Uveal Tract

Question 1

Pathology of malignant melanoma of choroid

Answer 1

Arises from existing naevus or denovo

1. Circumscribed(pedunculated) tumour
   - flat, grey which becomes raised and pigmented
   - further growth produces retinal detachment
2. Diffused(flat):spreads slowly without forming tumour mass
   - in this symptoms occurs late

Question 2

Histopathology of malignant melanoma of choroid

Answer 2

1. Spindle cell- good prognosis
   - spindle shaped cells
2. epitheliod-large round or oval cells
   - worst prognosis
3. mixed cell- contain both cell type
   - intermediate prognosis
4. necrotic - cell type is unrecognisable

Question 3

Quiescent stage of malignant melanoma of choroid

Answer 3

Symptoms- depends on location and size of tumour

Sign-
1-small tumour appear as elevated pigmented oval mass
-appearance of orange patch due to lipofuscin is pathagonomic sign
2-tumour penetrates through bruch membrane and leads to retinal detachment
-ribbon like wide vessels are seen coursing over tumour surface area

Question 4

Glaucomatousstage of malignant melanoma of choroid

Answer 4

Develops when left untreated in quienscent stage
Glaucoma develops
Symptoms-pain redness and watering in blind eye

Sign-conjunctiva- congestion abd edema
Cornea-edema
Anterior chamber- shallow
Pupils-fixed and dilated
Lens-opaque
Intraocular pressure-raised

Question 5

Stage of extra ocular extensions of malignant melanoma of choroid

Answer 5

Through rupture of sclera at limbus

Question 6

Stage of distant metastasis of malignant melanoma of choroid

Answer 6

Lymphatic metastasis not known

Blood metastasis-mainly & commonly to liver and is cause of death

Question 7

Differential diagnosis of malignant melanoma of choroid

Answer 7

1should be differentiated from other glaucoma

2. naevus,melanocytoma & hyperplasia of pigment epithelium
3. should be differentiated form other causes of retinal detachment

Question 8

Investigations in malignant melanoma of choroid

Answer 8

1indirect opthalmoscopy examination

2. transillumination test
3. ultrasonography
4. fluorescein angiography
5. radioactive tracer
6. MRI

Question 9

Treatment of malignant melanoma of choroid

Answer 9

Conservative treatment

• brachytherapy using iodine 125 or cobalt 60
• external beam radiotherapy protons and helium ions
• transpupillary thermotherapy with diode laser

Enucleation

Debulking

Palliative treatment with chemotherapy and immunotherapy
-trans scleral resection
Stereotatic radiosurgery

Question 10

Evisceration

Answer 10

Removal of content of eyeball-leaving behind sclera

Question 11

Indications pf evisceration

Answer 11

1 panopthamitis
2 expulsive choroidal haemorrhage
3 bleeding anterior staphyloma

Question 12

Surgical steps of evisceration

Answer 12

1Separation if conjunctiva and tenons capsule -conjunctiva is incised all around limbus with spring scissor

• tenons capsule and conjunctiva undermining is done with blunt tipped curved scissor
  2. Removal of cornea-cut at limbus is made with help of razor blade and then cornea is excised with corneao scleral scissor
  3. Removal of intraocular content-uveal tissue is separated from sclera with evisceration spatula and content is scooped out using evisceration curette
  4. Separation of extra-ocular muscle-is done same as enucleation
  5. Removal of sclera -using curved scissor,oly 3 mm frill is left around optic nerve
  6. Closure of tenons capsule and conjunctiva-same as enucleation

Question 13

Panopthamitis

Answer 13

It is an intense purulent inflammation of whole eyeball including tenons capsule

Disease usually begins as purlent anterior or posterior uveitis and soon develops into panopthamitis

Question 14

Aetiology of panopthamitis

Answer 14

It is an acute bacterial infection 
Same as infective bacterial endopthalmitis
1. Exogenous infection 
2. Endogenous infection 
3. Secondary infection

Question 15

Symptoms of panopthalmitis

Answer 15

Redness 
Swelling 
Pain
Lacrimation
Headache 
Complete loss of vision 
Purulent discharge
And associated fever and malaise

Question 16

Signs of panopthalmitis

Answer 16

Lid- oedema and hyperaemia 
Eyeball-proptosed,ocular movement are limited and painfull
Conjunctiva-congestion and chemosis
Cornea-cloudy and edematous
Anterior chamber is full of pus
Vision- completely lost
Intraocular pressure-raised

Question 17

Complications of panopthalmitis

Answer 17

1 orbital cellulitis
2 cavernous sinus thrombosis
3. Meningitis
4. Encephalitis

Question 18

Treatment of panopthalmitis

Answer 18

Anti-inflammatory and analgesic- to relive pain

Broad spectrumantibiotic-to preventspread of infection

Evisceration should be performed - to avoid spread of infection intracranially

Question 19

Toxic anterior segment syndrome

Answer 19

Postoperative sterile endopthalmitis is confined mainly to anterior segment of eyeball

Question 20

Masquerade syndrome

Answer 20

Intraocular tumour necrosis may present as sterile endopthalmitis

Question 21

Endopthalmitis

Answer 21

Inflammation of inner structures of eyeball i.e. Uveal tissue and retinae

Question 22

Infective endopthalmitis

Answer 22

1. Exogenous-infection fallowing perforating injury,corneal ulcer or post operatively
2. endogeneous-spread through blood from caries of teeth & generalised septicaemia
3. Secondary-orbital cellulitis, thrombophlebitis,corneal ulcers(infected)

Question 23

Non-infective endopthalmitis

Answer 23

Postoperative-toxic reaction to chemicals of intruments or lens

Post traumatic- due to retention of metal of foreign body

Phacoanaphylactic- in morgagnian cataract patient

Intraocular tumour necrosis

Question 24

Symptoms of endopthalmitis

Answer 24

Pain 
Photophobia
Lacrimation
Redness 
Loss of vision

Question 25

Sign of endopthalmitis

Answer 25

Lid-congestion and oedema Conjunctiva-chemosis & congestion Cornea- cloudy and oedematous Anterior chamber- pus filled Iris- when visible is edematous and muddy Pupils-shows yellow reflex Intraocular pressure-raised intially but later falls because of perforation

Question 26

Treatment of endopthalmitis

Answer 26

1 antibiotics therapy 2 steroid therapy 3 supportive therapy 4 vitrectomy

Question 27

Anatomical classification of uveitis

Answer 27

Anterior Intermediate Posterior Panuveitis

Question 28

Clinical classification of uveitis

Answer 28

Acute and chronic

Question 29

Pathological classification of uveitis

Answer 29

1.suppurative 2. Non suppurative •non granulomatous •granulomatous

Question 30

Etiological classification of uveitis

Answer 30

``` Infective Immune related Toxic Traumatic Non infective system Idiopathic ```

Question 31

Infective uveitis

Answer 31

1 exogeneous 2 endogenous 3 secondary

Question 32

Immune related uveitis

Answer 32

``` Microbial allergy 2 anaphylactic uveitis 3 atopic uveitis 4 autoimmune uveitis 5 HLA associated uveitis ```

Question 33

Toxic uveitis

Answer 33

1 endotoxins 2 exogeneous toxin 3 endoocular toxin

Question 34

Traumatic uveitis

Answer 34

``` 1 mechanical trauma 2 burn 3 chemical 4 sympathetic opthalmia 5 intraocular haemorrhage ```

Question 35

Non infective systemic diseases

Answer 35

``` Sarcoidosis Polyarteritis nodosa SLE DLE rheumatic fever gout Psoriasis Lichen planus Pemphigus ```

Question 36

Idiopathic uveitis

Answer 36

Specific | Non specific

Question 37

Symptoms of uveitis

Answer 37

``` 1 pain 2 redness 3 photophobia 4 lacrimation 5 defective vision 6 blepharospasm ```

Question 38

Malignant melanoma of choroid

Answer 38

Most common primary intraocular tumkr of adults Seen in 40-70 years of age Common in whites than blacks Arises from neural crest derived pigment cells Usually it is unilateral