Uveal Tract Flashcards
Pathology of malignant melanoma of choroid
Arises from existing naevus or denovo
- Circumscribed(pedunculated) tumour
- flat, grey which becomes raised and pigmented
- further growth produces retinal detachment - Diffused(flat):spreads slowly without forming tumour mass
- in this symptoms occurs late
Histopathology of malignant melanoma of choroid
- Spindle cell- good prognosis
- spindle shaped cells - epitheliod-large round or oval cells
- worst prognosis - mixed cell- contain both cell type
- intermediate prognosis - necrotic - cell type is unrecognisable
Quiescent stage of malignant melanoma of choroid
Symptoms- depends on location and size of tumour
Sign-
1-small tumour appear as elevated pigmented oval mass
-appearance of orange patch due to lipofuscin is pathagonomic sign
2-tumour penetrates through bruch membrane and leads to retinal detachment
-ribbon like wide vessels are seen coursing over tumour surface area
Glaucomatousstage of malignant melanoma of choroid
Develops when left untreated in quienscent stage
Glaucoma develops
Symptoms-pain redness and watering in blind eye
Sign-conjunctiva- congestion abd edema Cornea-edema Anterior chamber- shallow Pupils-fixed and dilated Lens-opaque Intraocular pressure-raised
Stage of extra ocular extensions of malignant melanoma of choroid
Through rupture of sclera at limbus
Stage of distant metastasis of malignant melanoma of choroid
Lymphatic metastasis not known
Blood metastasis-mainly & commonly to liver and is cause of death
Differential diagnosis of malignant melanoma of choroid
1should be differentiated from other glaucoma
- naevus,melanocytoma & hyperplasia of pigment epithelium
- should be differentiated form other causes of retinal detachment
Investigations in malignant melanoma of choroid
1indirect opthalmoscopy examination
- transillumination test
- ultrasonography
- fluorescein angiography
- radioactive tracer
- MRI
Treatment of malignant melanoma of choroid
Conservative treatment
- brachytherapy using iodine 125 or cobalt 60
- external beam radiotherapy protons and helium ions
- transpupillary thermotherapy with diode laser
Enucleation
Debulking
Palliative treatment with chemotherapy and immunotherapy
-trans scleral resection
Stereotatic radiosurgery
Evisceration
Removal of content of eyeball-leaving behind sclera
Indications pf evisceration
1 panopthamitis
2 expulsive choroidal haemorrhage
3 bleeding anterior staphyloma
Surgical steps of evisceration
1Separation if conjunctiva and tenons capsule -conjunctiva is incised all around limbus with spring scissor
- tenons capsule and conjunctiva undermining is done with blunt tipped curved scissor
2. Removal of cornea-cut at limbus is made with help of razor blade and then cornea is excised with corneao scleral scissor
3. Removal of intraocular content-uveal tissue is separated from sclera with evisceration spatula and content is scooped out using evisceration curette
4. Separation of extra-ocular muscle-is done same as enucleation
5. Removal of sclera -using curved scissor,oly 3 mm frill is left around optic nerve
6. Closure of tenons capsule and conjunctiva-same as enucleation
Panopthamitis
It is an intense purulent inflammation of whole eyeball including tenons capsule
Disease usually begins as purlent anterior or posterior uveitis and soon develops into panopthamitis
Aetiology of panopthamitis
It is an acute bacterial infection Same as infective bacterial endopthalmitis 1. Exogenous infection 2. Endogenous infection 3. Secondary infection
Symptoms of panopthalmitis
Redness Swelling Pain Lacrimation Headache Complete loss of vision Purulent discharge And associated fever and malaise
Signs of panopthalmitis
Lid- oedema and hyperaemia Eyeball-proptosed,ocular movement are limited and painfull Conjunctiva-congestion and chemosis Cornea-cloudy and edematous Anterior chamber is full of pus Vision- completely lost Intraocular pressure-raised
Complications of panopthalmitis
1 orbital cellulitis
2 cavernous sinus thrombosis
3. Meningitis
4. Encephalitis
Treatment of panopthalmitis
Anti-inflammatory and analgesic- to relive pain
Broad spectrumantibiotic-to preventspread of infection
Evisceration should be performed - to avoid spread of infection intracranially
Toxic anterior segment syndrome
Postoperative sterile endopthalmitis is confined mainly to anterior segment of eyeball
Masquerade syndrome
Intraocular tumour necrosis may present as sterile endopthalmitis
Endopthalmitis
Inflammation of inner structures of eyeball i.e. Uveal tissue and retinae
Infective endopthalmitis
- Exogenous-infection fallowing perforating injury,corneal ulcer or post operatively
- endogeneous-spread through blood from caries of teeth & generalised septicaemia
- Secondary-orbital cellulitis, thrombophlebitis,corneal ulcers(infected)
Non-infective endopthalmitis
Postoperative-toxic reaction to chemicals of intruments or lens
Post traumatic- due to retention of metal of foreign body
Phacoanaphylactic- in morgagnian cataract patient
Intraocular tumour necrosis
Symptoms of endopthalmitis
Pain Photophobia Lacrimation Redness Loss of vision
Sign of endopthalmitis
Lid-congestion and oedema
Conjunctiva-chemosis & congestion
Cornea- cloudy and oedematous
Anterior chamber- pus filled
Iris- when visible is edematous and muddy
Pupils-shows yellow reflex
Intraocular pressure-raised intially but later falls because of perforation
Treatment of endopthalmitis
1 antibiotics therapy
2 steroid therapy
3 supportive therapy
4 vitrectomy
Anatomical classification of uveitis
Anterior
Intermediate
Posterior
Panuveitis
Clinical classification of uveitis
Acute and chronic
Pathological classification of uveitis
1.suppurative
2. Non suppurative
•non granulomatous
•granulomatous
Etiological classification of uveitis
Infective Immune related Toxic Traumatic Non infective system Idiopathic
Infective uveitis
1 exogeneous
2 endogenous
3 secondary
Immune related uveitis
Microbial allergy 2 anaphylactic uveitis 3 atopic uveitis 4 autoimmune uveitis 5 HLA associated uveitis
Toxic uveitis
1 endotoxins
2 exogeneous toxin
3 endoocular toxin
Traumatic uveitis
1 mechanical trauma 2 burn 3 chemical 4 sympathetic opthalmia 5 intraocular haemorrhage
Non infective systemic diseases
Sarcoidosis Polyarteritis nodosa SLE DLE rheumatic fever gout Psoriasis Lichen planus Pemphigus
Idiopathic uveitis
Specific
Non specific
Symptoms of uveitis
1 pain 2 redness 3 photophobia 4 lacrimation 5 defective vision 6 blepharospasm
Malignant melanoma of choroid
Most common primary intraocular tumkr of adults
Seen in 40-70 years of age
Common in whites than blacks
Arises from neural crest derived pigment cells
Usually it is unilateral
