

Iridocycitis (intermediate uveitis) - iris and ciliary body

Choroiditis (posterior uveitis) - choroid at the back of the eye

Panuveitis - inflammation of the entire uveal tract

29
Q

Uveitis: Further classifications (based on source) (2)

A

Exogenic

Endogenic

30
Q

Exogenic

A

External disease/microbial infection or trauma has caused the inflammation

31
Q

Endogenic

A

Internal disease/microbial infection or systemic
(often inflammatory) disease has caused the inflammation.

32
Q

Panuveitis: Inflammation of…

A

Entire uveal tract

33
Q

Choroiditis: Inflammation of…

A

Choroid

34
Q

Iridocycitis: Inflammation of…

A

Iris and ciliary body

35
Q

Iritis: Inflammation of…

A

Iris

36
Q

Uveitis: Signs (6)

A

Perilimbal/circumlimbal injection with deep redness

Anterior chamber flare

Keratic precipitates (in severe cases)

Hypopyon and iris abnormalities

Iris Nodules (koeppe nodules – small and situated at pupil border and busacca nodules – situated on iris away from pupil margin)

Posterior Synechiae – adhesions between lens and iris

37
Q

Uveitis: Symptoms (5)

A

Photophobia

Pain

Reduced VAs

Lacrimation

(Chronic can be asymptomatic)

38
Q

Uveitis: Management (2)

A

Initially can refer to optom for cyclopentolate to relax the iris and relieve pain

Emergency referral with acute will then be treated with steroid drops (or treatment/management of the underlying autoimmune condition)

39
Q

Choroiditis (4)

A

Inflammation of choroid & surrounding tissue

Reasons include toxoplasmsis & or other systemic inflammatory diseases

Likely to scar and reduce acuity

Corticosteroids to manage and/or treat underlying condition

40
Q

Choroidal Detachment (3)

A

Associated with raised IOPs and fluid accumulation in suprachoroidal space

Can be cause by trauma, poor surgical outcome and haemorrhage

Symptoms same as retinal detachment

41
Q

Glaucoma: Classifications (2)

A

Open angle

Closed angle

42
Q

Open Angle Glaucoma

A

Where the anterior angle opening is not obstructed

43
Q

Closed Angle Glaucoma (2)

A

When the anterior angle opening is
compromised

Can be primary (no other factors) or secondary, following an associated predisposing condition/disease
(e.g. Uveitis).

44
Q

Acute Closed Angle Glaucoma: Risk Factors

A

Hyperopic

Female

50+ in age

45
Q

Acute Angle Closure Glaucoma: Lens changes

A

Lens increase in size with age, gradually reduces chamber angle and depth

Results in intermitted angle closure and intermittent symptoms

46
Q

Acute Angle Closure Glaucoma: Signs

A

Reduced Van Herick’s Measurement / Angle Closure

Iris Bombe

Hazy Cornea

Perilimbal injection

47
Q

Acute Angle Closure Glaucoma: Symptoms

A

Haloes around lights in evening/morning/night

Aching of the browline

Pain

Blurred vision

Symptoms may be intermittent initially

48
Q

Secondary Glaucoma: Pigment Dispersion Syndrome (4)

A

Predominantly myopic

Caused by anterior lens rubbing on posterior iris epithelium which sheds pigment into aqueous and anterior chamber

Seen as Krukenberg’s syndrome due to aqueous convention currents

Retro illumination of the iris can identify iris transillumination in those with PDS where pigment is lost

49
Q

Secondary Glaucoma: Pseudo Exfoliative Glaucoma (4)

A

Grey flecks of amyloid-like fibrillar material seen on lens capsule

More prevalent with increasing age

Flaking material occludes the
trabecular meshwork as with PDS

Iris transillumination may also be seen

50
Q

Secondary Glaucoma: Neovascular Glaucoma (3)

A

Neovascularisation of the iris (in advanced diabetic eye
disease) can invade the anterior angle
and prevent the outflow of aqueous
increasing the IOP

Slit lamp exam will show dilated
capillary tufts at the pupil margin

Note it is normal to see highly visible
blood vessels in lighter irides.

51
Q

Secondary Glaucoma - Neovascular Glaucoma: Management (2)

A

Can improve the opening of the anterior
angle with bypass of any
pupil block with iridectomy

Can improve outflow of aqueous by laser treatment on trabecular meshwork or trabeculectomy which allows outflow of aqueous into surrounding conjunctival tissue

CLO (13 decks)

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