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245 > 7.2 Anterior Uvea > Flashcards

7.2 Anterior Uvea Flashcards

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1
Q

What is iridodialysis?

A

Rupture of iris root secondary to blunt trauma or penetrating eye injury

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2
Q

Symptoms of iridodialysis?

A

Monocular diplopia, glare, photophobia

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3
Q

What is a peripheral iridectomy?

A

Surgical procedure with an intracapsular cataract extraction -> meant to prevent pupil block angle closure glaucoma

Rarely seen today because most surgeries are extracapsular now

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4
Q

What is laser peripheral iridotomy? Signs?

A

Use a laser to burn holes into the periphery of iris

Small superior holes in the iris (place superiorly to prevent issues with glare)

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5
Q

What is the purpose of laser peripheral iritodotomy?

A

Surgical tx for glaucoma (allow aqueous flow to anterior chamber)

Prevent angle closure glaucoma in Px with narrow angles

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6
Q

What should you never do if a patient has an iris supported intraocular lens?

A

Dilate! You never dilate these patients!

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7
Q

What is an iris supported intraocular lens?

A

First type of IOL (1980s and earlier), lens clipped or sutured to the iris

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8
Q

Who might you see an iris supported IOL in?

A

Px who had cataract surgery 20+ years ago

Px who had complications with cataract surgery (problems with posterior chamber IOL)

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9
Q

What is an iris nevus?

A

Common benign tumour of the iris; includes freckles or diffuse nevi

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10
Q

What does an iris nevi look like?

A

Flat or slightly elevated

Pigmented lesion on superficial layer of iris

Circumscribed, usually <3mm in diameter

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11
Q

Iris nevi - location, number, laterality

A

Usually found inferiorly

Usually multiple

Usually bilateral

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12
Q

Iris nevi - how might this affect others structures

A

May distort pupil if large

May extend into TM

May see ectropion uveaae

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13
Q

Iris nevi in Cogan-Reese syndrome

A

Diffuse nevi + nodules

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14
Q

Iris nevi in neurofibromatosis 1

A

Lisch nodules

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15
Q

What is neurofibromatosis 1?

A

Disorder that affects cell growth of neural tissues (AD inheritance, variable penetrance)

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16
Q

Systemic features of neurofibromatosis 1?

A

Intracranial tumours

Neurofibromas

Cafe au lait spots (skin)

Skeletal changes

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17
Q

Ophthalmic features of neurofibromatosis 1? (Anterior segment)

A

Eyelid neurofibromas

Iris lisch nodules

Congenital ectropion uvea

Mammilations (nodules on iris surface)

Prominent corneal nerves

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18
Q

Ophthalmic features of neurofibromatosis 1? (Posterior segment)

A

Optic nerve glioma

Orbital neural tumours

Choroidal nevi

Glaucoma

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19
Q

Iris nevi management?

A

Measure and document size and shape of all nevi (photos useful)

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20
Q

Signs of malignant transformation of an (iris) nevi

A

Vascularity

Rapid growth (diameter/thickness)

Diffuse spread

Seeding

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21
Q

Frequency of iris cysts?

A

Rare

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22
Q

Types of primary iris cysts?

A

Epithelial or stromal

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23
Q

Types of secondary iris cysts?

A

Secondary iris cysts develop as a result of

  1. Implantation (deposition of cornea or conjunctiva epithelium onto iris after surgery)
  2. Miotic (prolonged use of long-acting miotic)
  3. Parasitic (ie. tapeworms)
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24
Q

Primary epithelial iris cyst - symptoms?

A

Usually asymptomatic

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25
What is a primary epithelial iris cyst?
Cyst between the 2 layers of the iris pigment epithelium
26
Primary epithelial iris cyst - signs? laterality? number?
Brown or transparent globular structures Unilateral or bilateral Solitary or multiple
27
Primarily epithelial iris cyst - location
Found at pupil border, midzone or iris root May dislodge and float free
28
Primary epithelial iris cyst - treatment?
Only if visual axis obstructed
29
Primary stromal iris cyst - presentation, assocations
Presents in 1st years of life Remain dormant for many years or suddenly enlarge -\> cause 2ndary glaucoma & corneal decompensation
30
Primary stromal iris cyst - signs?
Solitary Unilateral Smooth translucent anterior wall May break free and float in anterior chamber
31
Primary stromal iris cyst - treatment?
Needle aspiration or Surgical excision
32
Secondary iris cysts - implantation (what it is, frequency)
Deposition of cornea or conjunctiva epithelium onto iris after surgery Most common of the secondary iris cyst subtypes
33
Secondary iris cysts - implantation (subtypes)
Pearls Serous
34
Secondary iris cysts - implantation (pearls)
Pearls: stromal, white, opaque walls, not connected to the wound
35
Secondary iris cysts - implantation (serous subtype, complications)
translucent fluid filled and often connected to the wound Risk of corneal edema, anterior uveitis, glaucoma
36
Secondary iris cysts - miotis (appearance)
Bilateral, small, multiple cysts at pupil border
37
Secondary iris cysts - miotics (prevention)
Prevent with concomitant use of 2.5% phenylephrine
38
Secondary iris cysts - miotics (details of cause)
Prolonged use of long-acting miotics
39
Secondary iris cyst - parasitic (example, frequency)
Parasite example: tapeworms Frequency: very rare
40
Iris metastasis (frequency, appearance)
Very rare Fast growing, white, pink or yellow mass
41
Iris metastasis may be associated with...
Anterior uveitis Hyphema
42
Frequency of uveal melanoma?
Most common intraocular tumour in adults Incidence increases with age
43
Uveal melanome can affect...
Iris (8% of uveal melanomas) Ciliary body (12%) Choroid (80%)
44
Uveal melanoma prognosis?
40% of uveal melanoma Px will die of liver metastases! Survival rate: 5-10 years
45
Risk factors for uveal melanoma?
* Fair skin * Light iris (blue/green) * Numerous cutaenous nevi * Congenital ocular melanocytosis * Oculodermal melanocytosis (Naevus of Ota) * Dysplastic cutaenous nevi (atypical moles) * Familial cutaneous melanoma * NF1 (neurofibromatosis 1) * Blue light (not UV) exposure
46
What is congenital ocular melanocytosis?
Increased # of melanocytes in the iris, choroid, and surrounding tissue
47
What are the possible complications of congenital ocular melanocytosis?
May develop melanoma of uvea, orbit, or meninges Glaucoma
48
What is Nevus of Ota (aka oculodermal melanocytosis)? Appearance?
Trapped melanocytes in the skin Blue hyperpigmentation that occurs on face (sclera affected in 2/3)
49
Nevus of Ota (Oculodermal melanocytosis) is localized to...
the first two branches of the trigeminal nerve
50
Iris melanoma frequency?
Extremely rare iris malignancy (8% of all uveal melanomas)
51
Iris melanoma - presentation?
Presents in 4th -5th decades Enlargement of pre-existing lesion
52
Iris melanoma - most common in which populations?
Moer common in blue eyes than brown Rare in African Americans Males = females
53
Iris melanoma - prognosis
May invade anterior chamber angle or ciliary body Overall prognosis: good Very small chance of metastases (5% within 10 years of treatment)
54
Iris melanoma - signs?
* Very slow growing tumour (may invade angle) * Nodule usually \>3mm diameter, \>1mm thick * Nodule usually in lower half of iris * Surface blood vessels usually * Possible pupil distortion, ectropion uveae, localized cataract
55
Iris melnoma - what is on your list of differential diagnosis?
* Iris nevus (if nevus large and distorting pupil) * Ciliary body melanoma (ciliary tumour may extend through iris root) * Metastasis to iris (rare, in Px with known systemic malignancy) * Iris cysts and very rare iris tumours (adenomas, leiomyomas, iris cysts)
56
Iris melanoma - treatment?
* Get a second opinion * Lifelong observation (slit lamp, gonio) * Iridectomy * Iridocyclectomy * Enucleation
57
What is iridectomy and when is it used in iris melanoma treatment?
Iridectomy: surgery, removes part of iris Only for small tumours
58
What is iridocylectomy and when is it used for iris melanoma Tx?
Iridocyclectomy: surgical removal of iris and CB Used if angle involved
59
What is enucleation and when is it used for iris melanoma?
Enucleation: removal of eye For diffusely growing tumours
60
Frequency of ciliary body melanoma?
Rare 12% of all uveal melanomas
61
Presentation of ciliary body melanoma?
Presents in 6th decade with vision Sx
62
Procedures to Dx ciliary body melanoma?
* Gonioscopy * Dilated fundus exam * Transillumination * Ultrasound * Biopsy
63
Ciliary body melanoma: signs?
Large dark mass in anterior chamber angle * may be visible on fundscopy after dilation * may extend to iris root and mimic iris tumour * may extend through the sclera or to choroid Sentinal vessels (dilated episcleral vessels in same quadrant)
64
Ocular associations of ciliary body melanoma?
Astigmatism (due to lens distortion) Exudative retinal detachment
65
Ciliary body melanoma - Tx?
* Iridocyclectomy (small-med tumours) * Enucleation (large tumours) * Radiation
66
Veteporfin (Visudyne) is a possible uveal melanoma Tx beecause...
It acts on YAP pathway (protein cascade) that is genetically abnormal in ~70% of all px with uveal melanoma

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