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Integrative Analysis II > Inflammation, Thyroid, Cornea > Flashcards

Inflammation, Thyroid, Cornea Flashcards

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1
Q

What does intermediate uveitis entail?

A

peripheral retina, pars plana, vitreous

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2
Q

What are mutton fat KPs?

A

dense, oily appearance of epitheliod cells and macrophages in granulomatous uveitis

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3
Q

What are fine KPs?

A

fine debris, keratic precipitates of lymphocytes, non-granulomatous

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4
Q

What are koeppe iris nodules?

A

granulomatous or non-granulomatous at pupillary border

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5
Q

What are bussaca iris nodules?

A

found on iris surface (midperiphery) in granulomatous uveitis

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6
Q

Iris atrophy

A

diffuse in simplex and sectoral in zoster

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7
Q

Fuch’s uveitis and iris changes

A

heterochromia due to chronic inflammation

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8
Q

IOP in uveitis

A

initially decreased due to inflammation and poor function of ciliary body, later increased due to trabeculitis and synechiae

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9
Q

What grading scale does anterior chamber cells/flare use?

A

SUN (using 1 mm slit lamp beam)

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10
Q

What is an approximate grading for cells?

A

0 <1// 1+ 6-15// 2+ 16-25// 3+ 26-50// 4+ >50

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11
Q

Should you see cells if you see flare?

A

ideally yes because of molecular weight but that does not always apply clinically

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12
Q

What is an approximate grading for flare?

A

0 none// 1+ faint// 2+ moderate aka iris details clear// 3+ marked// 4+ intense fibrin and plastic aqueous

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13
Q

What diseases are associated with nongranulomatous uveitis?

A

HLAb27, juvenile idiopathic arthritis, trauma, glaucomacyclitic crisis

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14
Q

What diseases are associated with granulomatous uveitis?

A

sarcoid, syphilis, TB, lens induced, sympathetic ophthalmia, VKH

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15
Q

When should you order a work up after uveitis?

A

bilateral, granulomatous, recurrent, children, panuveitis, posterior uveitis/retinal vasculitis, necrotizing retinitis

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16
Q

Treatment of uveitis?

A

aggressive corticosteroid treatment

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17
Q

What are topical corticosteroids?

A

prednisolone acetate, dexamethasone, difluprednate, loteprednol, fluorometholone

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18
Q

What are injectable corticosteroids?

A

triamcinolone acetonide, methylprednisone, betamethasone

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19
Q

What are oral corticosteroids?

A

prednisone, methylprednsione packs

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20
Q

What healthcare individuals might you consult in uveitis?

A

rheumatology, infectious disease, retina/ophthalmology

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21
Q

What is the most common orbital disorder in adults?

A

graves orbitopathy

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22
Q

What is the most common cause for proptosis

A

graves orbitopathy

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23
Q

What is the female male ratio of graves orbitopathy?

A

9 to 1

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24
Q

What are risk factors for ocular complications of thyroid disease

A

increased age at onset, smoking, use of radioactive iodine therapy

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25
TED pathophysiology
development of autoantibodies stimulate thyroid gland which can lead to goiter, t-cell mediated response in orbit; t-cell response affects orbital fibroblasts
26
How do tcells and orbital fibroblasts interact?
adipogenesis, accumulation of GAGs and resultant tissue edema, infiltration of lymphocytes and mast cells, fibrosis of extraocular muscles
27
What are the two phases of TED?
active and inactive/latent
28
What is the active phase of TED?
active inflammatory process: periorbital edema and erythema, conjunctival injection and edema, eyelid retraction, ptosis, diplopia, lasts longer in smokers
29
What is the inactive/latent fibrotic stage of TED?
plateau of active inflammation: reduced chemosis/injection/edema and persistent proptosis/lid retraction/diplopia
30
What are clinical features of TED?
lid retraction, lid lag on down gaze (von graefe), lid edema, exophthalmos, EOM changes, ON changes
31
What EOM changes occur in TED?
upgaze and abduction especially, inferior>medial>superior>lateral recti>obliques
32
Explain lid retraction
lid retraction occurs in 82% of patients may be due to increased sympathetic tone, overaction of the levator and superior rectus muscles to compensate for inferior rectus restriction or inflammation and scarring of the levator complex
33
What are secondary effects of TED?
exposure keratoconjunctivitis/lagophthalmos, diplopia due to EOM involvement/strabismus, APD due to ONH compression, increased IOP from compression effects
34
Where may IOP be higher in TED?
in upgaze because of compression
35
What is NOSPECS
no signs or symptoms, only signs and no symptoms, soft tissue involvement with signs and symptoms, proptosis, EOM involvement, corneal involvement, sight loss
36
What is VISA?
vision/optic neuropathy, inflammation/orbital congestion, strabismus, appearance/exposure
37
What is EUGOGO?
breaks down graves orbitopathy into activity (severity of inflammation) and severity (impact on QOL/risk of vision loss)-- clinical activity score: pain, redness, warmth, swelling, impaired function; severity assessment: eyelid measures, proptosis, EOMs, corneal integrity, neuropathy
38
Systemic symptoms of thyroid dysfunction
hair loss, heat or cold intolerance, weight loss/change, skin changes, memory difficulties, mood changes
39
What labs do you run for TED?
serum TSH (sensitive thyrotropin), free thyroxine T3 T4, thyroid related antibodies and thyroid peroxidase antibodies + anti-microsomal and anti-TSH
40
Orbital imaging
MRI for muscle bellies, CT for bone with decompression surgery
41
Management of TED
smoking cessation, lubricants, lid taping, short term fresnel, orbital decompression, orbital steroids, steroid sparing agents, orbital irradiation, glaucoma meds
42
What is tepezza?
inhibits insulin like growth factor-1 which plays a role in upregulating fibroblastic activity
43
How does tepezza work?
infusion every few weeks for 8 total treatments, reduces proptosis and associated exposure symptoms, reduced diplopia
44
What are the anterior corneal dystrophies?
epithelial basement membrane dystrophy, meesman dystrophy, reis-bucklers/thiel-behnke
45
Which corneal dystrophies are in Bowmans?
reis-bucklers and thiel-behnke
46
What are the stromal corneal dystrophies?
lattice, granular, macular
47
What are endothelial corneal dystrophies?
fuchs
48
What is the most common anterior corneal dystrophy?
epithelial basement membrane dystrophy
49
What improper developments of the basement membrane occur in EBMD?
thickened and misdirected development into the epithelium, intraepithelial microcysts degenerating epithelial cells, fibrillary material between descemets and bowmans
50
What are symptoms of EBMD?
dry eye, fluctuating vision, pain association with RCE, blur from irregular astigmatism
51
What are signs of EBMD?
intraepithelial lesions-gray, map patches, dots, fingerprint, whorls, best seen on retro illumination
52
What is the treatment of EBMD?
debridement, pressure patch, bandage CL for RCE, anterior stromal puncture for RCE, phototherpeutic keratectomy, superficial keratectomy, chronic hypertonic solution and ointment
53
What are hypertonic solutions
Muro 128 and freshkote
54
How does freshkote work?
polyvinyl pyrrolidone and polyvinyl alcohol create oncotic gradient for freshkote to reduce microcystic edema
55
What are signs of meesmann dystrophy?
diffuse intraepithelial cysts especially intrapalpebral, visualized well on retro illlumination
56
When does Meesmann present?
as young as age 1 but symptomatic in adult years
57
What are symptoms of meesmann?
mild irritation, DES, pain with ruptured cysts
58
What happens with cysts in Meesmann?
cysts may rupture like small bullae, ruptured cysts may scar
59
What are treatments of Meesmann?
bandage CL, superficial keratectomy
60
What are signs of reis bucklers?
sub-epithelial, reticular opacities in central cornea; may eventually have central opacification with irregular astigmatism
61
What are symptoms of reis bucklers?
reduced VA, pain from recurrent erosions
62
What are the treatments of reis bucklers?
bandage CLs for RCE, various keratoplasties (lamellar, penetration)
63
What dystrophy often occurs in a graft
reis bucklers, lattice, macular
64
What are signs of lattice dystrophy?
refractile lines in anterior stroma become more dense, opaque
65
What are symptoms of lattice dystrophy?
decreased VA, pain from RCE
66
What are treatments for lattice dystrophy?
bandage CL for RCE, PKP
67
What are signs of granular dystrophy?
dense, white clumps of opacities in anterior stroma, central with clear spaces between opactities that progress into hazy areas
68
What are symptoms of granular dystrophy?
erosions are rare, opacities progress and intervening space becomes haze reducing VA
69
What are treatments of granular dystorphy?
PKP when VA is reduced, possibly PTK
70
What makes macular dystrophy rare?
autosomal recessive inheritance
71
What are signs of macular dystophy?
hazy, gray stomal lesion extending to limbus
72
What are symptoms of macular dystophy?
PKP when VA is reduced
73
What are signs of Fuch's?
guttata formation indicating abnormal endothelial cell function resulting in corneal edema
74
What are symptoms of fuch's?
blur, glare, colored haloes worse in am, pain from ruptured bullae
75
What are treatments for fuchs?
hypertonic solutions, PKO, descemet's stripping automated endothelial keratoplasty
76
What is keratoconus?
a corneal ectasia
77
What are symptoms of keratoconus?
decrease vision, distortion, pain form hydrops, vision changes starting in teens
78
What are signs of keratoconus?
irregular astigmatism, apical thinning, steepening cornea, vogt stria, fleischer ring, munson sign, central corneal scarring
79
What are treatments of keratoconus?
rigid CLs, intacs, DALK, PKP, collagen crosslinking
80
RPR/VDRL
syphilis
81
ACE
sarcoidosis, TB
82
FTA-ABS/MHA-TP
syphilis
83
ANCA
autoimmune vasculitis (Wegeners)
84
Chest xray
TB, sarcoid, SLE
85
Hertel norms
white 12-20 mm and AA 12-24 mm
86
What is normal critical flicker fusion frequency?
33 dB, lower is decreased sensitivity
87
Lenses for keratoconus
Jupiter-sclera, rose K-RGP, synergeyes-RGP/hydrogel hybrid, accukone-RGP, SO2-scleral multifocal, Centracone-RGP
88
At what endothelial cell count do pumps struggle to function?
<500 cells/mm^2
89
What technique helps evaluate endothelial cells?
specular microscopy
90
Polymegetheism
change in cell size
91
Pleomorphism
change in cell shape
92
Guttata
focal clumping of excess abnormal basement membrane on descemets that has a beaten metal appearance especially on retro illumination
93
What is descemet's stripping automated endothelial keratoplasty DSAEK
partial thickness corneal transplant corneal layer, exchange patient's damaged endothelium and descemets membrane with donor tissue with healthy posterior stroma/descemet/endo
94
Advantages of keratopasty (PKP)
faster healing, quicker visual improvement, less surgery induced astigmatism, predictable and minimal change in anterior surface topography, sutures not necessary, decrease risk of wound dehiscence, decrease risk intra-operative expulsive suprachoroidal hemorrhage
95
Episcleritis treatment
palliative therapy with AT and FML, clinically Pred Forte with possible oral NSAID
96
Etiologies of episcleritis
idiopathic, collagen vascular disease, gout, infectious
97
What percent of RCE patients have EBMD?
50%
98
What demonstrates negative staining
EBMD
99
What is a RCE treatment?
anterior stromal puncture (creates scar and thus adhesion to anterior stromal bed, avoid visual axis) or phototherapeutic keratectomy which is a excimer laser to bowmans that increases collaged and hemidesmosome activity
100
Dalrymple's sign
lid retraction/ scleral show superiorly

Integrative Analysis II (5 decks)

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