- submucosal conjunctival elevation d/t actinic damage - fibrovascular tissue that encroaches onto the cornea - does not cross pupillary axis - does not affect vision (mild astigmatism)

- basal keratinocytes w/ increased melanin - melanocytes are in normal numbers, but enlarged

The Eye Flashcards by Leah Ritter

What is Graves Orbitopathy?

–thyroid disease (Graves) is the most common cause of U/L or B/L exophthalmos

–enlarged extraocular muscles w/ non-granulomatous inflammation (tendons are spared)

–increased glycosaminoglycans and endomysial fibers

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What are two complications of Graves Orbitopathy?

visual loss d/t compression of the optic nerve

- corneal complications d/t exposure

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How does Sarcoidosis affect the eye?

granulomatous uveitis
sympathetic ophthalmia (spared eye injury)
“mutton fat” keratic precipitate on anterior segment
“candle wax drippings” (retinal perivascular inflammation)

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How does Basal Cell Carcinoma affect the eye?

-most common malignant periocular tumor of the skin
-younger patients, sun-exposed skin (lower eyelid)
-pearly nodules, telangiectatic vessels, central ulcer

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What is seen on histology of Basal Cell Carcinoma?

basaloid cell nests, w/ peripheral palisading of nuclei
“blue” and “below” large masses below epidermis

-morpheaform: cords/tendrils of tumor cells embedded in fibrotic stroma; widely and deeply infiltrative

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What is seen on histology of Squamous Cell Carcinoma?

-keratin pearls

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What is Sebaceous Carcinoma?

common as SCC of eyelid in Asian women >40yrs
“Masquerade Syndrome”
-U/L keratoconjunctivitis unresponsive to therapy
can metastasize to regional LN’s, lung, liver, brain
15% mortality

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What is seen on histology of Sebaceous Carcinoma?

intraepithelial spread of tumor cells (Pagetoid)
larger nuclei, hyperchromatic, greater pleiomorphism
neoplastic cells w/ foamy cytoplasm
central necrosis
-Oil Red O fat stain on frozen tissue
-positive Epithelial Membrane Ag (EMA)
-positive BRST-1, P-16

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What is a pinguecula?

-thin epithelium (hyperplastic or dysplastic) w/ fragmented stromal collagen and BASOPHILIC degeneration d/t actinic damage from sun exposure

small, yellowish submucosal conjunctival elevation
does NOT invade the cornea

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What is a pterygium?

submucosal conjunctival elevation d/t actinic damage
fibrovascular tissue that encroaches onto the cornea
does not cross pupillary axis
does not affect vision (mild astigmatism)

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What is a freckle?

basal keratinocytes w/ increased melanin

- melanocytes are in normal numbers, but enlarged

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What is a lentigo?

-linear (non-nested) melanocyte hyperplasia restricted to the basal cell layer

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What is a nevus?

melanocytes are rounded and grow into “nests”
cells are uniform w/ a round nucleus, inconspicuous nuclei and little to no mitotic activity

Junctional Nevus: epidermal nests along dermo-epidermal junction

Compound Nevus: junctional nevus that grows into the underlying dermis as nests or cords

Intradermal Nevus: epidermal nests are lost completely

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What is the difference between superficial nevus cells and deep nevus cells?

superficial nevus cells are immature, larger, produce melanin and grow in nests
deeper nevus cells are more mature, in the basal layer, smaller, produce little to no pigment, and grow in cords

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What is the most common primary intraocular tumor in adults?

uveal melanoma (comprises 5% of melanomas)

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What is the most common intraocular tumor in adults?

-cutaneous melanoma that has metastasized to the eye

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True or False: uveal melanoma, like cutaneous melanoma, is linked to ultraviolet light exposure.

False; there is no clear link b/w UV light and uveal melanoma.

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What is the most common primary intraocular tumor in adults?

uveal melanoma (account for 5% of all melanomas)

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What two oncogenes are associated with uveal melanoma?

GNAQ and GNA11

code GPCR’s
-gain-of-function mutation found in 85%

Note: uveal nevi also have mutations in GNAQ and GNA11, but rarely transform into melanoma

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To what organ does uveal melanoma first spread?

liver

-spread almost exclusively by a hematogenous route

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What two types of cells comprise uveal melanomas and which has a more adverse outcome?

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-spindle cell and epithelioid cells

–epithelioid cells have more atypia and worse outcome

Discuss the two treatments for uveal melanoma and which is preferred.

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–there is no difference in survivability between melanomas treated w/ enucleation vs. eye-sparing radiotherapy (preferred)

How does the structure of the cornea affect corneal transplants?

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corneal stroma lacks blood vessels and lymphatics

- -lack of rejection

What happens in non-immunological graft rejection of a cornea?

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-loss of endothelial cells and corneal edema

What are common bacterial infections of the eye?

- S. aureus, Strep pneumo, Pseudomonas, Enterobacter - -PMN infiltrates and necrotic debris (can do a Gram stain, but culture is more accurate)

Describe Herpes Simplex Virus Keratitis, in regards to the eye?

Dendrite: linear arborizing pattern of opacification and swelling of epithelial cells Cowdry Bodies (intranuclear inclusions) seen on Giemsa stain infected cells can coalesce into multinucleated giant cells

What is the hallmark pathology of chronic herpes simplex keratitis?

- granulomatous rxn at Descemet Membrane (full thickness involvement) - chronic stromal keratitis leads to ulceration and scarring

What is a cataract?

- lenticular opacity | - congenital or acquired

What are risk factors for cataracts?

- DM - Wilson Dz - atopic dermatitis - corticosteroids - radiation - trauma

What causes age-related cataracts?

-opacification of the lens nucleus (nuclear sclerosis)

What causes a posterior subcapsular cataract?

-migration of the lens epithelium posterior to the lens equator d/t enlargement of abnormally-positioned lens epithelium

What is a Morgagnian (hypermature) cataract?

-liquefication of lens cortex --high-molecular-weight proteins may leak through the lens capsule (phacolysis) and clog the trabecular meshwork causing secondary open-angle glaucoma

What causes most cases of glaucoma?

-increased intraocular pressure | normal or low-tension glaucoma DO exist, however

What is open-angle glaucoma?

-complete open access to trabecular meshwork, but increased resistance to aqueous outflow, creating increased intraocular pressure Primary Open-Angle: most common form -MYOC gene mutations (sometimes OPTN gene) Secondary Open-Angle: - pseudoexfoliation (LOX1 gene) - -deposition of fibrillary material through anterior segment

What is angle-closure glaucoma?

peripheral zone of iris adheres to the trabecular meshwork and physically impedes the aqueous humor from draining

What are risk factors for glaucoma?

- race (AA and Hisp) - family Hx - DM, HTN - trauma - corticosteroids - eye abnormalities

What is the leading cause of blindness in people aged 20-64?

diabetic retinopathy

How does diabetes lead to blindness in diabetic retinopathy?

-primary changes in the retinal microcirculation

What is the treatment for diabetic retinopathy?

Laser Photocoagulation Tx - variable destruction of outer retina - destruction of retinal pigmented epithelium - occlusion of choriocapillaris - healing by proliferation of adjacent RPE, glial scarring

What is the leading cause of blindness in the US?

age-related macular degeneration --choroidal neovascularization (presence of angiogenic vessels originating from the choriocapillaris)

What is the most common intraocular malignancy in children?

-retinoblastoma | cell of origin in a neuronal progenitor

What is the genetic cause of retinoblastoma?

- germline mutation in RB allele and a subsequent somatic mutation in the other RB allele in a retinal progenitor (germline mutation often B/L phenotype) - 13q14 (long arm of chromosome 13)

What are the most common symptoms of retinoblastoma?

- leukocoria (white pupillary reflex) - strabismus (abnormal eye alignment) - ocular inflammation

How might a retinoblastoma affect the iris?

-cells shed into the anterior chamber, aggregate and form nodules on the iris, or they may settle inferiorly to form a pseudohypopyon

Where does retinoblastoma tend to metastasize?

- skull, brain, and spinal cord - bone marrow - LN's - abdominal viscera -most commonly escaping via the optic N. (poor prognosis)

What is the histology of retinoblastoma?

- -round, oval, or spindle-shaped hyperchromatic nuclei - -high mitotic rate - -scant cytoplasm - -necrosis w/ calcification - -perivascular cuffs of tumor cells

What is Flexner-Wintersteiner, a characteristic feature of retinoblastoma?

-single row of eosinophilic columnar cells w/ peripherally-oriented nuclei surrounding central lumen lined by refractile structure (external limiting membrane)

What is Homer Wright in regards to histology of retinoblastoma?

- less common that Flexner-Wintersteiner | - lumen filled w/ tangle of eosinophilic cytoplasmic processes

What is fleurette in regards to histology of retinoblastoma?

-curvilinear clusters of cells composed of rod and cone inner segments, often attached to abortive outer segments

What is papilledema?

-edema of the head of the optic N. that develops as a result of compression of the nerve ``` Increased intracranial pressure --B/L disc edema --not associated with vision loss --optic N. is swollen and hyperemic (while it's pale in anterior ischemic optic neuropathy) ``` Neoplasms --U/L disc edema

The Eye Flashcards

(50 cards)