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

Question

Key facts and info for: ## Footnote **Fuchs Endothelial Dystrophy**

Answer 1

• In the **Cornea** • **_Dystrophies**_ – Hereditary, _****Non**_inflammatory** • **Loss** of **_endothelial_ cells** • **_Stromal edema_** and **_bullous keratopathy_**

Answer 2

• 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

Answer 3

• 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

Answer 4

• 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.

Answer 5

• 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**

Answer 6

• 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)

Answer 7

• 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.

Answer 8

• 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**

Answer 9

• In the **Retina/Vitreous** • Toxoplasmosis

Answer 10

• 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.

Answer 11

**_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.

Answer 12

• 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**

Answer 13

**_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**

Answer 14

• **_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.

Answer 15

**_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**

Answer 16

Scene viewed by a person with **_diabetic retinopathy_** (vs. normal). The **areas** with **loss of vision** are s**econdary** to the **diabetic vascular changes**.

Answer 17

* **_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**)

Answer 18

• **__**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**.

Answer 19

• **__**_**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_**.

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

(43 cards)