Neuro: Eye Disorders

Question 1

• Impaired vision that improves with glasses

Answer 1

Refractive Error

• Hyperopia
• Myopia
• Astigmatism
• Presbyopia

Question 2

• Eye too short for Refractive Power of Cornea and Lens –> Light focused Behind Retina

Answer 2

Hyperopia

Question 3

• Eye too long for Refractive Power of Cornea and Lens –> Light focused in Front of Retina

Answer 3

Myopia

Question 4

• Abnormal Curvature of Cornea resulting in Different Refractive Power at Different Axis

Answer 4

Astigmatism

Question 5

• Decrease in Focusing Ability during Accomoodation due to Sclerosis and Decreased Elasticity

Answer 5

Presbyopia

Question 6

• Inflammation of Anterior Uvea and Iris w/ Hypopyon (sterile pus)
• Accompanied by Conjunctival Redness
• A/w Systemic Inflammatory disorders (e.g. Sarcoid, Rheumatoid arthritis, Juvenile idiopathic arthritis, TB,
  HLA-B27-associated conditions)

Answer 6

Uveitis

Question 7

• Retinal Edema and Necrosis leading to Scar
• Often viral; CMV, HSV, HZV
• A/w Immunosuppression

Answer 7

Retinitis

Question 8

• Acute, Painless monocular vision loss
• Retina cloudy w/ attenuated vessels and “Cherry-red” spot at the fovea

Answer 8

Central Retinal Artery Occlusion

Question 9

• Blockage of Central or Branch retinal vein due to compression from nearby arterial Atherosclerosis
• Retinal hemorrhage and edema in affected area

Answer 9

Retinal Vein Occlusion

Question 10

• Retinal damage due to Chronic Hyperglycemia
• Formation of Capillary microaneurysms
• Hemorrhages, Arteriolar Hyalinization, Cotton-wool spots, Neovascularization, and Fibroplasia
• (2) Types:
  
  • Non-proliferative - damaged capillaries leak blood –> Lipids and Fluid seep into Retina –> Hemorrhages and Macular edema
  • Tx: Blood sugar control, Macular laser
  • Proliferative - Chronic hypoxia results in New blood vessel formation w/ resultant traction on Retina
  • Tx: Peripheral retinal photocoagulation, anti-VEGF injections

Answer 10

Diabetic Retinopathy

Answer 11

Uveitis

Answer 12

CMV Retinitis

Answer 13

Central Retinal Artery Occlusion

Answer 14

Non-proliferative Diabetic Retinopathy

Answer 15

Proliferative Diabetic Retinopathy

Answer 16

Retinal Vein Occlusion

Question 17

• Optic disc atrophy w/ characteristic Cupping
• Deepening of the Optic Cup –> decreasing Vision
• Increased frequency of Headaches
• Usually w/ Increased Intraocular Pressure (IOP) and Progressive Peripheral Visual field loss
• (2) Classifications of Glaucoma
  
  1. ​Open Angle
     
     • Primary and Secondary
  2. Acute (Closed) Angle
     
     • ​Primary and Secondary

Answer 17

Glaucoma

Answer 18

Glaucoma

Question 19

• A/w increase in Age, African-American race, Family History, Painless, more common in U.S.
• Primary - Cause unclear, a/w GLC1A gene on Chromosome 1
• Secondary - Blocked trabecular meshwork from WBCs (e.g., uvetis), RBCs (e.g. vitreous hemorrhage), Retinal elements (e.g. Retinal detachment)

Answer 19

Open Angle Glaucoma

Question 20

• Primary - enlargement or forward movement of lens against Central Iris (pupil margin) leads to obstruction of normal aqueous flow through Pupil –> Fluid builds up behind Iris –> Pushing peripheral Iris against Cornea and impeding flow through Trabecular meshwork
• Secondary - Hyposcia from Retinal disease (e.g. Diabetes, Vein occlusion) induces Vasoproliferation in Iris that contracts angle
• Chronic closure - Often asymptomatic w/ dmg to Optic nerve and Peripheral vision
• Acute closure - True Ophthalmic emergency. Increase IOP pushes Iris forward –> Angle closes abruptly –> Very painful, sudden vision loss, Halos around lights, Rock-hard eye, Frontal headache. DO NOT GIVE Epinephrine because of its Mydriatic effect

Answer 20

Acute (Closed) Angle Glaucoma

Question 21

• Painless, often bilateral, opacification of Lens
• Decrease in vision
• A/w Systemic therapy w/ Glucocorticoids
• A/w Age, Smoking, EtOH, Excessive Sunlight, Prolonged corticosteroid use, Classic galactosemia, Galactokinase deficiency, Diabetes (sorbitol), Trauma, Infection

Answer 21

Cataract

Answer 22

Cataract

Question 23

• Optic disc swelling (usually bilateral) due to Increased Intracranial pressure (e.g. 2nd to mass effect)
• Enlarged blind spot and elevated Optic disc w/ blurred margins seen on Fundoscopic exam
• A/ increased Intra-cranial pressure is NOT Typically a/w Visual loss

Answer 23

Papilledema

Answer 24

Papilledema

Question 25

* Degeneration of Macula (Cental area of Retina) * Causes Distortion (metamorphopsia) and eventual loss of Central Vision (Scotomas) * Dry (nonexudative, \> 80%) - deposition of Yellowish extracellular material in and beneath Bruch membrane and Retinal pigment epithelium ("Drusen") w/ gradual Decrease in vision. Prevent progression w/ multivitamin and antioxidant supplements * Wet (exudative, 10 - 13%) - rapid loss of vision due to bleeding, 2nd to **Choroidal neovascularization --\>** local production of VEGF * Tx: anti-vascular endothelial growth factor injections (**anti-VEGF**) or laser.

Answer 25

Age-related Macular Degeneration | (ARMD)

Question 26


Answer 26

Dry Age-related Macular Degeneration

Question 27


Answer 27

Wet Age-related Macular Degeneration

Question 28

* Increase in orbit contents that push the eye forward * Results in chronic corneal exposure to the air --\> Corneal Ulceration and Infection * Inferiorly medially: Lacrimal gland inflammation, lymphoma, Pleomorphic adenoma, Adenoid cystic carcinoma * Axial: Glioma, Meningioma

Answer 28

Proptosis

Question 29

* Proptosis caused by Exracellular matrix (ECM) accumulation and Rectus Muscle fibrosis * Severity is independent of Thyroid status

Answer 29

Thyroid Ophthalmopathy | (Graves Disease)

Question 30

* Most common eyelid malignancy * Predilection for Lower eyelids and Medial Canthus

Answer 30

Basal Cell Carcinoma

Question 31

* Second most common Eyelid malignancy * Metastisizes first to Parotid and Submandibular lymph nodes * May form a local mass that mimics Chalazion or may diffusely Thicken the Eyelid * May resemble inflammatory Blephitis or Ocular Cicatricial Pemphigoid due to intraepithelial spread * Exhibits Intraepithelial pagetoid spread into the Nasopharynx and Lacrimal glands * 22% Mortality rate

Answer 31

Sebaceous Carcinoma

Question 32

* Third most common Lesion * Melanomas are rare * Tend to follow an indolent course * A/w HPV type 16 and 18

Answer 32

Squamous Cell Carcinoma

Question 33

* Sebaceous drainage blocked by inflammation

Answer 33

Blephatis

Question 34

* Neoplasm, extravasated lipid provokes a Lipogranulomatous response

Answer 34

Chalazion

Question 35

* Nonkeratinizing stratified squamous epithelium * Responds to inflammation by forming minute Papillary folds

Answer 35

Palpebral Conjunctiva

Question 36

* Pseudostratified columnar epithelium rich in Goblet cells * A/w Lacrimal and Lympoid tissues and can be expanded in Viral conjunjuntivitis or Lympoid malignancy

Answer 36

Fornix Conjunctiva

Question 37

* Nonkeratinizing stratified squamous epithelium that covers the surface of the eye

Answer 37

Bulbar Conjunctiva

Question 38

* Common and typically benign * Rarely involve the Cornea, Fornix, or Palpebral conjunctiva (pigmented lesions) * Chornic inflammation can occur during adolescence (inflamed juvenile nevus) and involve Lymphocytes, Plasma cells, and Eosinophils * Contain subepithelial cysts lined w/ surface epithelia

Answer 38

Conjunctival Nevi

Question 39

* Unilateral * Middle-aged, Fair-complexioned patients * Have a Intraepithelial phase --\> Primary acquired Melanosis w/ atypica --\> spread through the lymphatics to Regional lymph nodes * Parotid and Submandibular lymph nodes are favored for Initial Metastatic sites * 25% Mortality rate

Answer 39

Conjunctival Melanomas

Question 40

* Calcific band keratopathy, a common complication of chronic uveitis * Calcium deposition in Bowman's layer * Actinic band keratopathy involves ultraviolet-induced corneal collagen degeneration

Answer 40

Band Keratopathies

Question 41

* Corneal thinning and Ectasia cause the Cornea to become Conical (rather than spherical) * Distored vision * Bowman's layer fractures are Hallmarks * Mtalloproteinase activation may be causal but Inflammation is absent

Answer 41

Keratoconus

Question 42

* Primary loss of Corneal endothelial cells --\> Stromal edema and Bullous Keratopathy (epithelial detachment from Bowman's layer, forming bullae) * Blurring and loss of Vision

Answer 42

Fuchs Endothelial Dystrophy

Question 43

* Deposits of various stromal proteins (resulting from mutations that affect folding) and form discrete opacities in the Cornea * Compromising vision * Deposits adjacent to Epithelium or Bowman's layer can also cause Painful Erosions and Scarring

Answer 43

Stromal Dystrophies

Question 44

* Most common form of Glaucoma * Intraocular pressures are elevated despite an Open angle and Normal-appearing structures * Some functional increases in Resistance to Aqueous Humor outflow * Familial MYOC mutations encoding for the protein Myocilin * Physical clogging of the Trabecular meshwork, Particulate matter (senescent erythrocytes after trauma, or iris pigment epithelial granules, etc.)

Answer 44

Open-angle Glaucoma

Question 45

* The Peripheral zone of the Iris (a/ tissue) adheres to the Trabecular Meshwork and Physically impedes the Aqueous Outflow from the eye * May occur as a Primary angle-closure Glaucoma in eyes w/ shallow anterior chambers (pts. are often Hyperopic) or can occur subsequent to Neovascular membrane formation (after trauma) or Ciliary Body tumors

Answer 45

Angle-closure Glaucoma

Question 46

* Non-infectious Uveitis limited to the Eye * A/w Penetrating eye injury, developing w/in 2 weeks (to many years) after the insult * Retinal antigens establish a delayed Hypersensitivity response that affects not only the injured eye but also the Contralateral, Uninjured eye * Bilateral granulomatous inflammation affecting ALL Uveal Components

Answer 46

Sympathetic Ophthalmia

Question 47

* A/w Full-thickness retinal defect developing when Structural collapse of the Vitreous exerts traction on the Retinal Internal limiting membrane * Liquefied viteous humor then seeps through the tear and separates the neurosensory Retina and RPE

Answer 47

Rhegmatogenous Retinal Detachment

Question 48

* Exudates accumulate or Fluid leaks from the Choroidal circulation beneath the retina (e.g. w/ Choroidal tumors or malignant HTN)

Answer 48

Non-rhegmatogenous Retinal Detachment | (w/out a Retinal break)

Question 49

* HTN --\> Retinal arteriosclerosis w/ Wall thickening * Malignant HTN --\> damaged Choroidal vessles can cause Choroidal Infarcts (?) or Exudate accumulation between the Neurosensory retina and RPE --\> detachment

Answer 49

Elschnig Pearls

Question 50

* Immature Retinal vessels respond to increased Oxygen tension (administered to premature infants) by constricting --\> resulting in local Ischemia

Answer 50

Retinopathy of Prematurity | (Retrolental Fibroplasia)

Question 51

* Collection of fairly common inherited disorders that affect various aspects of Vision * Including Visual cascade and cycle, Structural genes, Transcription factors, Catabolic pathways, and Mitochondrial metabolism * Night blindness caused by loss of rod photoreceptors is an early symptom --\> Eventual loss of Cones too * Branching reticulated pattern to the Retina * Optic disc may appear pale and waxy pallor * Attenuation of Retinal blood vessels * Both Rods and Cones are lost to Apoptosis and there is a/ Retinal Atrophy w/ Perivascular Retinal Pigment Accumulationkl;

Answer 51

Retinitis Pigmentosa

Question 52

* Blood supply to the Optic nerve can be interrupted by Vascular inflammation (e.g. Temporal arteritis) or by Embolism or Thrombosis

Answer 52

Anterior Ischemic Optic Neuropathy

Question 53

![]()

Answer 53

Tay-Sachs Disease "Cherry-red Spot"

Question 54

* Pupillary Light-near Dissociation * No Direct or Consensual Light reflex * Accommodation - Convergence Intact * A/w **Neurosyphilis**, Diabetes

Answer 54

Argyll Robertson Pupil

Question 55

* Lesion of Afferent Limb of Pupillary light reflex * Diagnosis made w/ swinging flashlight * Shine light in affected pupil --\> pupils do not constrict fully * Shine light in normal eye --\> pupils constrict fully * Shine light immediately again in affected eye --\> apparent dilation of both eyes because of stimulus carried through that CN II is weaker * A/w Multiple Sclerosis

Answer 55

Marcus Gunn Pupil | (Relative afferent)

Question 56

* Caused by a lesion of the Oculosympathetic Pathway * Syndrome consists of Miosis, Pthosis, Apparent Enophthalmos, and Hemianhidrosis

Answer 56

Horner Syndrome

Question 57

* Dilated pupil that reacts sluggishly to light, but better to Accommodation * Seen in Women and a/w Loss of Knee Jerks * Ciliary ganglion lesion

Answer 57

Adie Pupil

Question 58

* Increased Intraocular pressure --\> Leads to Uncal herniation --\> CN III Compression --\> Fixed and Dilated Pupil * "Down-and-Out" eye, ptosis

Answer 58

Uncal Herniation Transtentorial Herniation

Question 59

* Most common cause of Corneal ulcers * Intranuclear inclusions * Perforate through the globe --\> medical emergency * Chornic herpetic corneal infections --\> Localized Opacity * Lymphocytes, Plasma cells, Viral inclusions in Corneal Epithelial cells are present

Answer 59

Herpes Simplex Virus

Question 60

* Most common malignant ocular neoplasm in children * Clusters of Cuboidal or Short Columnar cells around a Central lumen "Flexner-Winter-Steiner Rosettes" * Can spread to the Orbit or along the Optic Nerve

Answer 60

Retinoblastoma