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Pathology II > Ocular Pathology > Flashcards

Ocular Pathology Flashcards

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1
Q

What ocular abnormality is present?

A

Corneal edema

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2
Q

MDx

A

MDx: cataract

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3
Q

Causes of corneal opacity

A

Corneal edema- MOST COMMON- fluid in the corneal stroma

– Injury to epithelium (ulceration)

– Injury to endothelium
• Cornealendothelial

dystrophy
• Increased IOP (Glaucoma) • Immune-mediated

– Keratitis–neovascularization has leaky capillaries

Corneal deposits – covered later

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4
Q
A

Corneal edema due to an ulcer

Ulcer stains green with flourescein dye

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5
Q
A

Corneal edema due to keratitis

Note gross features of inflammation

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6
Q
A

MDx: diffuse corneal edema

Corneal endothelial dystrophies

Inherited; breed predilections

Old age change

Bilaterally symmetrical foci of opacity which progress to diffuse opacity

Endothelial degeneration of unknown cause

It’s a gross diagnosis! - no histo!

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7
Q
A

MDx: diffuse corneal edema

Puppy that survived the acute phase of infectious canine hepatitis (CAV-1 infection); immune complex deposition in corneal endothelium

“Blue Eye”

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8
Q
A

Cataract

The most common disease of the lens

Swelling/degeneration of lenticular fibersopacity

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9
Q
A

Lens response to injury:

Hydropic swelling of injured fibersfiber fragmentation & disintegration

Hyperplasia and fibrous metaplasia of lens epithelium

Posterior lens epithelial migration

When chronic (“hypermature”): shrinking and wrinkling of lens capsule and mineralization

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10
Q

What causes a cataract?

A

Radiation

Increased IOP (Glaucoma)

Endophthalmitis

Hereditary defect in lenticular metabolism

Diabetes mellitus (high glucose in aqueous)

Trauma

ANYTHING THAT DAMAGES THE LENTICULAR FIBERS!

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11
Q

What do you evaluate in a fundic exam?

A

Indications of retinal degeneration (& atrophy)

  • Decreased vascularity
  • Optic disc atrophy
  • Changes in tapetal reflection
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12
Q

If you are loosing retina, the tapendum will become ______ reflective?

A

MORE

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13
Q

Causes of retinal degeneration & atrophy

A

Senile change

Inherited metabolic defect of photoreceptor cells

– Collectively known as PRAs (“progressive retinal atrophy”)

– SARD

Toxicity

Metabolic deficiencies – taurine, vitamin A

Increased IOP (glaucoma)

Retinal detachment

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14
Q
A

Retina from an adult cat with acquired blindness

Lost photoreceptor and outer nuclear & plexiform layers

Morphologic diagnosis: Retinal atrophy (& degeneration)

Cause:
Enrofloxacin toxicity

histo can’t tell you the etiology

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15
Q
A

Retina from a horse with increased IOP (glaucoma)

Loss of nerve fiber and ganglion cell layers, but excellent preservation of photoreceptors and outer nuclear layer

MDx: retinal atrophy

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16
Q

Causes of retinal detachment (separation)

A

Exudative
– Choroiditis, retinitis – Hemorrhage
– Neoplasm

• Tractional

– maturation of fibrin in vitreous (fibrous adhesions between ciliary bodies = “cyclitic membrane”)

Usually due to inflammation

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17
Q
A

Retinal detachment due to effusion from the growth of metastatic lymphoma within the choroid and subretinal space

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18
Q
A

Retinal detachment (separation)

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19
Q
A

Consequence = retinal degeneration & atrophy

Separates between neural and pigmented layers

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20
Q

What is the most likely cause of the corneal opacity?

A

Glaucoma

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21
Q

Glaucoma

A

= ↑ IOP
• bad bad BAD

obstruction of the filtration angle

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22
Q

Primary Glaucoma

A

Cause = goniodysgenesis, a detectable malformation of the trabecular meshwork

Dogs – inherited, common

Other species – severely anomalous eyes

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23
Q
A

Goniodysgenesis, primary glaucoma

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24
Q

Secondary Glaucoma

A

Most common type

Causes = anything that obstructs the pupil or trabecular meshwork

– Exudate(endophthalmitis)

– Lens luxation

– Posteriorsynechia

– Peripheralanteriorsynechia

– Compression of the filtration angle

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25
Peripheral anterior synechia- iris adheres to the cornea
26
Consequences of glaucoma...
Buphthalmos Corneal edema +/- striae Retinal degeneration & atrophy Optic disc cupping Optic nerve atrophy (because of loss of ganglion cells) Cataract Lens luxation Iris atrophy
27
pressure on optic nerve head causes this cuffing; can see on fundic
28
Dog with iris atrophy (note, this can also be an old age degenerative change of the iris)
29
Dog with posterior luxated lens
30
calf with dermatophytosis
31
Dog with a chalazion
32
Blepharitis
Inflammation of the eyelids Causes = same for skin in general • Exception: – Chalazion – granulomatous inflammation directed against meibomian gland – Stye – common name for bacterial infection of hair follicle or meibomian gland (usually Staph aureus)- more common in people
33
Conjunctivitis
Response to injury same as for other mucous membranes Gross features – Hyperemia – Swelling/edema – Discharge – Chemosis – severe conjunctival edema – Pigmentation – chronic lesions Hyperemia alone does not necessarily indicate conjunctivitis
34
chemosis in a dog with conjunctivitis, cause unknown
35
Chemosis in a sheep with photosensitization
36
Causes of Conjunctivitis
Primary pathogens rare Exceptions = cats – Herpesvirus (FHV-1) – Chlamydophiliafelis – Mycoplasmafelis–normal resident or secondary pathogen Histology – unlikely to establish cause!!
37
Feline conjunctivitis Primary pathogens are only common in cats: - herpes - Chylamdophilia felis - Mycoplasma
38
Nodular Granulomatous Episcleritis
Herding breeds esp. collies **Immune-mediated** pathogenesis Junction of cornea and sclera, often bilaterally symmetrical Histology = granulomatous keratoconjunctivitis What would be some ddx for the gross lesion, and how would you establish a dx?
39
Nodular Granulomatous Episcleritis
40
Corneal ulceration
41
Corneal response to injury
Edema Epithelial regeneration Neutrophil mediated stromal lysis Neovasularization Stromal fibrosis If only eroded, epithelial regeneration is very rapid If ulcerated, stromal repair must proceed epithelial regeneration If chronic/persistent injury, cutaneous metaplasia may occur (combination of keratinization, epithelial hyperplasia, pigmentation, subepithelial fibrosis and vascularization)
42
Case of Equine Corneal Ulcer Owner declines treatment A few days later the eye now looks like below What is the most likely cause?
Most likely cause- opportuntistic bacteria; when bacteria get into the stroma, neutrophils degranulate and also eat up corneal stroma
43
Etiology of Keratitis
Trauma Bacterial: – usually opportunistic, especially Pseudomonas aeruginosa – primary pathogen = Moraxella bovis Chlamydia/mycoplasma Viruses: IBR, MCF, FHV-1 Fungi: Aspergillosis, Mucormycosis Drying and desiccation: Keratoconjunctivitis sicca Idiopathic: – Chronic superficial keratitis (“Pannus”) in German Shepherd – Superficial indolent ulcers in Boxers – Feline eosinophilic keratitis
44
Cow with “infectious keratoconjuncitivitis” (due to Moraxella bovis)
45
“Melting ulcers” (Keratomalacia) Necrosis of corneal epithelium and stroma, usually due to innocent bystander injury from leukocytes Due to rapidly progressing bacterial infection In this case we culture a swab for bacteria and fungus – get Pseudomonas aeruginosa
46
Following a few days of aggressive antibiotic therapy With a lesion similar to right, a descemetocele- desmes membrane is coming off Emergency referral to specialist- EYE IS ABOUT TO RUPTURE What went wrong?
47
Horse with a corneal ulcer and iris prolapse iris is sucked into the cornea
48
Horse with a staphyloma following a perforated corneal ulcer "starburst"
49
Dog with corneal edema, neovascularization, and staphyloma
50
Horse with corneal pigmentation and scarring following ulcerative keratitis chronic ulcerated keratitis Can have fibrosis
51
Cow with an old staphyloma (enucleated eye)
52
Phthisis bulbi(END STAGE EYE) from a horse – end stage eye. Shrunken/atrophic and scarred/fibrotic.
53
Corneal pigmentation from scarring/staphyloma, not to be confused with... Corneal sequestrum * Cats * Localized necrosis of the epithelium and anterior stroma from severe corneal injury * Affected area gets infiltrated with dark pigment that is present in the tear film resulting in the characteristic black lesion in the cornea
54
What is the most appropriate morphologic diagnosis?
keratitis- raised
55
Chronic Superficial Keratitis (“Pannus”) German shepherds Immune-mediated pathogenesis Characteristic inflammation of the superficial corneal stroma Grows in from the lateral limbus
56
Keratoconjunctivitis Sicca (KCS, “dry eye”) Pathogenesis: Immune- mediated injury to lacrimal glandsdecreased tears and/or change in composition of tearsdrying out of cornea/conjunctiva  chronic irritation Can be incited by other causes of lacrimal gland injury Note mucopurulent exudate
57
describe and if the exudate is in the anterior chamber, then what's the MDX
2 year old cat with photophobia, miosis & blepharospasm(spastic contraction- indicate pain) MDx: Anterior uveitis
58
Anterior uveitis
iris (iridis) and ciliary body (cyclitis)
59
Posterior uveitis
choroid (choroiditis)
60
Chorioretinitis
choroid and retina
61
Endophthalmitis
uvea, retina, and vitreous
62
Panophthalmitis
+ cornea and sclera
63
Causes of uveitis
• Hypersensitivity- immune mediated – Feline idiopathic lymphoplasmacytic uveitis – Equine recurrent uveitis – Sporadically associated with other systemic disease • Infectious- – Usually systemic disease and uvea one of many vascular tissues affected – Perforating corneal ulcers – Penetratinginjuries • Lens-induced tr
64
What could also be going on with this eye?
OUR CASE: FIP vs idiopathic lymphoplasmacytic uveitis?
65
Cat with keratic precipitates, and rubeosis iridis
66
Dog with corneal ulcer, corneal edema, and hypopyon
67
Cat with keratic precipitates, and dyscoria due to posterior synechia
68
Dog with corneal edema, hyperemia of bulbar conjunctiva, iris neovasuclarization
69
Iris bombé in a cat
70
Posterior synechia
71
Pre-iridal fibrovascular membrane
72
Consequences of Uveitis
Synechia - fibrous adhesions – Posterior - between iris and lens – Anterior - between iris and cornea Preiridal fibrovascular membrane (PIFM) Iris bombé Cataracts - due to inadequate aqueous flow or posterior synechia Lens luxation Glaucoma - blockage of the filtration angle by exudate or adhesions, or by posterior synechia Retinal detachment Phthisis bulbi
73
Horse with cataract and dyscoria due to posterior synechia
74
Equine recurrent uveitis
Periodic ophthalmia, moon blindness, iridocyclitis Most common cause of blindness in horses, ponies and mules- IMMUNE MEDIATED Characterized by variable degree of uveitis in one or both eyes Hypersensitivity to previous systemic infection, particularly Leptospira interrogans serovars implicated
75
Equine recurrent uveitis
76
Lens-induced uveitis
Inflammatory response to lens protein Phacolytic - leakage of lens proteins from hypermature cataract Phacoclastic - rupture of the lens Phacoclastic more severe
77
Retinitis
Usually an extension from choroiditis or encephalitis Neurotropic viral infections (rabies, pseudorabies, distemper) Visceral larval migrans – Toxocara canis, Baylisascaris procyonis Consequences: scarring (gliosis), atrophy
78
Hyphema
Blood􏰀in􏰀the􏰀anterior􏰀chamber Source􏰀– typically􏰀uvea􏰀or􏰀 retina Primary􏰀vascular􏰀lesion􏰀vs􏰀 disorder􏰀of􏰀hemostasis What 􏰀is􏰀a􏰀serious􏰀consequence􏰀of􏰀 this􏰀lesion?􏰀 Obstruct the filtration angle; increased IOP; lead to glaucoma
79
Hyphema
80
Retinal 􏰀hypertensive 􏰀vasculopathy typical in hyperthyroid cats and CHF dogs Increase in bp has lead to thickening of the membrane; vessels are prone to rupture
81
Incomplete 􏰀separation 􏰀of 􏰀th e􏰀orbits􏰀 during 􏰀embryogenesis Veratrum 􏰀californicum􏰀in gestion􏰀on􏰀 day􏰀14􏰀gestation
82
Cyclopia/Synophthalmos􏰀in􏰀 lambs􏰀
83
Lambs with inherited microphthalmia
84
Calf with microphthalmia due to in utero BVD infection
85
Eyelid agenesis in a cat
86
Ankylobephraon in a cat; eyelids are fused; normal right after birth physiological or can be abnormal
87
Distichia in a dog
88
Ectropion in a dog eyelids roll out
89
Entropion and secondary trichiasis in a dog
90
Corneal dermoid in a calf
91
Luxated lens – L posterior in dog, R anterior in cat Can be aquired how? trauma or glaucoma- eye expands so much
92
Iris hypoplasia in a dog
93
Goniodysgenesis Cause of primary glaucoma
94
Choroidal hypoplasia and coloboma in a collie
95
Collie􏰀Eye􏰀Anomaly
96
Collie􏰀Eye􏰀Anomaly
Scleral􏰀ectasia Common disease of smooth and rough collies; inherited as an autosomal recessive trait Ophthalmoscopic findings – retinal vessel tortuosity – focal to diffuse choroidal and tapetal hypoplasia – optic nerve coloboma – retinal separation with intraocular hemorrhage Disease is always bilateral Coloboma􏰀=􏰀Notch􏰂like􏰀defects􏰀of􏰀 optic􏰀disk,􏰀retina,􏰀and/or􏰀uvea􏰀as􏰀a􏰀 result􏰀of􏰀defective􏰀closure􏰀of􏰀the􏰀 embryonic􏰀fissure􏰀of􏰀the􏰀eye
97
Retinal dysplasia – note jumbling of retinal layers; can develop as a result of a wide variety of retinal injuries in the embryonic eye (BVD, bluetongue, canine parvo / feline panleuk, or as an inherited condition.
98
Optic nerve hypoplasia vs atrophy– accompanies primary retinal lesions (lack/loss of ganglion cells).
99
Iris melanoma
100
Feline 􏰀Diffus e􏰀Iris􏰀 Melanoma
Most􏰀common􏰀intra􏰂ocular􏰀 neoplasm Esp.􏰀cats􏰀with􏰀yellow􏰀eyes Most􏰀are􏰀malignant Clinical􏰀evidence􏰀of􏰀malignancy􏰀(vs􏰀 melanosis􏰀“iris􏰀freckle”)􏰀– raised􏰀 lesions,􏰀velvet􏰀surface,􏰀distortion􏰀of􏰀 pupil/iris Rate􏰀of􏰀metastasis􏰀low Rate􏰀of􏰀glaucoma􏰀high
101
Feline 􏰀Diffuse 􏰀Iris􏰀 Melanoma
102
Uveal 􏰀melanoma 􏰀in 􏰀other􏰀 species
Most􏰀common􏰀intra􏰂ocular􏰀 neoplasm Most􏰀are􏰀benign􏰀in􏰀the􏰀dog
103
Uveal 􏰀melanoma 􏰀in 􏰀other􏰀 species
104
Feline diffuse iris melanoma - Histological criteria of malignancy are not prognostically significant.
105
Canine􏰀melanoma􏰀in􏰀other􏰀locations • Haired􏰀skin􏰀of􏰀eyelid􏰀– benign • Conjunctiva􏰀– malignant􏰀 Species and location are the most important prognostic factors for melanocytic neoplasms in general.
106
Ciliary􏰀(Iridociliary)􏰀 Adenoma/Carcinoma Dogs􏰀\>\>\>􏰀cats Most􏰀are􏰀benign;􏰀usually􏰀behave􏰀 benign􏰀even􏰀when􏰀histologically􏰀 malignant Discrete􏰀nodules􏰀in􏰀posterior􏰀 segment􏰀 Secondary􏰀glaucoma,􏰀hyphema,􏰀 retinal􏰀detachment􏰀why??
107
Intraocular􏰀sarcoma
108
Intraocular􏰀sarcoma
Unique to the cat (rare) Arises following ocular trauma Malignant􏰀– wide􏰀invasion􏰀 throughout􏰀eye,􏰀including􏰀down􏰀 optic􏰀nerve􏰀and􏰀distance􏰀metastasis􏰀 occurs􏰀following􏰀enucleation Probably􏰀derived􏰀from􏰀lenticular􏰀 epithelium
109
Uveal 􏰀lymphoma
Most􏰀common􏰀metastasis􏰀involving􏰀 the􏰀eye,􏰀especially􏰀in􏰀cats Thickening/pallor􏰀of􏰀uvea Clinically􏰀difficult􏰀to􏰀distinguish􏰀from􏰀 uveitis
110
Uveal 􏰀lymphoma VERY COMMON
111
Meibomian (sebaceous) adenoma in a dog
112
Meibomian (sebaceous) adenoma in a dog
113
Corneal squamous cell carcinoma in a cow (R) and eyelid/conjunctival SCC in a cat (L)
114
Corneal lipidosis Breed 􏰀predilections Associated􏰀with􏰀hyperlipidemia Somewhat􏰀crystalline􏰀 Calcification􏰀following􏰀keratitis􏰀appears􏰀 similar􏰀 Ddx =􏰀early􏰀“corneal􏰀(endothelial)􏰀 dystrophy” Corneal􏰀lipidosis
115
Corneal 􏰀pigmentation
Derived from uvea (staphyloma) Response to injury (chronic keratitis) • Porphyrins from tear film (corneal sequestrum in cats)

Pathology II (20 decks)

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