Exam 2: Eye - Clinical and Pathology (summarys and pictures from DSA) Flashcards

(43 cards)

1
Q

Name some conditions related to the following region of the eye:

Orbit

A

—Proptosis/Exophthalmos (Graves Disease)

inflammation

tumors

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2
Q

Name some conditions related to the following region of the eye:

Eyelid

A

——Inflammations/Infections (Sty, Chalazion, Xanthelesma)

Tumors (Basal Cell Carcinoma, Sebaceous Carcinoma)

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3
Q

Name some conditions related to the following region of the eye:

Conjunctiva

A

———Inflammations/Infections (e.g. Trachoma)

Degenerative (Pterygium, Pinnecula)

Neoplasms

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4
Q

Name some conditions related to the following region of the eye:

Sclera

A

————Collagen Disorders

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5
Q

Name some conditions related to the following region of the eye:

Cornea

A

—Inflammation/Infection (including HSV, Amebiasis)

Dystrophies (Fuchs)

Degenerations (Keratoconus)

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6
Q

Name some conditions related to the following region of the eye:

Anterior Segment

A

—Glaucoma (Open-, Closed-angle)

Cataracts

Inflammation

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7
Q

Name some conditions related to the following region of the eye:

Uvea

A

—Inflammation** (Uveitis – Sarcoidosis, Sympathetic Ophthalmia), **Neoplasms (Melanoma)

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8
Q

Name some conditions related to the following region of the eye:

—Vitreous

A

Retinitis* (infections)

Retinoblastoma*

*vitreous as well as the retina

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9
Q

Name some conditions related to the following region of the eye:

Retina

A

—Degenerations (Macular Degeneration)

Retinitis (Retinitis Pigmentosa)

Vascular (Hypertensive and Diabetic Retinopathy)

Neoplasms (Retinoblastoma, Melanoma)

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10
Q

Name some conditions related to the following region of the eye:

Optic Nerve

A
  • —Papilledema —(swelling of optic nerve/disc with increased intracranial pressure)
  • Optic Neuritis (demyelination - MS)
  • Tumors (Optic gliomaNF2)
  • —IschemiaAnterior Ischemic Optic Neuropathy (—Similar to stroke)
  • —Glaucomatous nerve damage (See glaucoma) - cupping
  • —Leber hereditary optic neuropathy (—Mitochondrial inheritance)
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11
Q

Name some conditions related to the following region of the eye:

End-stage eye

A

—Phthis bulbi

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12
Q

Name some conditions related to the following region of the eye:

——Systemic Diseases

A
  • —MANY systemic diseases affect the eye
  • —Can be a strong push towards diagnosis

—• Examples

—Sarcoidosis

—Sjögren Disease – lacrimal glands

—Infections

—Endocrine disorders

—Hypertension

—Diabetes

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13
Q

Key facts and info for:

——Thyroid Ophthalmopathy (Graves disease)

A
  • The accumulation of GAG (principally hyaluronic acid) causes a change in osmotic pressure, which in turn leads to a fluid accumulation, muscle swelling, and an increase in pressure within the orbit.
  • These changes, together with retroorbital adipogenesis, displace the eyeball forward and can also interfere with the function of the extraocular muscles and the venous drainage of the orbits
  • GAG secretion by fibroblasts is increased by thyroid-stimulating antibodies and activated T cell cytokines such as tumor necrosis factor (TNF) alpha and interferon gamma (implying that both B and T cell activation are important parts of this immunopathology)
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14
Q

What condition would you consider with this image and buzz words:

  • The accumulation of GAG (principally hyaluronic acid)
  • increase in pressure within the orbit
  • retroorbital adipogenesis
  • displace the eyeball forward
  • B and T cell activation
A

——Thyroid Ophthalmopathy (Graves disease)

  • The accumulation of GAG (principally hyaluronic acid) causes a change in osmotic pressure, which in turn leads to a fluid accumulation, muscle swelling, and an increase in pressure within the orbit.
  • These changes, together with retroorbital adipogenesis, displace the eyeball forward and can also interfere with the function of the extraocular muscles and the venous drainage of the orbits
  • GAG secretion by fibroblasts is increased by thyroid-stimulating antibodies and activated T cell cytokines such as tumor necrosis factor (TNF) alpha and interferon gamma (implying that both B and T cell activation are important parts of this immunopathology)
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15
Q

Key facts and info for:

Sty or Hordeolum

A
  • In the eyelid region
  • —acute inflammatory** involving **hair follicles or sebaceous/apocrine glands
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16
Q

Key facts and info for:

——Xanthelasma

A
  • In the eyelid region
  • ——yellow plaques

——nasal aspect often

• ——associated with hyperlipidemia (in young)

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17
Q

Key facts and info for:

Chalazion

A
  • In the eyelid region
  • ———granulomatous
  • around meibomian glands or glands of Zeis (sebaceous glands)
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18
Q

Key facts and info for:

—Neoplasms

(In the eyelid region)

A
  • In the eyelid region
  • ————Basal cell carcinoma – Most common

—• ————Sebaceous carcinoma – Arise in sebaceous glands

—• ————Other - Kaposi sarcoma

19
Q

What condition would you consider with this image and buzz words:

  • eyelid shows ectropion
  • cornea shows neovascularization
  • foamy cytoplasm
  • clear cytoplasm
A

——Sebaceous Carcinoma

  • (Left image) Pagetoid* spread of sebaceous carcinoma. Neoplastic cells with foamy cytoplasm are detected within the epidermis.
  • Sebaceous cell carcinoma of the left lower eyelid. (Right Top image) The patient’s left lower eyelid shows ectropion**, and the cornea shows neovascularization.
  • (Right Bottom) mild expansion of the conjunctival epithelium due to infiltration by single or small groups of malignant sebaceous cells with large, hyperchromatic nuclei and occasional mitoses. These display little clear cytoplasm reminiscent of sebaceous differentiation

* Pagetoid refers to this spread of neoplastic cells within the epidermis

** ectropion: a condition, typically a consequence of advanced age, in which the eyelid is turned outward away from the eyeball

20
Q

Key facts and info for:

Chlamydia****Trachoma

A
  • In the Conjunctiva
  • ————Caused by Chlamydia trachomatis infection that is transmitted through flies
  • ————Epithelial cell inclusions
  • ————Chronic inflammation results in follicles and scarring
21
Q

What condition would you consider with this image and buzz words:

  • infection
  • flies
  • follicles and scarring
A

Conjunctiva - Trachoma

  • Repeated infection with Chlamydia trachomatis ( transmitted through flies) causes chronic inflammation
  • resulting in follicles (Panel A) and scarring (Panel B), in the form of white lines, bands, or sheets, in the tarsal conjunctiva of the upper eyelid and causing eyelashes to turn inward and abrade the cornea (Panel C).
22
Q

Key facts and info for:

Pinguecula

A
  • In the Conjunctiva
  • Degenerative (actinic* lesions)
  • ————Does not invade cornea
  • ————Yellowish area of thickening
  • ————Elastosis

*actinic: refers to damage resulting from sun exposure. This part of the eye is on the outside and can be easily damaged by the sunlight.

23
Q

Key facts and info for:

Pterygium

A
  • In the Conjunctiva
  • Degenerative (actinic* lesions)
  • Fibrovascular tissue migrates onto cornea
  • White

*actinic: refers to damage resulting from sun exposure. This part of the eye is on the outside and can be easily damaged by the sunlight.

24
Q

Key facts and info for:

Inflammations

(In the cornea region)

A
  • In the Cornea
  • keratitis and ulcers (e.g. contact lens complications)
  • Bacterial, Fungal, Viral (HSV, herpes zoster),
  • Helminth (Onchocerciasis “Loa Loa”, River Blindness); Transmitted by blackflies. Fluffy opacities in cornea and conjunctiva (degenerating microfilariae.
  • Protozoal – amoebic (contact lens)
25
Key facts and info for: ## Footnote **Fuchs Endothelial Dystrophy**
• In the **Cornea** —• **—_Dystrophies**_ – Hereditary, _****Non**_inflammatory** • —**Loss** of **_endothelial_ cells** —• —**_Stromal edema_** and **_bullous keratopathy_**
26
Key facts and info for: ## Footnote **Keratoconus**
• In the **Cornea** —• **—_Degeneration**_ – _**—Non_****familial** * ——**_Thinning_** and **_fibrosis_** of cornea with _**breaks** in **Bowman layer**_. * ——Leads to **distortion** of **cornea** and **visual problems** * **Thinning** of **cornea** leads to **astigmatism** **•** often hard to correct
27
Key facts and info for: **Glaucoma** (**Open** angle)
• In the **Anterior Segment** —• **—****_unimpeded_ flow**of**_aqueous_ humor _into angle_**with _**increased resistance**to_**_outflow**_into_**Canal_ of Schlemm** —• **_——Primary_** Some due to **defects** in **gene coding** for **_myocilin_** —• —**_Secondary_** **Particles _clog trabecular meshwork_** (tumors, RBC, lens fragments) **Increase** in **episclerial pressure** secondary to **_surface ocular vascular malformations_** (Sturge Weber) • **_Pathophysiology/Consequence_** **Glaucomatous retinopathy** with **cupping** of **optic nerve head** and nasal displacement of retinal vessels **_Optic atrophy_** – **Loss** of **axons** and **ganglion cells** **\*** **_Image_**: shows cupping of optic nerve head in glaucoma. This is secondary to axonal degeneration and subsequent loss of axons
28
Key facts and info for: **Glaucoma** (**Closed** angle)
• In the **Anterior Segment** —• **_Blockage_** of **_angle_ _prevent flow_** _into **angle**_ and then through **trabecular meshwork** into **Canal** **of** **Schlemm**. —• **_——Primary_** **shallow anterior chamber** (especially with **pupil dilation**) —• —**_Secondary_** can be due to _**development** of **membranes**_ which _**contract** and **close angle**_ – **vessels** (neovascularization), **tumors**, **surgery** • **_Pathophysiology/Consequence_** **Glaucomatous retinopathy** with **cupping** of **optic nerve head** and nasal displacement of retinal vessels **_Optic atrophy_** – **Loss** of **axons** and **ganglion cells** **\*** **_Image_**: In angle-closure glaucoma, the aqueous humor is physically blocked from the canal of Schlemm. This can be due to a pupillary block or to a neovascular membrane.
29
Key facts and info for: ## Footnote **Cataract**
• In the **Anterior Segment** —• **_Lens opacities_ interfere** with **vision** —• **Systemic diseases** can have **increases** in **cataracts** (i.e. association with cataract) * **Galactosemia**, **Diabetes**, **Wilson**, **Atopic** **dermatitis**, Drugs (steroids), Radiation, Trachoma * **Age-related** (senile) * **_Debris_ from cataract** may subsequently **_obstruct_ flow** of **_aqueous humor_** * When necessary, the affected lens can be **replaced by** a **_plastic_ lens**
30
Key facts and info for: ## Footnote **—Uveitis**
• In the **_Uvea_** (**_choroid_** and **_stroma_** of **ciliary body** and **iris**; _vascular layer_) —• **_—Infectious_** e.g. pneumocystis, toxoplasmosis, MAI ——• —**_Noninfectious_** **_—Sympathetic ophthalmia_** – often with **penetrating** injury which **leads** to **protrusion** of **uveal tract** followed by **uveal tract inflammation** in **injured** and **opposite eye** (via **antibodies**) **_—Granulomatous_** (sarcoid)
31
Key facts and info for: **—Neoplasms** (In the Uvea region)
• In the **_Uvea_** (**_choroid_** and **_stroma_** of **ciliary body** and **iris**; _vascular layer_) —• —**Nevi** and **_Melanoma_** (Fig 29-15) ——• —Metastases (no lymphatics) **_In pictures_:** **_Uveal melanoma_** (Melanomas are often pigmented) A, **Fundus** photograph from an individual with a relatively **flat pigmented lesion** of the **choroid** near the optic disc. B, Fundus photograph of the same individual several years later; the **tumor** has **grown** and has **ruptured through** the **Bruch membrane**. C, Gross photograph of a **choroidal melanoma** that has **ruptured** the **Bruch membrane**. The overlying **retina** is **detached**. D, **Epithelioid melanoma** cells associated with an adverse outcome.
32
Key facts and info for: ## Footnote **—Macular Degeneration**
• In the **Retina** —• —_**Center** of **macula**_ is _**point** of **greatest visual acuity**_. Macular degeneration affects this region and visual acuity. **Peripheral vision** is **often maintained**. ——• —Most common cause of **irreversible visual morbidity** ——• —Many have **genetic basis** – **mutations** of **_CFH gene_** that **codes for _complement factor H_** or other mutations —• ——**Changes** in **underlying retinal pigment epithelium** (including BM), and **innermost layer of choroid vasculature** (choriocapillaris) **affect retinal health** ——• **_—Types_** —**_Dry_** – **deposits** of **degraded material** in **Bruch’s membrane** (drusen) and **geographic atrophy** of **retinal pigment epithelium** —**_Wet**_ – _**follows dry_** _with **angiogenesis**_ leading to **leakage** and **scars**
33
Key facts and info for: ## Footnote **Retinitis (infections)**
• In the **Retina/Vitreous** —• —Toxoplasmosis
34
Key facts and info for: ## Footnote **Retinoblastoma**
• In the **Retina/Vitreous** —• **Rb gene**; **_inherited_** (_often bilateral_) **vs**. **_sporadic_** forms * _**small blue**-**cell**_ tumor * Malignant **\* _Image_:** A, Gross photograph of retinoblastoma. B, **Tumor cells appear viable** when in **proximity to blood vessels**, but **necrosis** is **seen** as the **distance from the vessel increases**. **_Dystrophic calcification_** (dark arrow) is **present** in the **zones of tumor necrosis**. **_Flexner-Wintersteiner rosettes_**—arrangements of a **single layer** of **tumor cells around** an apparent “**_lumen_**”—are **seen throughout** the **tumor**, and one such rosette is indicated by the white arrow.
35
_What condition would you consider with this image and buzz words_: * **_bilateral_** * **_small blue-cell_ tumor** * **Malignant** * **Dystrophic** calcification * _**Flexner-Wintersteiner** rosettes_
**_Retinoblastoma_** —• **Rb gene**; **_inherited_** (_often bilateral_) **vs**. **_sporadic_** forms * _**small blue**-**cell**_ tumor * Malignant **\* _Image_:** A, Gross photograph of retinoblastoma. B, **Tumor cells appear viable** when in **proximity to blood vessels**, but **necrosis** is **seen** as the **distance from the vessel increases**. **_Dystrophic calcification_** (dark arrow) is **present** in the **zones of tumor necrosis**. **_Flexner-Wintersteiner rosettes_**—arrangements of a **single layer** of **tumor cells around** an apparent “**_lumen_**”—are **seen throughout** the **tumor**, and one such rosette is indicated by the white arrow.
36
Key facts and info for: ## Footnote **Hypertensive Retinopathy**
• In the **Retina** —• —_**HTN leads** to **arteriosclerosis**_ **—Arteriolar wall** is **thickened** with **narrowed lumen** **—Compression** of **vein** at crossing points **—Changes** in **appearance** of **vessel** (—**_Copper-wire_**, —**_Silver-wire_**) —• ——_**Malignant hypertension** leads to **vascular damage**_ **—Hemorrhage**, **Exudates** —**_Cotton wool spots_ (**—**Infarcts** of **choroid** and **retina**; —**Axonal damage** and **accumulation** of **mitochondria** in **swollen axons**) **—_Damage_** _to_ **_retinal pigment epithelium_** – **detachment**
37
_What condition would you consider with this image and buzz words_: * **_Copper_-wire** * —**_Silver_-wire** * —Hemorrhage, Exudates * _**Cotton wool** spots_
**_Hypertensive Retinopathy_** • In the **Retina** —• —_**HTN leads** to **arteriosclerosis**_ **—Arteriolar wall** is **thickened** with **narrowed lumen** **—Compression** of **vein** at crossing points **—Changes** in **appearance** of **vessel** (—**_Copper-wire_**, —**_Silver-wire_**) —• ——_**Malignant hypertension** leads to **vascular damage**_ **—Hemorrhage**, **Exudates** —**_Cotton wool spots_ (**—**Infarcts** of **choroid** and **retina**; —**Axonal damage** and **accumulation** of **mitochondria** in **swollen axons**) **—_Damage_** _to_ **_retinal pigment epithelium_** – **detachment**
38
Key facts and info for: ## Footnote **Diabetes**
• —**_Cataracts_** —• —**_basement membrane_ thickening** in **ciliary body** —• —**_Retinal vasculopathy_** **\* _image_:** The **ciliary bo**dy in **chronic diabetes mellitus**, PAS stain. Note the **massive thickening** of the **basement membrane** of the **ciliary body** epithelia, reminiscent of changes in the mesangium of the renal glomerulus.
39
Key facts and info for: ## Footnote **Diabetic Retinopathy**
—**_—Retinal vasculopathy_** **1) ——****_Background (preproliferative)_** —**Thickening** of **basement membrane**; can be seen in the **ciliary body** **—Loss** of **pericytes** and then **capillary endothelial cells** (apoptosis) **—_Microaneurysms_** and **dot intraretinal hemorrhages** **—_Leakage_:** —**_Macular edema**_ (breakdown of blood-retinal barrier) and _**hard_ exudates;** —**_Hemorrhagic_ exudates;** —**_Cotton – wool spots_** **2) ———****_Proliferative (VEGF)_** **—_Neovascularization_** _of_ **_retina_:** **—Hemorrhages** (_posterior vitreous detachment_); **—_Traction retinal_** detachment **—_Neovascularization_** _of **iris**_: **_—Glaucoma_** —**Newly formed blood vessels** are the **target of laser therapy**
40
_What condition would you consider with this image and buzz words_: * Thickening of basement membrane * Microaneurysms —• Cotton – wool spots —• Neovascularization —of retina or iris
Scene viewed by a person with **_diabetic retinopathy_** (vs. normal). The **areas** with **loss of vision** are s**econdary** to the **diabetic vascular changes**.
41
Name some **conditions** related to the following **region of the eye**: **_Optic Nerve_**
* **_—Papilledema_** —(swelling of optic nerve/disc with increased intracranial pressure) * **_Optic Neuritis_** (demyelination - **_MS_**) * **_Tumors_** (**Optic glioma** – _NF2_) * **_—Ischemia_** – **Anterior Ischemic** Optic Neuropathy (—Similar to _stroke_) * —**Glaucomatous** nerve damage (See glaucoma) - **_cupping_** * **—_Leber hereditary_** optic neuropathy (—**_Mitochondrial_** **inheritance**)
42
Name some **conditions** related to the following **region of the eye**: **_Optic Glioma_**
• **_—_**—Seen in **_childhood_** —• ——Association with **_NF1_** —• ——Mostly **low-grade _astrocytomas_** **\* _image_:** Optic nerve glioma. B, Optic nerve glioma seen on axial computed tomography (CT) scan. Although the **tumor** is clearly **seen on the CT scan**, magnetic resonance imaging is preferred to monitor for extension of tumor into brain. C, Histopathologic appearance of a **low-grade astrocytoma** of the **optic nerve**.
43
Name some **conditions** related to the following **region of the eye**: **_End-Stage - Phthisis Bulbi_**
• **_—_**——_**Severe damage** to **eye**_ can **result in _end-stage_ eye** (**_phthisis bulbi_**) —• ———Can be result of different insults and conditions (e.g. trauma, inflammation, chronic detachments, etc.). —• **———End-stage eye** is **_shrunken_** and **_internally disorganized_**.