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Friedman's Ophthalmology > Pathology (Mike) > Flashcards

Pathology (Mike) Flashcards

1
Q

Gram stain is able to stain what types of organisms?

A

bacteria and fungi

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2
Q

Gemsia stain is used to test for which organisms?

A

Acanthamoeba, fungi, and cytology; best for intranuclear inclusion bodies

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3
Q

Acid fast (Ziehl-Neelsen) stain is used to test for which organisms?

A

Mycobacterium, Nocardia

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4
Q

Periodic acid-Schiff (PAS) stain is used to test for which organisms?

A

fungi

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5
Q

Gomori’s methenamine silver stain is used to test for which organisms?

A

fungi

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6
Q

Calcofluor white stain is used to test for which organisms?

A

fungi and Acanthamoeba

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7
Q

How does Calcofluor white stain bind to fungi and what is used to view this stain?

A

fungi and Acanthamoeba (binds to cell wall, visible with fluorescent microscopy

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8
Q

KOH stain is used to test for which organisms?

A

fungi

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9
Q

Blood agar is used to grow which organisms? Which grows best?

A

most bacteria; very good for atypical Mycobacterium

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10
Q

Blood agar in 5–10% carbon dioxide is used to grow which organisms?

A

Moraxella

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11
Q

Chocolate agar is used to grow which organisms?

A

Haemophilus, Neisseria

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12
Q

Which important substrates does chocolate agar contain?

A

contains hemin and nicotinamide adenine dinucleotide [NAD]

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13
Q

Thioglycolate broth is used to grow which organisms?

A

anaerobes

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14
Q

Sabouraud’s agar is used to grow which organisms?

A

fungi

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15
Q

Löwenstein-Jensen medium is used to grow which organisms?

A

Mycobacterium tuberculosis, Nocardia

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16
Q

Loeffler’s medium is used to grow which organisms?

A

Corynebacteria

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17
Q

Non-nutrient agar with E. coli overgrowth is used to grow which organisms?

A

Acanthamoeba

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18
Q

Intracytoplasmic basophilic inclusions using Giemsa stain are seen in which organisms?

A

Chlamydia

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19
Q

Intranuclear eosinophilic inclusions using Papanicolaou stain (Tzanck smear) are seen in which organisms?

A

herpes

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20
Q

Hematoxylin and eosin (H&E) satins which colors?

A

Pink and Blue

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21
Q

Hematoxylin is specific for which biomolecule?

A

specific for nucleic acids within nuclei and stains blue (basophilic)

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22
Q

Eosin is specific for which intracellular structures?

A

specific for most cytoplasmic organelles (such as mitochondria) and stains pink (eosinophilic)

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23
Q

What does PAS stain for? which color does it stain?

A

stains basement membrane material Magenta

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24
Q

Which intraocular structures are PAS positive?

A
  • Descemet’s
  • lens capsule
  • Bruch’s membrane
  • ILM
  • gutattae
  • drusen
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25
Q

Which organisms stain PAS positive?

A

fungi

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26
Q

How is PAS stain useful in differentiating corneal and conjunctival epithelium?

A

stains conjunctival goblets cells

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27
Q

Which metabolic substrate is PAS positive?

A

glycogen

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28
Q

What colors are seen in Masson trichrome stain? What tissues are stained by Masson trichrome?

A

Collagen- blue

Hyaline- red

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29
Q

What condition is Masson trichrome stain used to identify?

A

granular dystrophy

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30
Q

Congo red stains which tissue? what color does it stain?

A

stains amyloid orange

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31
Q

What condition is Congo red stain used to identify?

A

Lattice dystrophy

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32
Q

Crystal violet stains which tissue? what color does it stain?

A

stains amyloid red-purple

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33
Q

Alcian Blue stains which tissue? what color does it stain?

A

stains acid mucopolysaccharide blue

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34
Q

What condition is Alcian blue stain used to identify?

A

macular dystrophy

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35
Q

Colloidal iron stains which tissue? what color does it stain?

A

stains acid mucopolysaccharide blue

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36
Q

What condition is Colloidal iron stain used to identify?

A

macular dystrophy

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37
Q

Oil red O stains which tissue?

What color does it stain?

How does the tissue have to be prepared?

A

stains neutral lipids red-orange in frozen section

Must be applied to fresh tissue because formalin leaches out lipid

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38
Q

Sudan Black stains which tissue?

Waht neurologic tissue is this useful for?

A

stains phospholipids

myelin in ON

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39
Q

Luxol fast blue stains which tissues?

How can you tell if there is tissue pathology present?

A

stains myelin blue

demyelinated plaques lose affinity for stain

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40
Q

Bodian stain is used to stain which tissues?

A

stains nerve fibers black

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41
Q

Mucicarmine stains which tissue? what color does it stain?

A

stains mucus pink/red

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42
Q

Which tumors can be identified with Mucicarmine?

A

mucus-secreting adenocarcinomas (i.e. GI, breast)

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43
Q

Verhoeff Van Gieson stains which tissue? what color does it stain?

A

stains elastic tissue black

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44
Q

Which pathologic state is Verhoeff Van Gieson stain used for?

A

used for elastotic degeneration

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45
Q

Movat’s pentachrome stains which tissue? what color does it stain?

A

stains elastic tissue black

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46
Q

Wilder stain is used on which tissue? what color does it stain?

A

stains reticulin fibers black

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47
Q

Alizarin red stains which substance? what color does it stain?

A

stains calcium red-orange

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48
Q

von Kossa stains which substance? what color does it stain?

A

stains calcium black

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49
Q

What ocular condition is von Kossa stain used to diagnose?

A

used for band keratopathy

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50
Q

Prussian blue stains which stubstance? what color does it stain?

A

stains iron (hemosiderin, ferric ions) blue

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51
Q

Fontana-Masson stains which stubstance? what color does it stain?

A

stains melanin black

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52
Q

What ocular condition is Fontana-Masson stain used to diagnose?

A

used for amelanotic melanoma

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53
Q

What lesions can be identified with the S-100 protein?

A

stains

  • nevi
  • melanomas
  • schwannomas
  • neurofibromas
  • other heterologous cell lines
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54
Q

What can polarizing filters be used to identify?

A

for evaluating structures or deposits that have a regular molecular structure (amyloid, calcium oxalate crystals), as well as suture granulomas and vegetable foreign bodies

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55
Q

When grossing a specimen, how does one orient the globe?

A

identify superior oblique (SO) (tendinous insertion) and inferior oblique (IO) (muscular insertion) muscles

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56
Q

What is the most commone embedding process for histologic examination?

A

Parrafin embedding

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57
Q

Briefly how does parafin embedding work?

A
  • water is removed
  • organic solvents leach out lipids
  • PMMA is dissolved completely
  • to preserve lipids, fresh or frozen tissue specimens are used
  • paraffin must be removed before different stains are applied
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58
Q

What chemical is necessary to use for electron microscopy?

A

Glutaraldehyde

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59
Q

Formalin and Bouin’s fixative is used for which tissue viewing method?

A

for light microscopy

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60
Q

Briefly, describe how Formalin and Bouin’s fixative works-

A

10% buffered formalin (formalin = 40% solution of formaldehyde in water); formalin stabilizes protein, lipid, and carbohydrates, and prevents postmortem enzymatic destruction of tissue

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61
Q

Cyctology require which chemical to be used?

A

Ethyl alcohol

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62
Q

What is shown in the picture below?

A

Lange’s fold

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63
Q

What is a Lange’s fold?

A

fold at ora serrata in newborn eyes probably caused by unequal shrinkage of retinociliary tissues during fixation

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64
Q

What is the finding seen in the picture below?

A

Artifactual RD:

common histologic finding, differentiated from true retinal detachment by:

  1. lack of subretinal fluid
  2. preservation of photoreceptors
  3. pigment attached to outer surface of rods and cones
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65
Q

What is seen in the picture below?

A

True RD with material in the subretinal space and degeneration of the outer retinal layers

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66
Q

Do clefts in corneal stroma increase or decrease in corneal edema?

A

obliterated in corneal edema

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67
Q

What is a Type 1 Hypersensitivity Reaction?

A

anaphylactic/immediate hypersensitivity

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68
Q

What molecule mediates a Type 1 hypersensitivity reaction?

A

IgE

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69
Q

Name examples of Type 1 hypersensitivty reactions

A
  1. hay fever
  2. vernal, atopic, giant papillary conjunctivitis (GPC)
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70
Q

What is a Type II Hypersensitivity reaction?

A

cytotoxic hypersensitivity

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71
Q

What molecule mediates a Type II Hypersensitivity reaction?

A

compliment mediated

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72
Q

Name 2 examples of Type II Hypersensitivity Reactions

A
  1. OCP
  2. Mooren’s ulcer
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73
Q

What is a Type III Hypersensitivity Reaction?

A

Immune Complex Deposition

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74
Q

What molecules mediate at Type III hypersensitivity reaction?

A

Ag-Ab Complex

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75
Q

Name at least 4 of the 8 ocular examples of a Type III hypersensitivity reaction

A
  1. Stevens-Johnson
  2. marginal infiltrates
  3. disciform keratitis
  4. subepithelial infiltrates
  5. Wessely ring
  6. scleritis
  7. retinal vasculitis
  8. phacoanyphlaxis
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76
Q

What is a Type IV hypersensitivity reaction?

A

Delayed Hypersensitivity

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77
Q

What mediates a Type IV hypersensitivity reaction?

A

Cell mediated (CD4 lymphocytes)

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78
Q

Name 4 of the 7 ocular examples of Type IV Hypersensitivity Reactionsphlyctenule, graft reaction, contact dermatitis, interstitial keratitis, granulomatous disease (TB, syphilis, leprosy), sympathetic ophthalmia, Vogt-Koyanagi-Harada (VKH) syndrome

A
  1. phlyctenule
  2. graft reaction
  3. contact dermatitis
  4. interstitial keratitis
  5. granulomatous disease (TB, syphilis, leprosy)
  6. sympathetic ophthalmia
  7. Vogt-Koyanagi-Harada (VKH) syndrome
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79
Q

What is a Type V Hypersensitivity Reaction?

A

stimulating antibody

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80
Q

Name 2 ocular examples of Type V Hypersensitivty Reactions

A
  1. Graves’ disease
  2. myasthenia gravis
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81
Q

Which is the most abundant immunoglobulin?

A

IgG

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82
Q

Which immunoglobulin is able to cross the placenta?

A

IgG

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83
Q

To what molecule does IgG bind?

A

complement

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84
Q

What is the second most abundant immunoglobulin?

A

IgA

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85
Q

What is the structure of IgA?

A

monomeric or joined by J chain

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86
Q

Where is IgA found?

A

mucous secretions

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87
Q

What type of infections are IgA particularly important?

A

important against viral infection

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88
Q

What is the largest immunoglobulin?

A

IgM

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89
Q

What does IgM bind to?

A

complement

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90
Q

What is IgM important for?

A

important in primary immune response

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91
Q

Which immunoglobulin is present in newborns?

A

IgD

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92
Q

Which is the only immunoglobulin not found in the tear film?

A

IgD

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93
Q

What is teh role of IgE?

A

sensitizes mast cells and tissue leukocytes

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94
Q

Which immunoglobin is involved in atopy?

A

IgE

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95
Q

In humans, which molecules are HLA molecules?

A

MHC proteins

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96
Q

Where are MHC proteins found?

A

the surfaces of all nucleated cells

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97
Q

Where are the gene loci for MHC proteins found?

A

located on chromosome 6

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98
Q

Class I MHC proteins perform which function?

A

antigen presentation to cytotoxic T cells (CD8 positive)

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99
Q

Where are the genes for Class I MHC proteins found?

A

loci A, B, C

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100
Q

Class II MHC proteins perform which function?

A

antigen presentation to helper T cells (CD4 positive)

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101
Q

Where are the genes located for class II MHC proteins?

A

loci DR, DP, DQ

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102
Q

HLA A29 is associated with which disease?

A

Birdshot retinochoroidopathy (90%)

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103
Q

HLA B7, DR2 are associated with which disease?

A

Presumed ocular histoplasmosis syndrome (80%)

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104
Q

HLA B8, B13 are associated with which disease?

A

Sarcoidosis

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105
Q

Intermediate Uveitis is associated with whcih 4 HLA comlplexes?

A

HLA B8, B51, DR2, DR15

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106
Q

HLA B 27 is associated with which 5 ocular conditions?

A
  1. Adult iridocyclitis (usually unilateral)
  2. Reiter’s syndrome (75%)
  3. ankylosing spondylitis (90%)
  4. inflammatory bowel disease (90%)
  5. psoriatic arthritis, juvenile rheumatoid arthritis (JRA) (subtype V)
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107
Q

What percentage of the population is HLA B27 positive?

A

1-5% of the population

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108
Q

HLA B51 is associated with which disease?

A

Behçet’s disease (70%)

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109
Q

HLA DR4 is associated with which 2 ocular diseases?

A
  1. Sympathetic ophthalmia
  2. Vogt-Koyanagi-Harada syndrome
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110
Q

HLA DR15 is associated with which disease?

A

Pars planitis

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111
Q

HLA DQ7 is associated with which disease?

A

Acute retinal necrosis (50%)

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112
Q

Which HLA complexes are associated with HSV keratitis?

A

B5

DR3

DR4

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113
Q

Which HLA complexes are associated with Sjögren’s syndrome?

A

B8

DR3

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114
Q

HLA B12 is associated with which disease?

A

Ocular cicatricial pemphigoid

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115
Q

HLA B15 is associated with which disease?

A

Scleritis

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116
Q

HLA DR3 is associated with which disease?

A

Thygeson’s superficial punctate keratitis (SPK)

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117
Q

Which HLA complexes are associated with Myasthenia gravis?

A

A1

B8

DR3

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118
Q

Which HLA complexes are associated with Multiple sclerosis?

A

B7

DR2

119
Q

HLA DR3 is associated with which ocualr disease?

A

Grave’s disease

120
Q

What is the definition of inflammation?

A

Tissue infiltration by inflammatory cells

121
Q

What is the primary cell of acute inflammation?

A

Neutrophils (PMNs)

122
Q

Name the immune cell type–

A

PMN- multilobed nucleus

123
Q

What is a focal collection of PMNs called?

A

an abcess

124
Q

What is it called when PMNs are combined with tissue necrosis?

A

pus

125
Q

What kind of immune reactions are associated with eosinophils?

A

Allergic and parasite-related reactions

(‘worms, wheezes, weird diseases’)

126
Q

What is the role of eosinophils in the immune response?

A

modulation of mast cell reactions, phagocytosis of Ag–Ab complexes

127
Q

Name the below immune cell type–

A

Eosinophil-Bilobed nucleus, granular cytoplasm

128
Q

Which cell type are tissue basophils?

A

mast cells

129
Q

What molecule is bound to the surface of mast cells?

A

IgE

130
Q

What is released when a antigen binds to a mast cell?

A

degranulation with release of histamine and heparin

131
Q

What is an example of mast cell degranulation?

A

anaphylaxis, allergic conjunctivitis

132
Q

Name the below immune cell–

A

Mast cell- looks like plasma cell

133
Q

What is the main cell in humoral and cell-mediated immune reactions?

A

Lymphocytes

134
Q

What are the different types of lymphocytes?

A
  • B cells
  • T cells (helper, suppressor, cytotoxic, killer, null cells)
135
Q

Name the below immune cell type:

A

Lymphocyte- scanty cytoplasm

136
Q

What is a plasma cell?

A

activated B cells

137
Q

What is the role of a plasma cell?

A

Synthesis and secretion of antibodies

138
Q

Name the following cell type-

A

Plasma cell- Eccentric ‘cartwheel’ nucleus, basophilic cytoplasm

139
Q

Name the cell type

A

Plasmacytoid cell: granular eosinophilic cytoplasm

140
Q

Name the inclusions inside these plasma cells

A

Russell body: immunoglobulin crystals

141
Q

What are the two different types of macrophages?

A

histiocytes

monocytes

142
Q

What is the primary phagocytic cell in the body- the second line of defense?

A

phagocytosis

143
Q

Name the immune cell type:

A

Macrophage- kidney shaped nucleus

144
Q

How do macrophages work?

A

regulation of lymphocytes

(via Ag presentation and monokine production)

145
Q

What cell types do macrophages transform into?

A

epithelioid histiocytes and giant cells

146
Q

Name the below cell type

A

epitheliod histiocyte

147
Q

What is an epitheliod histiocyte?

A

activated macrophage with vesicular nucleus and eosinophilic cytoplasm

resembles epithelium

148
Q

What is the hallmark of granulomatous inflammation?

A

Epithelioid histiocyte

149
Q

What forms when epithelioid histiocytes fuse?

A

they form giant cells

150
Q

How many different types of Giant cells are there?

A

3 types:

  1. Langhans’ cell
  2. Foreign Body
  3. Touton
151
Q

Name the cell type: How can you tell?

A

Langhans’ giant cell: nuclei arranged around periphery in ring/horseshoe pattern

152
Q

What is an example of 2 diseases where you might see Langhan’s giant cells

A
  1. TB
  2. sarcoidosis
153
Q

Name the cell type:

How can you tell?

A

Touton:

  • midperipheral ring of nuclei
  • central eosinophilic cytoplasm
  • nuclei are surrounded by clear zone of foamy lipid
154
Q

In what ocular condition would Touton giant cells be seen?

A

juvenile xanthogranuloma (JXG)

155
Q

Name the cell type: what can you tell?

A
156
Q

Name the 2 types of Acute inflammation

A
  1. Suppurative
  2. Nonsuppurative
157
Q

Which cell types are seen in acute inflammation?

A
  • Suppurative: neutrophils
  • Nonsuppurative: lymphocytes
158
Q

Name the 4 types of chronic inflammation

A
  1. Nongranulomatous
  2. Granulomatous
  3. Endophthalmitis
  4. Panophthalmitis
159
Q

WHat cell types are involved in nongranulomatous inflammation?

A

lymphocytes and plasma cells

160
Q

During which phase is granulation tissue seen in nonrganulomatous inflammation?

A

reparative phase

161
Q

What forms when there is an exuberant nongranulomatous response?

A

pyogenic granuloma

162
Q

What cell is seen in Granulomatous inflammation?

A

epithelioid histiocytes

163
Q

What are the 3 patterns of granulomatous inflammation?

A
  1. Diffuse
  2. Discrete
  3. Zonal
164
Q

Name the pattern of granulomatous inflammation:

A

Diffuse: epithelioid cells distributed randomly against background of lymphocytes and plasma cells

165
Q

Name 4 ocular conditions in which diffuse grnulomatous inflammation can be seen?

A
  1. sympathetic ophthalmia
  2. fungal infection
  3. JXG
  4. lepromatous leprosy
166
Q

name the pattern of granulomatous inflammation:

A

DISCRETE: epithelioid cells form nodules with giant cells, surrounded by rim of lymphocytes and plasma cells

167
Q

Name 3 ocular conditions in which discrete granulomatous inflammation can be seen-

A
  1. sarcoidosis
  2. miliary TB
  3. tuberculoid leprosy
168
Q

Name the pattern of granulomatous inflammation-

A

ZONAL: palisaded giant cells surround central nidus

169
Q

What are 3 conditions is which zonal granulomatous inflammation is can be seen-

A
  1. phacoantigenic endophthalmitis
  2. rheumatoid scleritis (nidus = scleral collagen)
  3. chalazion
170
Q

Is phcotoxic uveitis granulomatous or nongranulomatous?

A

nongranulomatous

171
Q

What is the definition of endophthalmitis? (lee is unsatisfied with this definition)

A

Endophthalmitis: inflammation involving at least one ocular coat and adjacent cavity, sclera is not involved

172
Q

What is the difference between Endophthalmitis and Panophthalmitis?

A

Panophthalmitis is suppurative endophthalmitis that also involves the sclera and orbit

173
Q

What happens chronically when inflammation occurs in the cornea?

A

scarring:

  • Band Keratopathy
  • Inflammatory pannus
  • degenerative pannus
174
Q

Name the ocular inflammatory condition:

A

Calcific band keratopathy

175
Q

What is the pathologic finding present in band keratopathy?

A

basophilic granules in Bowman’s membrane

176
Q

Name this type of corneal scarring:

A

Corneal inflammatory pannus

177
Q

What pathology is seen in an inflammatory corneal pannus?

A

subepithelial fibrovascular and inflammatory ingrowth with destruction of Bowman’s membrane

178
Q

In which condition is an inflammtory pannus seen?

A

Trachoma

179
Q

Name the type of corneal scarring

A

Degenerative pannus

180
Q

What is the pathology seen in degenerative corneal pannus?

A
181
Q

What is an example of a degenerative pannus?

A

chronic corneal edema

182
Q

What are the 2 ways inflammation can occur in the anterior chamber?

A
  • hypopyon
  • retrocorneal fibrous membranes (PAS)
183
Q

What is it called if PAS is completely scarred down 360 degrees?

A

seclusio pupillae

184
Q

What is a complete fibrovascular membrane across the pupil?

A

occlusio pupillae

185
Q

Name the type of cataract in the picture:

A

Anterior subcapsular cataract:

fibrous plaque beneath folded anterior capsule, secreted by irritated metaplastic anterior epithelial cells

186
Q

What is the underlying cause of the cataract in the picture?

A

Posterior subcapsular cataract: bladder cells adjacent to capsule

187
Q

What is is cyclitic membrane?

A

retrolental collagenous membrane attached to the ciliary body

188
Q

what happens when a cyclitic membrane contracts?

A

detachment of the pars plana

189
Q

What causes a cyclitic membrane?

A
  • due to organization and scarring of vitreous
  • metaplastic ciliary epithelium
  • organized inflammatory residua
190
Q

What cell type is swollen in CME?

A

retinal vascular leakage or Müller cell edema

191
Q

Why can phthisical eyes appear square at times?

A

rectus muscle traction on hypotonous globe causes squared-off appearance

192
Q

What are 3 signs of phthisis?

A
  • thickened sclera
  • high incidence of retinal detachment and disorganization
  • calcareous degeneration of lens
193
Q

What is the name of the eyelid epithelial changes that result in thickening of the keratin layer?

A

Hyperkeratosis

194
Q

What is it called when hyperkeratosis appears white and flaky?

A

Leukoplakia

195
Q

What is the eyelid change called when thickening of the keratin layer with retention of nuclei occurs?

A

Parakeratosis

196
Q

What does parakeratosis indicate?

A

indicates shortened epidermal regeneration time; granular layer is thin or absent

197
Q

What is the eyelid epithelial change called when there is keratin formation within the basal cell layer or deeper?

A

Dyskeratosis

198
Q

What is the eyelid epithelial change called when there is thickening of the squamous cell layer due to proliferation of prickle cells?

A

Acanthosis

199
Q

What is the eyelid epithelial change called when there is loss of cohesion between epidermal cells with breakdown of intercellular junctions, creating spaces within the epidermis?

A

Acantholysis

200
Q

What disease is acantholysis present in? What forms when acantholysis occurs?

A

occurs in pemphigus and produces intraepithelial bullae

201
Q

What is the eyelid epithelial change called when there is disorderly maturation of epithelium with loss of polarity, cytologic atypia, and mitotic figures found above the basilar layer?

A

Dysplasia

202
Q

What is the difference between mild and moderate dysplasia?

A

Mild: <50% epidermal thickness involved

Severe: >50% involved

203
Q

What is the eyelid epithelial change called when there is full-thickness replacement of epithelium by malignant cells without invasion through the basement membrane?

A

Carcinoma in situ (CIN)

204
Q

What is it called when malignant epithelial cells invade below basement membrane?

A

Squamous cell carcinoma

205
Q

What is it called when cytologic malignancy with pleomorphism, anisocytosis, abnormal nuclei, and mitotic figuresare present?

A

Anaplasia

206
Q

What is it called when there is a proliferation of dermal papillae, causing surface undulation of the skin?

A

Papillomatosis

207
Q

What is an inflammatory response with hyperplasia of epithelium, which mimics carcinoma?

A

Pseudoepitheliomatous hyperplasia

acanthosis with protrusion of broad tongues of benign epidermis into the dermis

208
Q

Name the skin changes seen in the picture below:

A

Elastosis

actinic damage; seen as blue staining (normally pink) of superficial dermal collagen with H&E stain; damaged collagen stains with elastic tissue stains but is not susceptible to digestion with elastase

209
Q

What are the age related changes seen in the corneal periphery:

A

Hassal-Henle warts (excrescences and thickenings of Descemet’s membrane in corneal periphery) look like peripheral guttae

210
Q

What age related changed occur in the pars plana and plicata over time?

A

clear (teardrop) cysts

211
Q

What age related changes occur in the retina over time?

A
  • loss of retinal cells and replacement with glial tissue
  • chorioretinal adhesions and pigmentary lesions in periphery
212
Q

What is the eponym called when peripheral retinal microcystoid degeneration occurs?

A

Blessig-Iwanoff cysts

213
Q

In which layer are Blessig-Iwanoff cysts located?

A

located in outer plexiform layer

214
Q

Which cell type line Blessig-Iwanoff cysts?

A
215
Q

What is contained within Blessig-Iwanoff cysts?

A

mucopolysacharides

216
Q

If there are no blood vessels in the cornea, how does wound healing occur?

A
  • stromal healing is avascular
  • healing can result in fibrosis
  • neutrophils arrive via tears in 2–6 hours
  • wound edges swell and glycosaminoglycans (keratan sulfate, chondroitin sulfate) disintegrate at edge of wound
  • activated fibroblasts migrate across wound and produce
217
Q

How long does it take for full cornea thickness after injury?

A

4-6 weeks

218
Q

How does Descemet’s membrane regenerate?

A

endothelium migrates and regenerates Descemet’s membrane

219
Q

How does the sclera heal?

A

does not heal itself; it is avascular and acellular; ingrowth of granulation tissue from episclera and choroid

220
Q

How does the iris heal a wound?

A

It doesn’t no healing

221
Q

Scars formed from healing response in the retina are produced by what cell type?

A

glial cells rather than fibroblasts

222
Q

Name the wound complication seen in the photo:

A

epithelial ingrowth

223
Q

What is epithelial ingrowth?

A
  • sheet of multilayered nonkeratinized squamous epithelium over any intraocular surface
  • may form cyst (free-floating or attached to iris);
  • implanted cells tend to be 2–4 cell layers thick and have conjunctival characteristics (more than corneal)
224
Q

Name the wound healing complication in the photo:

A

Fibrous downgrowth

225
Q

What is fibrous downgrowth?

A
  • proliferating fibroblasts originate from episcleral or corneal stroma; contraction can occur
  • can occur with a puncture wound if there is a break in Descemet’s membrane
226
Q

Name the wound healing complication in the photo:

A

Corneal blood staining

227
Q

What is corneal blood staining?

A

hemoglobin (Hgb) breakdown products are forced through endothelial cells by increased intraocular pressure (IOP)

228
Q

How are Hgb cells removed from the cornea?

A

Hgb molecules are removed by phagocytic and biochemical processes. Clears centripitally

229
Q

What is Hemosiderosis bulbi?

A

Deposition of hemoglobin on an intraocular structure due to longstanding intraocular hemorrhage.

  • hemosiderin contains iron
  • can damage essential intracellular enzyme systems
230
Q

What is an ochre membrane?

A

hemorrhage that accumulates on posterior surface of detached vitreous

231
Q

Name the wound healing complication seen in the photo:

A

Synchysis scintillans

232
Q

What is Synchysis scintillans?

A

accumulation of cholesterol within vitreous following breakdown of red blood cell (RBC) membranes; angular, birefringent, flat crystalline particles with golden hue located in dependent portions of globe

233
Q

What are the white spaces seen in the photo?

A

Cholesterol clefts

cholesterol dissolves during preparation of tissues in paraffin; cholesterol clefts are negative image of cholesterol crystals, surrounded by tissue

234
Q

What is the differentail diagnsosis for intraocular calcification?

A
  • Retinoblastoma
  • Choroidal osteoma
  • Choroidal hemangioma
  • Phthisis
  • Osseous choristoma
235
Q

What is the differential diagnosis for intraocular cartilage?

A
  • PHPV (retrolental plaque)
  • Medulloepithelioma
  • Teratoma
  • Trisomy 13 (seen in photo)
  • Complex choristoma of conjunctiva
236
Q

Where is Type 1 collagen found in the eye?

A
  • normal corneal stroma
  • Bowman’s membrane (highly disorganized type 1, basal lamina has type 4)
237
Q

Where is Type 2 collagen found in the eye?

A

vitreous (two is in the goo)

238
Q

Where is type 3 collagen found?

A

stromal wound healing

239
Q

Where is type 4 collagen found?

A

basement membranes

240
Q

Name the locations of the 4 most likely areas of the sclera to rupture during blunt force trauma?

A
  1. Limbus (on opposite side from trauma)
  2. Posterior to rectus muscle insertions
  3. Equator
  4. Lamina cribrosa (ON)
241
Q

At which 3 locations is the uveal tract connected to the sclera?

A
  1. scleral spur
  2. Internal ostia of vortex veins
  3. Peripapillary tissue
242
Q

Name and describe the ocular disorder seen in the photo:

A

cyclodialysis cleft

disinsertion of longitudinal fibers of ciliary muscle from scleral spur

243
Q

Name and describe the ocular disorder seen in the photo:

A

Iridodialysis

disinsertion of iris root from ciliary body

244
Q

Name and describe the ocualr pathology seen in the photo:

A

angle recession:

rupture of face of ciliary body

plane of relative weakness at ciliary body face extending posteriorly between longitudinal fibers and more central oblique and circular fibers; oblique and circular muscles atrophy, changing cross-sectional shape of ciliary body from triangular to fusiform

245
Q

Name and describe the ocular pathology seen in the photo:

A

Vossius ring

compression and rupture of IPE cells against anterior surface of lens deposit ring of melanin concentric to pupil

246
Q
A

Lens capsule rupture

cataract can form immediately; epithelium may be stimulated by trauma to form anterior lenticular fibrous plaque

247
Q

Where is the lens capsule thinnest?

A

capsule is thinnest at posterior pole

248
Q

Name a describe the ocular trauma pathology seen in the photo:

A

Descemet’s rupture

causes acute edema (hydrops); due to minor trauma (keratoconus) or major trauma (forceps injury)

249
Q

Name a describe the ocular trauma pathology seen in the photo:

A

Choroidal rupture

often concentric to optic disc; risk of CNV

250
Q

Name a describe the ocular trauma pathology seen in the photo:

A

Sclopoteria:

choroidal rupture with overlying necrosis of retina

251
Q

Name a describe the ocular trauma pathology seen in the photo:

A

Retinal dialysis

circumferential tear of retina at point of attachment of ora or immediately posterior to vitreous base attachment

252
Q

Where is the attachment site of the retina anteriorly?

A

retina anchored anteriorly to nonpigmented epithelium of pars plana and reinforced by vitreous base, which straddles the ora serrata;

253
Q

Name a describe the ocular trauma pathology seen in the photo:

A

Commotio retinae

temporary loss of retinal transparency; due to disruption of photoreceptor elements, not true retinal edema

254
Q

What is the difference between penetrating ocular injury vs Perforating ocular injury?

A
  • Penetration- partial-thickness wound (into)
  • Perforation- full-thickness wound (through)
  • (globe penetration is due to perforation of the cornea or sclera; globe perforation is a double penetrating injury)
255
Q

Name the 3 types of Phthisis bulbi

A
  1. Atrophia bulbi without shrinkage
  2. Atrophia bulbi with shrinkage
  3. Atrophia bulbi with disorganization
256
Q

Describe Atrophia bulbi without shrinkage-

A
  • initially, size and shape of eye are maintained
  • with loss of nutrition: cataract develops, retina atrophies and separates from RPE by serous fluid accumulation, synechiae cause increased IOP
257
Q

Describe Atrophia bulbi with shrinkage:

A
  • eye becomes soft owing to ciliary body dysfunction
  • internal structures are atrophic but histologically recognizable
  • globe becomes smaller with squared-off shape (because of tension of rectus muscles); anterior chamber (AC) collapses; corneal endothelial cell damage leads to corneal edema and opacification
258
Q

Describe Atrophia bulbi with disorganization (true phthisis bulbi)

A
  • globe shrinks to average diameter of 16–19 mm
  • most ocular contents are disorganized
  • calcification of Bowman’s layer, lens, retina, and drusen
  • bone formation in uveal tract
259
Q

What 2 bad things can happen when copper gets inside the eye?

A
  1. ≥85%: noninfectious suppurative endophthalmitis
  2. <85% chalcosis
260
Q

What is chalcosis and b=name 3 ways it can present in the eye

A

copper deposits in basement membranes

  1. Kayser-Fleisher ring
  2. sunflower cataract
  3. retinal degeneration
261
Q

What haooens when steel gets into the eye?

A

Steel contains Iron:

siderosis bulbi

262
Q

How can you follow siderosis bulbi clnically?

A
  • follow with electroretinogram (ERG)
  • (early increased a wave, normal b wave
  • later decreased b wave leading to extinguished
263
Q

What kind of response is seen to getting organic vegetable matter into the eye?

A

severe granulomatous foreign body response

264
Q

Describe what an acidic chemical injury does to the proteins in the eye-

A

precipitates proteins

zone of coagulative necrosis acts as barrier to deeper penetration

265
Q

Describe what an alkali chemical injury does to the proteins in the eye-

A

denatures proteins and lyses cell membranes

  • Liquificative necrosis: no effective barrier is created – therefore deeper penetration; vascular occlusion, ischemia, corneal damage during healing phase owing to collagenase released by regenerating tissue
  • limbal bleaching in severe cases (if limbal stem cells are depleted the corneal surface is repopulated with conjunctival cells)
266
Q

Name two types of radiation that can damage the eye:

A
  1. Nonionizing- depends on wavelength
  2. Ionizing
267
Q

How does non-ionizing microwave radiation effect the eye?

A

cataract formation

268
Q

How does non-ionizing INFRARED radiation effect the eye?

A

true exfoliation of lens capsule (glassblower’s cataract)

269
Q

How does non-ionizing UV radiation effect the eye?

A

keratitis (welder’s flash)

270
Q

Name some of the ways that ionizing raditation can damage the eye:

A
  • tissue damage is direct (actively reproducing cells) or indirect (blood vessels
  • epithelial atrophy and ulceration
  • dermatitis of eyelids
  • dysfunction of adnexa
  • destructive ocular surface disease with keratinization
  • cataract
  • retinal necrosis, ischemia, neovascularization
  • (retina is relatively radioresistant, but retinal blood vessels are vulnerable)
  • optic atrophy
271
Q

Name the two most commonly seen pathogens in Acute postoperative endophthalmitis (<6 weeks)

A
  • Coagulase-negative Staphylococcus
  • Staphylococcus aureus
272
Q

Name the two most commonly seen pathogens in delayed endophthalmitis (>6 weeks)

A
  • Propionibacterium acnes
  • coagulase-negative Staphylococcus
273
Q

Name the three most commonly seen pathogens in filtering bleb associated endophthalmitis.

A
  • Streptococcus pneumoniae
  • Staphylococcus
  • Haemophilus influenzae
274
Q

Name the three most commonly seen pathogens in post traumatic endophthalmitis.

A
  • Staphylococcus species
  • Bacillus cereus
  • Gram-negative organisms
275
Q

Name the most commonly seen pathogens in endogenous endophthalmitis.

A

Candida

276
Q

Name the two most commonly seen pathogens in Dacryocystitis

A
  • S. pneumoniae
  • Staphylococcus
277
Q

Name the most commonly seen pathogens in Dacryoadenitis

A

Staphylococcus

278
Q

Name the most commonly seen pathogen in canaliculitis

A

Actinomyces

279
Q

Name the most commonly seen pathogen in orbital cellulitis (children)

A

S. aureus

280
Q

Name the most commonly seen pathogen in pre-septal cellulitis

A

S. aureus

281
Q

Name the most commonly seen pathogen in angular blepharitis

A

Staphylococcus, Moraxella

282
Q

What is a hamartoma?

A

tumor composed of tissues normally found in that area

283
Q

Name this type of ocular hamartoma

A

hemangioma

284
Q

What is a choristoma?

A

tumor composed of tissues not normally found in that area

285
Q

Name this ocular choristoma

A

choroidal osteoma

286
Q

What is the Most common primary malignant intraocular tumor in adults?

A

uveal melanoma

287
Q

What is the Second most common primary malignant intraocular tumor in adults?

A

lymphoma

288
Q

What is the Most common primary malignant intraocular tumor in children?

A

retinoblastoma

289
Q

What is the Second most common primary malignant intraocular tumor in children?

A

medulloepithelioma

290
Q

What is the Most common malignant lacrimal gland tumor?

A

adenocystic carcinoma

291
Q

What is the Most common benign orbital tumor in adults?

A

cavernous hemangioma

292
Q

What is the Most common benign orbital tumor in children?

A

capillary hemangioma

293
Q

What is the Most common primary malignant orbital tumor in children?

A

rhabdomyosarcoma

294
Q

What is the Most common metastasis to orbit in children?

A

neuroblastoma

Friedman's Ophthalmology (12 decks)

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