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SCLERA AND UVEA Flashcards

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1
Q

WHAT MAKES THE UVEA?

A

IRIS
CILIAR BODY
CHOROID

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2
Q

CILIARBODY AND CHOROID JUNCTION

A

choroid becomes the ciliary body from the ora serrata

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3
Q

what shape is the ciliary body as a cut section?

A

triangular

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4
Q

what are the parts present in the outer , inner and base of the triangle and whats present in the tip of the triangle?

A

outer surface - ant and post chamber angle
inner surface - ciliary process ~ pars plicata
w no process ~ pars plana
tip consists of iris
base of triangle is the suprachoroidal space and sclera

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5
Q

what are the microscopic layers of ciliary body?

A 
from out to in
#supraciliary lamina
#stroma
#ciliary muscle- longitudinal,circu,radial/obliqu fibres
#pigment epithelium
#non pigment epithelium
#internal limiting membrane
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6
Q

blood supply of the uvea?

A

short posterior ciliary artery
long posterior ciliary artery
anterior ciliary artery

venous - iris-ciliary body- chorid VORTEX VEIN- superior and inferior temporan and same nasal veins -superior and inferior ophthalmic veins

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7
Q

define anterior uveitis - the structures affected?

A

inflammaton of the uveal tissue

from the iris to the pars plicata(ciliary process containing) of ciliary body

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8
Q

clinical feature significant point of irido cyclitis?

A

more marked inflammation in iris or ciliary body

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9
Q

symptoms in acute irido cylclitis?

A

pain, photophobia,lacrimation,redness

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10
Q

what is the severity of symptoms in chronic iridocyclitis with respect to the severity of the condition?

A

minimun symptoms even when there is increased inflammation

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11
Q

eitiology of uveitis? according to mode of onset of infection

A

exogenous infection- direct invasion~ suppurative or

#endogenous infection-from someother source through blood / anything
#secondary- from adjacent structures
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12
Q

eitiology of uveitis according to infectious agents

A 
bacterial
viral 
protozoal
rickettisial
fungal
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13
Q

types of pathomechanism of infection in uveitis?

A

suppurative infections and non suppurative infections

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14
Q

non suppurative uveitis is due to?

A

granulomatous or non granulomatous origin

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15
Q

type of pain in ant uveitis?

A 
# main symptom
# throbbing and dull
#increased at night
#radiating along 5th nerve areas like forehead and scalp
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16
Q

where is the reffered pain in ant uveitis?

A

to the scalp and fore heead along the branches of 5th nerve

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17
Q

what is the characteristics of redness found in ant uveitis? and why is it produced?

A

circumcorneal congestion

due to hyperemia of the ant ciliary vessels due to hiatamines and toxins

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18
Q

what is th ereason for photophobia and blepharospasm in acute ant uveitis?

A

due to irritated 5th nerve - that is the sensory

and the 7th nerve- motor fibres ((ornicularis oculi)

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19
Q

why does lacrimation occur in ant uveitis?

A

due to irritation of the 5th nerve

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20
Q

causes of blurred vision in ant uveitis?

A 
#corneal edema 
#cilicary spasm
#cyclitic memebrane
#pupillary black
#aueous turbidity
#complicated cataract
#2* galucoma
#vitreous haze
#induced mypoia 
#associated macular edema
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21
Q

what is the pathogonomic sign in ant uveitis?

A

keratic precipitates

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22
Q

where and what is it made of and where does it mostly occur?

KERATIC PRECIPITATES

A

IN THE BACK OF CORNEA

MADE OF PROTEINACIOUS CELLULAR DEPOSIT

MOSTLY IN THE CENTER AND LOWER PART OF THE CORNEA

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23
Q

TYPES OF KERATIC PRECIPITATES?

A

1.mutton chop
2. small and medium
3 .fine/stellate kp
4. old kps

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24
Q

where is mutton chop KPs found?

A

in granulomoatous iridocyclitis

greasy and waxy
made or macrohpages and epitheloid cells
few in number

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25
small and medium kps are found in? | what are they made of?
non granulomatous inflammation of ant uveitis lymphocytes
26
stellate KPs are found in ?
Fuchs heterochromatic iridocyclitis, CMV retinitis and herpitic iritis cover whole cornea
27
what is stellate type of keratic precipiate also known as and where are they found?
aka endothelial dusty , in whole cornea in Fuchs heterochromatic iridocyclitis cmv retinitis and herpitic iritis
28
old keratic precipitates are found in?
all the other kps when they heal shrink fade and pigmented
29
what are the signs in ant iridocyclitis?
#lid edema #circumcorneal congestion #corneal edema keratic precipitates post corneal oppacity ``` #anterior chamber signs #iris signs #pupillary signs #lens signs #vitrous and retinal signs ```
30
anterior chamber signs in ant iridocyclitis?
aqueous cells aqueous flare change in ant chamber dept change in angle of ant chamber
31
iris signs in ant uveitis?
loss of pattern change in colour IRIS NODULES posterior synechiea neovascularisation
32
what are posterior synechiae?
they are adhesions formed between the iris and the ant surface of the lens
33
what are the types of post synechia ?
annular type/ring type - cause iris bombe - secondary angle closure glaucoma segmental synechia total synechia
34
what is the earliest sign of ant uveitis?
aueous flare
35
what causes aueous flare?
in ant uveitis when there is damage to the blood vessels the cells gets into the aueous humour and when seen in slit lamp exam with an point beam of light brownian movements are observed, this is called aques flare.
36
In which condition is aqueous flare seen?
most marked in granulomatous ant uveitis | less in granulomatous
37
grading of aqueous flare
``` from 0 to 4 0 none 1 faint 2 moderate w iris and lens details seen 3 marked and details hazy 4 intense flare (fibrin or plastic aqueous) ```
38
types of hypophyon seen in ant uveitis?
DENSE IMMOBILE - HIGH FIBRIN - HLA B27 ANT UVEITIS COLD HYPOPHYON - BEHCETS SYNDROME - CHANGE POSITION WITH CHANGE IN HEAD POSITION HAEMORRHAGIC - HERPETIC , TRAUMA
39
WHAT ARE IRIS NODULES
THEY ARE NODULES FOUND IN ANT UVEITIS, CALLED KOEPPES NODULES - IN THE IRIS BOORDER , INITIATE POST SYNECHIAE BUSACCA'S NODULES - LESS COMMON
40
PUPILLARY SIGNS IN ANT UVEITIS
``` NARROW PUPIL IRREGULAR SHAPE ECTROPION PUPIL (elevated pupil margin) occlusio pupillae sluggish pupil reaction ```
41
what are the changes seen in the lens in ant uveitis?
``` deposition of pigment exudate deposition (in acute plastic ant uveitis) complicated cataract( ```
42
what are the vireous changes and retinal changes in the eye due to iridocyclitis?
exudates and inflammatory cells cyatoid macular edema(esp in chronic macular edema)
43
what happens to the iOP in iridocyclitis? does it increase or decreace?
both happens or even stays normal incREASE- due to 2 ACG DECREASE DUE TO 1. ACUTE IRIDOCYCLITIS - SHOCK OF CILIARY BODY 2. CHRONIC IRIDOCYCLITIS- PHYTHISIS BULBI
44
WHAT IS THE END RESULT OF CHRONIC IRIDOCYCLITIS
PHYTHISIS BULBI WHERE THE EYE BALL SHRIKS AND LOOSES VISION
45
WHAT ARE THE FEATURES U NOTICE IN A PATIENT WITH ACUTE IRIDOCYCLITIS?
``` GRADUAL ONSET OF SYMTOPMS WATERY DISCHARGE PAIN - MOD AND ALONG DIV OF 5TH NERVE VISION IS SLIGHTLY IMPAIRED CONGESTION - OF DEEEP CILIARY VESSELS TENDERNESS IS MARKED PUPIL BECOMES - SMALL AND IRREGULAR ANT CHAMBER- AQUESOU SFLARE AND DEEPER IRIS IS MUDDY IOP - USUALLY NORMAL NO CLOURED HALOS ```
46
WHAT ARE THE POINTS THAT U SHOULD KNOWS AT THE TOP OF YOURE HEAD ABOUT ANT UVEITIS?
``` koppes nodules and bussacas nodules keratic precipitates aqueous flare muddy iris post synechiae ``` Inflammation of the iris and pars plicata due to infection or autoimmune or allery systemic, granulomatous or non granulomatous
47
complications of iridocyclitis
``` complicated cataract secondary glauco ma (divided into early and late) band shaped keratopathy choroiditis retinitis retinal damages papillitis phthysis bulbi (3 stages) ```
48
stages of phythisis bulbi
atropic changes without shrinkage atrophy with skrinkage with collapse of structures
49
what are the drugs used to treat iridocylclitis?
``` cycloplegic drugs steriods antibiotics broad spectrum systemic steriods immunosuppressants NSAIDS ```
50
what does cycloplegis do in iridocyclitis? and an eg of it?
``` they reduse spasm increase circulation inc circulating antibiotics decrease load of ant ciliary vessels prevent synechiea break formed synechiae ```
51
why use NSAIDs and immunosuppresives?
use of nsaids when the steriods are contraindicated and | immunosuppresives to use when steroids dont work
52
which kind of iridocyclitis is best treated with steroids?
non granulomatous iridocyclitis!
53
physical measures used in iridocyclitis
dark goggles | hot fermentation
54
complication treatment in iridocyclitis
``` glaucoma during infection - 0.5% timolol no infection - peripheral iridectomy phythisis - enucleation cataract - pciol CONTRAINDICATIO IS FRESH KPs retinal detachments - vitrectomy ```
55
what is sarcoidosis?
its a multi systemic disease which is granulomatous in nature
56
what are the systems affected by it?
pulmonary ocular lesions hilar lymph node enlargement skin lesions
57
how many patients with sarcoidosis present with ocular manifeatations ?
20-50%
58
what is the type of granuloma found in sarcoidosis?
macrophages | its an epitheloid cell granuloma
59
what are the structures affected in sarcododis ocular manifestations?
conjuctiva ant uvea and lacrimal glands
60
types os sarcoidal uvea found?
anterior sarcoidal intermediate and posteior sarcoidal
61
what happens in ant uveal sarcoidal lesion?
``` ant uveitis ~ aueous flare, aqueous cells, iris nodules, mutton fat kps, post synechiae ```
62
what is the kind of kPs found in sarcoidosis?
mutton chop, cause it is a granulomatous type of iridocyclitis
63
what are the structures affected in intermediate type of sarcoidal uveitis?
viterous
64
characteristics of sarcoidal intermediate uveitis
vitrous cells snowball opacities snow banking
65
structures affected in posterior sarcoidal uveitis?
retina and choroid
66
charateristics of post sarcoidal uveitis?
1. chorodal and retinal granulomas 2. cystoid macular edema 3. periphlebitis retinae 4. CANDLE WAX APPEARANCE ^ 5. punched out atrophies
67
what is HEERFORDT'S SYNDROME?
UVEioparotid fever - 1. bilat panuveitis 2. painful enlarged parotids 3. skin rashes 4. fever 5. malaise
68
complications of sarcoidal uveitis?
complicated cataract inflammatory glaucoma cyatoid macular edema
69
other ocular lesions of sarcoidosis?
conjuctival - sarcoidal nodules, keratoconjuctivitis sicca | lacrimal glands - enlargements
70
what is MICKULICZ'S syndrome?
lacrimal swell with salivary gland swell in sarcoidosis
71
how is sarcoidal uveitis diagnosed?
KVEIMS test- positive abnorm chest x ray serum angiotensin converting enzyme increased
72
confirmation of sarcoidosis?
histology of biopsy from conjuctival nodules skinn and lymph nodes
73
treat sarcoidal ocular disease
``` usual as iridocyclitis steriods cycloplegics immunosuppresives NSAIDS dark goggles hot fermentation and complication treatment ```
74
what is FUCH'S uveitis syndrome?
non granulomatous low grade ant uveitis early cataract unilat and middle aged people
75
is FUCH'S unilat or bilat?
unilateral
76
clinical features of fuch's uveitis syndrome
``` MOTH EATEN IRIS - diffuse stromal atrophy HETEROCHROMIA IRIS FINE STELLATE KPs faint aqueous flare no post synechiae rubeosis iridis angle of ant neovascularization BUT EARLY DEVELOPMENT OF CATARACT AND 2* GLAUCOMA ```
77
WHAT IS NOT USED IN THE TREATMENT OF FUCHS AND WHY?
CYCLOPLEGICS NOT USED CAUSE NO POST.SYNECHIAE
78
TREATMENT OF FUCHS
ONLY STEROIDS
79
WHAT IS posner schlossman syndrome?
granulomatocyclitic crisis Recurrent acute unilat increase in IOP (40 - 50 mmHg) no post.synechiae no shallow ant. chamber edeoma of cornea fine keratic precipitates in the post cornea dilated pupil
80
C.F OF posner schlossman syndrome ?
``` recurrent unilar acute inc. in IOP no shallow ant chamber no post synechiae dil pupil WHITE EYE epitheloid edema of corne post cornea has FINE kps ```
81
which age group is affected by poshner schlossman syndrome? | what is the common antigen thats positive?
YA | HLA BW54
82
TREATMENT OF POSHNER SCHLOSSMAN?
ANTIGLAUCOMA FOR REDUCING IOP | STEROIDS SHORT COURSE
83
what is episclera?
episclera is the outter vasular cover of sclera proper , it has macrophages and lymphocytes
84
what is the tenons capsule?
its a capsule covering the sclera (actually the episclera) | {and i think its only in the posterior part}
85
what is episcleritis?
inflammation of episclera + tenons capsule over it benign recurrent
86
who are more susceptable ?
women and ya age group (women) get it?
87
what are the causes of (eitiology) of episcleritis?
1. idiopathis 2. systemic disease association - gout,psoriasis,rosacea,conn tissue disorder 3. allergic - tubercular toxin(endogenous) 4. infectious- herpes,syphiilis,lymes,TB
88
PATHOLOGY OF EPISCLERITIS? | WHAT DOES IT CAUSE?
Localised lymphoid aggregate of episcleral tissue | EDEMA CONGESTION - CONJUCTIVA AND TENONS
89
SYMPTOMS OF EPISCLERITIS?
1. redness 2. mild discomfort- GRITTY, 3. burning and/or foreign body sensation 4. nild photophobia or lacrimation maybe NO DISCOMFORT AT ALL
90
SIGNS OF EPISCLERITIS? | 2 clinical types of it?
nodular and simple simple - sectorial (mosre common) or diffuse - engorged episc vessles big and radial under conjuctiva nodular - pink or purple - around which injection present 2-3mm away from limbus -firm and tender nodule - moves seperately without sclera or conjuctiva
91
course of episcleritis?
self limiting but recurrent . | lasts 10 days to 3Ws.
92
DD of episcleritis?
simple- conjuctivitis | nodular- pinguecula , foreign body swell and nodule,scleritis
93
treatment of episcleritis
``` NSAIDS STEROIDS mild ARTIFICIAL TEARS COLD COMPRESSION SYSTEMIC NSAIDS ```
94
WHAT IS SCLERITIS? | WHAT IS SCLERA MADE OF?
INFLAMMATION OF SCLERA PROPER | ITS MADE OF CONNECTIVE TISSUE AND ITS AVASCULAR LAYER
95
GIVE SOME SPECIFICATIONS ABOUT SCLERITIS
``` # MOSTLY IN ELDERLY #FEMALES #LESS COMMON INCIDENCE THAN EPISCLERITIS #BUT- Can lead to vision or total eye loss if not treated properly #MOSTLY (50%) RELATED TO SYSTEMIC CONNECTIVE TISSUE DISORDERS ```
96
WHAT ARE 50% OF SCLERITIS ASSOCIATED WITH?
WITH SYSTEMIC CONNECTIVE TISSUE DISORDER
97
EITIOLOGY OF SCLERITIS
1. AUTOIMMUNE- SLE, ankylosis spondylosis,RhA 2. INFECTIOS- ch stap and strep, herpes 3. GRANULOMATOUS DISEASE- tb , leprosy , sarcoidosis 4. IDIOPATHIC 5. POST SURGERY 6. METABOLIC DISORDERS - thyrotoxicosis , gout 7. MISCELLANIOUS -bachets diseae, rosacea , chemical burns , irradiation
98
what is the pathology of scleritis?
that of granulomatous disease polymorphonuclear cells , macrophages , lymphocytes , plasma cells, - inside surrounded by - multinucleated epitheloid giant cell , new vessels vasculitis
99
classify scleritis
auto immune and infectious autoimmune - anterior and posterior non necrotising necrotising
100
symptoms of scleritis
no or mild photophobia and lacrimation moderate to severe pain redness - local or diffuse vision may reduce
101
explain the character of pain in scleritis
deep and boring character worse in morning and wakes up patient in the mornings radiate to jaw and temple

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