Uvea Pathologies Flashcards
Iris Naevi: Aetiology (1)
Physiological change in pigmentation composed of small spindle and dendritic naeval cells
Iris Naevi: Signs (4)
Can be flat or raised
Avascular
Superficial layers only
Rarely distorts surroundings
Iris Naevi: Management (1)
Monitor for changes
Iris Naevi: Symptoms (1)
Cosmetic only
Iris Melanoma: Aetiology (4)
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
Iris Melanoma: Signs (6)
Raised
Replaces Iris stroma
Variable pigmentation- frequently dark brown
Visible intrinsic tumour vessels
Commonly located at pupil margin
Distorts pupil
Iris Melanoma: Symptoms (4)
Usually none
May affect vision if interacts with pupil or cross visual axis
Can shed pigment
Block anterior angle - causing secondary glaucoma
Iris Melanoma: Management (3)
Refer within 2/52
Long-standing can be routinely referred
Urgent if increases IOPs
Iris Coloboma: Aetiology (1)
Congenital abnormalities associated with poor macula development
Iris Coloboma: Signs (1)
Part of the Iris missing
Iris Coloboma: CL related management (2)
Cosmetic
Hand painted lens with opaque backing
Aniridia: Aetiology (2)
Congenital
Traumatic
Aniridia: Signs (3)
Majority or entire Iris is missing
Nystagmus may be present
Amblyopia
Aniridia: CL related Management (3)
Cosmetic
Hand painted lens with Iris and opaque backing (prevents light scatter)
Scleral lenses may be fitted
Albinism: Aetiology (2)
Congenital
Can be just ocular of full albinism
Albinism: Signs/Symptoms (6)
High refractive error
Associated with high astigmatism
Nystagmus
Reduced VAs
Photophobia
Pale skin, hair, iris due to lack of pigment
Albinism: CL related management (5)
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
Fixed Dilated Pupil: Aetiology (4)
Unilateral or bilateral
Many causes, including blunt trauma and anterior uveitis
Neurological causes usually involve CNIII and accompany ptosis
Acute glaucoma may cause mydriasis
Fixed Dilated Pupil: Signs/Symptoms/Management (1)
Will vary depending on the cause
Choroid Naevi: Aetiology (2)
Often congenital
Pigment changes in the choroid
Choroid Naevi: Signs (2)
Always flat
Slate grey in colour
Choroid Naevi: Symptoms (1)
Typically asymptomatic
Choroid Naevi: Management (2)
Monitor for changes (growth and visual symptoms)
Can develop into malignant melanoma
Choroid Melanoma: Aetiology (3)
Most common primary malignant intraocular tumour
More common in caucasians ages 55-75
Systemic metastasis occurs in 40% of patients
Choroid Melanoma: Signs (3)
Slate grey in colour (similar to Naevi)
Concerning when raised
Overlaying vessels are pushed forward
Choroid Melanoma: Symptoms (4)
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
Choroid Melanoma: Management (2)
Consider retinal detachment first with symptoms - refer for dilated examination same day or next
Once ruled out retinal detachment, refer routinely
Uveitis: Structures it involves (4)
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
Uveitis: Further classifications (based on source) (2)
Exogenic
Endogenic
Exogenic
External disease/microbial infection or trauma has caused the inflammation
Endogenic
Internal disease/microbial infection or systemic
(often inflammatory) disease has caused the inflammation.
Panuveitis: Inflammation of…
Entire uveal tract
Choroiditis: Inflammation of…
Choroid
Iridocycitis: Inflammation of…
Iris and ciliary body
Iritis: Inflammation of…
Iris
Uveitis: Signs (6)
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
Uveitis: Symptoms (5)
Photophobia
Pain
Reduced VAs
Lacrimation
(Chronic can be asymptomatic)
Uveitis: Management (2)
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)
Choroiditis (4)
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
Choroidal Detachment (3)
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
Glaucoma: Classifications (2)
Open angle
Closed angle
Open Angle Glaucoma
Where the anterior angle opening is not obstructed
Closed Angle Glaucoma (2)
When the anterior angle opening is
compromised
Can be primary (no other factors) or secondary, following an associated predisposing condition/disease
(e.g. Uveitis).
Acute Closed Angle Glaucoma: Risk Factors
Hyperopic
Female
50+ in age
Acute Angle Closure Glaucoma: Lens changes
Lens increase in size with age, gradually reduces chamber angle and depth
Results in intermitted angle closure and intermittent symptoms
Acute Angle Closure Glaucoma: Signs
Reduced Van Herick’s Measurement / Angle Closure
Iris Bombe
Hazy Cornea
Perilimbal injection
Acute Angle Closure Glaucoma: Symptoms
Haloes around lights in evening/morning/night
Aching of the browline
Pain
Blurred vision
Symptoms may be intermittent initially
Secondary Glaucoma: Pigment Dispersion Syndrome (4)
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
Secondary Glaucoma: Pseudo Exfoliative Glaucoma (4)
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
Secondary Glaucoma: Neovascular Glaucoma (3)
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.
Secondary Glaucoma - Neovascular Glaucoma: Management (2)
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
