Eye disorders

Question 1

Exophthalmosis
Extraocular muscle enlargement
tendons not inflamed
Increased glucosaminoglycans

Answer 1

Thyroid disease: Graves orbitopathy

Question 2

Most common malignancy of eyelid 
Younger patients, sun exposure 
"rodent ulcer" 
lower eyelid mostly
peripheral palisading of nuclei, blue=BAD

Answer 2

Basal Cell Carcinoma

Question 3

Common as squamous cell carcinoma 
Most misdiagnosed 
upper eyelid mostly
>40 yo, asian women 
Spread first to parotid and submandibular nodes

Answer 3

Sebaceous carcinoma

Question 4

Thin epithelium
Fragmented stromal collagen
Basophilic degeneration (elastic degeneration)

Answer 4

Pinguecula

Question 5

Similar to pinguecula BUT encroaches onto cornea in winglike fashion
Recurrent form: lack elastic regeneration

Answer 5

Pterygium

Question 6

Increased melanin within keratinocytes

Melanocytes normal in # but may be slightly enlarged

Answer 6

Freckle

Question 7

Linear, (non-nested) melanocytic HYPERPLASIA restricted to basal layer

Answer 7

Lentigo

Question 8

Melanocytes become round, uniform and grow in aggregates of “nests”
Cells have little or no mitotic activity
Immature cells: larger, superficial, produce melanin, grow in nests
More mature cells: smaller, deeper, do not produce melanin, grow in cords

Answer 8

Conjunctival Nevus

Question 9

Epidermal nests along the DERMO-EPIDERMAL junction

Answer 9

Junctional Nevus

Question 10

Epidermal nests from dermo-epidermal junction grow into underlying DERMIS as nests or cords

Answer 10

Compound Nevi

Question 11

Epidermal nests lost completely

Answer 11

Intradermal Nevi

Question 12

Most common primary intraocular tumor in adults
~5% of melanomas in the US
Oncogenes: GNAQ & GNA11
Morph: two types of cells:
Spindle-fusiform
Epitheloid-spherical, greater cytologic atypicality, WORST PROGNOSIS
80% 5-year survival rate, 40% at 10 yr

Answer 12

Uveal Melanoma

[uvea=iris+ciliary body+choroid]

Question 13

Lacks blood vessels and lymphatics
Contributes to lack of transplant rejection=>easily transplanted
Vascularization may accompany chronic edema, inflammation and scarring and vision will be compromised

Answer 13

Cornea

Question 14

Most common cause of blindness outside the US

Answer 14

Clamidia trachomatis

Question 15

Progressive thinning of cornea with breaks in Bowman layer=halmark
No evidence of vascularization or inflammation
Common disorder
Condition that distorts the contour of cornea and alters the refractive surface, producing an irregular form of astigmatism

Answer 15

Keratoconus

Question 16

Opacification of lens
Risk factors: DM, Wilson Dz, Atopic dermatitis, drugs (corticosteroids), radiation , trauma
Age related=>opacification of lens nucleus (nuclear sclerosis)
Morgagnian (hypermature): Lens cortex liquifies
Phacolysis: high mol-weight proteins from liquefied lens cortex leak through the lens capsule, may clog the trabecular meshwork and increase intraocular pressure=PHACOLYTIC GLAUCOMA (form of secondary open angle glaucoma)

Answer 16

Cataract

Question 17

Complete open access to trabecular meshwork
Increased resistance to aqueous outflow
Increased intraocular pressure

Answer 17

Open-angle glaucoma

Question 18

Most common form of glaucoma

Mutated gene: MYOC

Answer 18

Primary open-angle glaucoma

Question 19

Pseudoexfoliation most common form=
Deposition of fibrillary material throughout anterior segment
Mutated gene: LOX1
Phacolytic glaucoma=leakage of high mol-weight proteins from liquified lens through the lens capsule that clogs the trabecular meshwork

Answer 19

Secondary open-angle glaucoma

Question 20

Peripheral zone of iris adheres to trabecular meshwork and physically obstructs outflow of fluid

Answer 20

Angle-closure glaucoma

Question 21

Two types:
1. Pupillary block
2. Iris bombe
Marked elevation of intraocular pressure

Answer 21

Primary angle-closure glaucoma

Question 22

Proliferation of vasculature (neovascularization) of iris leads to occlusion of trabecular meshwork
Increased intraocular pressure

Answer 22

Secondary angle-closure glaucoma

Question 23

1 of 4 most frequent causes of blindness in the US
Primary changes in retinal microcirculation
Thickening of the basement membrane of retinal blood vessels

Answer 23

Diabetic retinopathy

Question 24

Results from damage to the macula which is required for central vision
Occurs in two forms:
1. Atrophic or “dry” form–> no neoangiogenesis, atrophy of the RPE, severe loss of vision with no current tx
2. Neovascular or “wet” form–> choroidal neovascularization, age related, associated with cigarette smoking

Answer 24

Age-related macular degeneration (AMD)

Question 25

Most common primary intraocular malignancy in children Neuroblastic origin from nucleated layers of retina Chr 13q14=RB, tumor-suppressor gene Arising in the context of germline mutation is bilateral Most common sx: White pupillary reflex (leukocoria), strabismus, & ocular inflammation Pseudohypopyon=cells aggregate in anterior chamber and form nodules on iris Most common route of escape: OPTIC NERVE=poor prognosis Histo: round, oval or spindle shaped hyperchromatic nuclei with scant cytoplasm, high mitotic rate, necrosis with calcification Flexner-Wintersteiner rosettes=characteristic features Homer-wright=less common

Answer 25

Retinoblastoma (RB)

Question 26

Optic disc swelling Due to increased intracranial pressure Enlarged blind spot and elevated optic disc with blurred margins

Answer 26

Papilledema