8: the uvea - pearce Flashcards Preview

IP 11 Ophthalmology > 8: the uvea - pearce > Flashcards

Flashcards in 8: the uvea - pearce Deck (87):
1

which vascular tunic is the uveal tract?

middle vascular tunic

2

what are the components of the anterior uveal tract?

iris
ciliary body

3

what are components of the ciliary body?

anterior: pars plicata
posterior: pars plana

4

what is the fxn of the pars plicata?

aqueous production

5

what makes up the posterior uveal tract?

choroid

6

where is the choroid loc?

behind the retina

7

what is the significance of the uveal tract being an "immuno sensitive" organ?

it tells us a story - manifestation of 1* ocular dz OR is an ocular manifestation / sentinal for systemic dz

8

what is the importance of the choroid in terms of pharmacokinetics of drugs in the eye?

topical medication cannot reach the back of the eye d/t the choroid

NEED systemic meds to reach the back of the eye

9

what is heterochromia iridis?

etiology?

congenital condition

multiple colors occurring w/in one iris

10

what is heterochromic iridium?

etiology?

congenital condition

multiple colors occurring btwn 2 eyes

11

t/f

in cases of heterochromia iridis, the posterior uveal tract, in addition to the anterior uveal tract, is affected

true

12

what part of the posterior uveal tract is impacted in cases of heterochromia iridis?

choroid has less or no pigment - so less or absent tapetum

why the red eye reflection occurs in blue eyes

13

what is the normal appearance of the reflection of the eye?

how is it different in humans, animals with blue eyes and in cases of heterochromia iridis?

normal: green/yellow reflection is the tapetum w/in the choriod

abnormal: red eye reflection b/c non pigmented choroid / lack of pigment / tapetum

14

what is an iris coloboma?

etiology?

congenital conditions

absence / defect of iris tissue

15

which location does an iris coloboma MC occur?

why?

in the "6 o'clock" position

b/c there is an incomplete closure of the embryonic fissure in this location

16

what are persistent pupillary membranes (PPMs) ?

incomplete resorption of iridal embryonal vasculature and mesenchymal tissues

normal: the sheet of mesenchyme in the pupil atrophies in the embryo

17

what is the result of persistent pupillary membranes?

what is seen in the eye?

strands of tissue seen in the eye - originate at the iris collarette [in the middle of the iris]

18

in persistent pupillary membranes, what are 3 locations the strands can go to?

what is the manifestation of each?

iris to iris [more benign]

iris to cornea [corneal opacity]

iris to lens [cataract]

19

how does synechia differ from persistent pupillary membranes?

synechia is adherence of tissue
vs
PPMs are strands

PPMs originate from iris collarette - synechia does not

20

what is pupil dyscoria?

abnormally shaped pupil

21

what is pupil corectopia?

abnormal location of pupil

22

what is anterior segment dysgenesis also referred to? [why?]

what conditions typically occur with this condition?

merle ocular dysgenesis - common with accidental Merle to Merle breeding


- iris colobomas
- corectopia
- PPMs
- others also

23

what is anterior segment dysgenesis?

lens does not sepaarate properly from corneal tissue

24

what is iris atrophy?

spontaneous progressive thinning of the stroma or pupillary portion of the iris (or both)

common finding in middle-aged and older dogs

25

why might iris atrophy lead to light sensitivity?

- thin area allows light through instead of through the pupil

- and/or dec constriction ability of the pupil

26

2 common degenerative uveal changes?

- cyst

- melanoma

27

how to differentiate a cyst from a melanoma?

melanoma does NOT transilluminate - neoplasia will not let light though

cysts DO transilluminate

28

what are 2 forms of 1* uveal neoplasia?

- melanocytic iridal neoplasia [melanoma / melanocytoma]

- ciliary body adenoma / adenocarcinoma

29

what is MC 1* uveal neoplasia?

which species (dog or cat) has the worst prognosis?

melanocytic iridal neoplasia [melanoma / melanocytoma]

cat worse prognosis
overall - less than 10% malignant typically

30

what is the 2nd MC 1* uveal neoplasia?

prognosis?

ciliary body adenima / adenocarcionma

- pigmented or non pigmented

50/50 benign / malignant

31

what is MC 2* uveal neoplasia?

lymphosarcoma

32

c/s of 2* uveal neoplasia d/t LSA?

what ocular structures are typically affected?

what % of dogs and cats show ocular signs?

- uveitis

- 40% of dogs show ocular signs
- 50% of cats show ocular signs

- iris and ciliary body usually affected

33

what are less common causes of 2* uveal neoplasia?

TVT
HSA
malignant melanoma
carcinomas (renal, panc, thyroid)

34

what are 3 ways uveal tumors are treated?

- locally - Sx excision, diode laser for focal lesions
- enucleation
- chemotherapy [systematic or metastatic dz]

35

in what cases would enucleation be considered to Tx uveal tumor?

- extensive 1* tumors
- inflamed or glaucomatous eyes

36

what are some benefits to using laser Tx for uveal tumors?

- less invasive Tx option
- does NOT damage the cornea => only affects damaged tissue
- good for focal lesions and/or in early stages

37

what is aqueous flare?

what condition is it pathogneumonic for?

tyndall effect of haziness in the posterior chamber d/t presence of particulates suspended in the fluid and illuminated by light

anterior uveitis => inflammation leading to inc permeability of ocular vessels [impaired blood/ocular barriers] -> protein leaks out, into the posterior chamber

38

c/s of anterior uveitis?

ciliary flush
corneal edema
dec IOP
dec vision
hyphema
hypopyon / fibrin
iris color change
iris swelling
keratic percipitates
mioosis
pain
conjunctival hyperemia

39

what is ciliary flush?

360* corneal vascularization ("hedge" appearance) that is present with deep intra ocular dz, uveitis, glaucoma, deep corneal dz

40

why is corneal edema seen with anterior uveitis?

hazy cobblestone appearance of cornea

b/c endothelial cells are not able to pump fluid out of the cornea like they should do, b/c of the inflammation

41

why does dec IOP occur w anterior uveitis?

toxic things floating around in the eye affects its ability to produce fluid - b/c the non pigmented epithelium of the ciliary body does not perform well

dec fluid production -> dec IOP

42

what is hypopyon?

pus in the eye

43

what color changes occur to the iris during anterior uveitis?

under what circumstances?

darker -> brown to dark brown / black OR blue to yellow
rubeosis iridis

chronic uveitis

44

what is reubeosis iridis and what does it mean?

blood vessels grow on the iris surface

pathogneumonic for uveitis

45

what do keratic precipitates look like?

a greasy appearance => granulomatous inflammation

46

why does miosis occur with anterior uveitis?

inflammation with PGs - stimulates PG receptors of the iris - miosis occurs

also - spasm of iris sphincter M occurs

47

what are c/s of posterior uveitis?

- tapetal hyporeflectivity
- granulomas
- retina: edema, detachment, hemorrhage
- vitreous opacity

48

what part of the uveal tract does posterior uveitis occur in?

choroid

49

what is common sequelae of uveitis?

cataract
synechia
iris atrophy

50

what is synechia?

adherence of iris to lens tissue

posterior: can stick to lens
anterior: can stick to cornea

51

what are common sequelae to uveitis?

lens luxation - d/t zonular break down
phthisis bulbi - d/t chronic lack of fluid produciton
iris bombe - 360* adherence of pupil martin -> fluid pushes iris fwd and pupil stays on loc of lens b/c it is stuck there
2* glaucoma

52

what is endophthalmitis?

inflammation of intra ocular contents

NOT cornea and sclera

53

what is panophthalmitis?

inflammation of all ocular structures ==> including orbital fissure

includes fibrous tuinc (cornea and sclera)

54

the first thing to do when approaching a uveitis patient is to make an etiologic diagnosis. over ____% of cases are idiopathic.

50

55

common infectious causes of canine uveitis?

viral - distemper, CAV-1
tick born - RMSF, ehrlichia
fungal
bacT - brucella, lyme
parasitic - dirofilaira
algal - protheca
protozoal - toxo, neospora

56

common causes of feline uveitis?

4 Fs and 1 T:

FeLV
FIV
VIP
Fungal
Toxoplasma

maybe Bartonella

57

classifications of non infectious uveitis?

metabolic
immune mediated
trauma
lens associated

58

what are metabolic causes of uveitis?

hyper lipidemia -> aqueous fills up with lipid -> eye looks very milky

diabetic - cataract related / lens induced uveitis

59

common immune mediated cause of uveitis?

uveodermatologic syndrome

targets pigmented cells - many loc w/in uveal tract

60

2 types of lens associated uveitis?

phacolytic - protrusion across intact lens capsule
phacyclastic - lens capsule rupture

61

2 types of traumatic causes of uveitis?

blunt or piercing
ulcerative keratitis

62

Dx of uveitis?

complete PE
blood work (cbc, chem)
urinalysis
chest x rays
abdominal x rays
lnn aspirates
abdominal u/s
infectious dz testing

63

after etiologic dx of uveitis is made, what next?

control inflammation
px undesirable sequelae
relieve pain

64

Tx of uveitis?

Tx 1* cause, if an etiologic cause is made

specific abx, chemotherapy, remove lens / foreign material, Tx of ulcerative keratitis

65

presumptive tx of uveitis in cats:

clindamycin (anti-toxoplasma)

anti fungal

66

presumptive tx of uveitis in dogs:

doxycycline (anti rickettsial)

anti fungal

67

drugs to control inflammation in Tx of uveitis?

3 classes and some examples in each

corticosteroids - topical, systemic, sub conjunctival

NSAIDs - topical, systemic

immuno suppressive agents - cyclosporine, azathioprine

68

what 2 classes of drugs should NOT be used together in the Tx of uveitis?

systemic NSAIDs and steroids

69

contra indications to corticosteroid use?

ulcerative keratitis - NO topicals

deep mycotic dz - NO systemics

70

concerns with topical corticosteroid use?

2* infections
inhibits wound healing
systemic absorption

71

concerns with systemic corticosteroid use?

immunosuppression
adrenocortical suppression

72

t/f

the best treatment for an ulcer is topical steroids

false

never give topical steroids if an ulcer

73

what is solubility of a corticosteroid?

potency?

solubility: acetate and alcohol forms more lipid soluble than phosphate forms; relates to penetration of the drug into a tissue

potency: the extend of the anti-inflammatory effect, irrespective of penetration

74

high lipid solubility of a steroid means better penetration into which tissue layer?

corneal epithelium

75

the addition of what to a molecule enhances the anti inflammatory activity?

i.e. improves potency

fluoride and methyl molecules

76

t/f

a more potent corticosteroid is just as good as a more soluble steroid, if given at higher doses

false

a more potent drug will do NO good if it cannot penetrate the target tissue

77

what corticosteroids are very lipid soluble, therefore penetrate tissues well?

this is effective in the Tx of what?

prednisolone acetate

anterior uveitis

78

common NSAIDs used to treat uveitis?

for what type of uveitis are systemic NSAIDs necessary?

carprofen
meloxican

necessary for posterior uveitis

79

t/f

topical NSAIDs are often used along with topical steroids

true

80

what are two examples of commonly used topical NSAIDs?

didofenac sodium
flurbiprofen sodium

81

what is the 1* indication for topical NDAID use in uveitis?

anterior uveitis

82

concerns of the use of NSAIDs in Tx of uveitis?

hyphema
glaucoma

83

indications for systemic NDAIDs?

- adjunct to topical Tx of anterior uveitis
- ocular discomfort

84

concerns with systemic NSAIDs in tx of uveitis?

dry eye (KCS)
renal
GI
hematologic

85

what drugs are used in the Tx of uveitis to Px undesirable sequelae?

- anti glaucoma drugs
- mydriatics / cycloplegics

86

2 classes of mydriatics / cycloplegics used in Tx of uveitis?

functions?

contraindications?

- anti cholinergics [atropine, tropicamide]
- adrenergics [phenylephrine hydrochloride]

- eliminates ciliary spasm / pain
- dilates pupil and Px synechia
- stabilizes blood aqueous barrier


- contraindicated in glaucoma or if tear deficiency

87

what medications can be used to relieve pain in the Tx of uveitis?

- mydriatics/cycloplegics
-anti-inflammatory agents

- dark environment - stall or eye mask - eliminates photophobia

- analgesics if needed: butorphanol, morphine, tramadol, oxymorphone, hydromorphone