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Path - Eye

QuestionAnswer
What is a chalazion? A GRANULOMATOUS inflammation around the meibomian glands or the glands of zeis. Forms as a reaction to extruded lipid secretions... resulting in PAINLESS swelling of the eyelid. Has a hailstone like appearance
Painless swelling of the eyelid. Likely dx? Chalazion (meibomian gland / glands of zeis inflammation). If it is recurrent or does not resolve / respond to abx: it should be evadeluated to determine if it is a sebaceous carcinoma
Describe histological appearance of a chalazion? Lipid pool surrounded by epitheliod histocytes and multinucleated giant cells.
What is a hordeolum? A sty. acute supparation (usually staph.) of sebacious glands. 2 forms: 1) acute folliculitis of glands of moll or seiz (EXTERNAL!!) 2) inflammation of meibomian glands: internal
What is the leading cause of blindness worldwide? Trachoma (Chlamydial, chronic, contagious, conjunctivitis.) Due to chlamydia serotypes A B and C
What serotype of chlamydia causes conjunctivitis/ blindness? A, B, and C.
What are leber cells... what disease are they asso with? Leber cells are large cellular debris-laden mphages containing nuclear fragments. They are pathomnemonic for trachoma (chlmaydia serotype A,B, or C mediated conjunctivitis)
What is the PE finding of trachoma? Trachoma = chlamydia serotype A-C conjunctivitis. The key PE finding is white patches bilaterally found upon eversion of the eyelid
How does trachoma cause blindness? The stage of trachoma in which blindness occur. In this stage the cornea is invaded by blood vessels and fibroblasts. This stage is called What is trachomatis pannus?
What is What is trachomatis pannus? The stage of trachoma in which blindness occur. In this stage the cornea is invaded by blood vessels and fibroblasts.
What is trichiasis? not to be confused with Trachoma (but it is caused by trachoma) (chlamydial conjunctivitis), it is the inversion of the eyelashes due to scarring of the palpebral conjunctiva, leading to corneal scratching.
Under what conditions is trachroma transmitted? Overcrowding/poor hygeine. tx'd by fingers, fomites (material on tables), and flies. Immigrants used to be examied for this at ellis island
Pathonemonic for trachoma (histolgical finding): lieber cells. cellular debris laden macrophages that form when macrophages consume the remnants of cells that have bursted to realease elementary bodies.
Describe how blindness occurs with trachoma. Scarring of the palpebral conjunctiva leads to inversion of the eyelashes, which causes corneal scratching and then progresses over time to severe scarring. The scarring leads to opacification and blindness.
What is trichiasis? Inversion of eyelashes due to palpebral conjuctival scarring, which leads to scratching and opcification of the cornea.
What is pinguecula? What causes it? Proliferation of the subepithelial support of the conjuctiva (***ACTINIC ELASTOSIS***) , yielding a yellow discoloration (DOES NOT INDICATE A FAT DEPOSITION, but instead, a small area of yellow thickening). Occurs as a result of sun damage. NO BLINDNESS
Actinic elastosis is the pathological process of what eye pathology? pinguecla.
What is pterygium? What causes it? "the bad cousin of pinguecula." Benign growth of the conjuctiva on the nasal side of the sclera as a result of ELASTOTIC DEGEN OF COLLAGEN AND *FIBROVASCULAR PROLIFERATION* (NEW VESSELS). Caused by UV exposure CAUSES BLINDNESS B/C IT ENTERS THE CORNEA.
Pinguecula vs pterygium? Pinguecula is an actinic elastosis leading to subepi prolif yielding a yellow discoloration nasally due to sun damage. does not encroach the corneum and is rarely excised. Pterygium: *fibrovascular prolif* and *elastoic degen* that causes blindness)
**WHAT ARE THE 5 LAYERS OF THE CORNEA? 1) Epithelium, 2) Bowman's (anterior limiting) membrane, 3) stroma, 4) descemet's (post. limiting membrane) 5) endothelium ***KNOW THIS***
What viral eye infection is characterized by corneal ulceration? Secondary (reinfection) of herpes. Primary herpes infection do not cause this. Key finding is DENDRITIC ULCERS of the cornea on slit lamp examinations
Dendritic ulcers of the cornea indicates: Herpetic keratosis. (deep ulceration of the cornea due to secondary herpes infxon)
**What is Fuch's Endothelial Dystrophy** ? What is the presentation? Who is most commonly affect? Mutation of type 8 collagen in the corneal endothelium leading to ENDOTHELIAL DYSTROPHY AND FORMATION OF GUTTAE (drops) IN THE DESCEMET membrane (endothelial surface).
guttae on descemet's membrane is indicative of what disease? FUCH'S ENDOTHELIAL DYSTROPHY!! Also will show endothelial atrophy.
What is keratoconus? a congenital ectasia of the central cornea that manifests in FIRST DECADE OF LIFE. Thinning of epithelium and stroma leads to a cone shaped cornea / loss of visual acuity. Mayl lead to rupture of descemet's membrane.
What is the driving force of cataracts? degeneration of cryallins (transparent proteins of the lens) leading to the lens becoming opaque. The degenerated lens material can lead to clocgging of the trabecular meshwork SECONDARY OPEN ANGLE GLAUCOMA.
What is an important complication associated with cataracts (aside from loss of vision) secondary open angle glaucoma due to clogging of trabecular meshwork due to degenerated lens material
Where in the lens are senile cataracts? Anterior capsular (Remember: *a*nterior = *A*ge related
What is the uvea? Collective name for the iris, ciliary body, and choroid (iris is diaphragm for light, ciliary body suspends / flexes the lens and makes aqueous humor, choroid nourishes the outer retina)
Where is aqueous humor made? ciliary body.
What is a keratic precipitate? exudates in the aqueous seen in IRITIS (anterior uveitis)
What is iritis inflammation of the anterior uveal tract (iris). 70% are idiopathic. ***Others are immune mediated (sarcoidosis, akylosis spondylitism IBS, reiters, psoritatic arthritis, RA)***
Key findings (2) of anterior uveitis (iritis) keratic precipitates on the back of the cornea (floats to the bottom of the cornea and float in the aq humor) and **congestion of the ciliary blood vessels near the cornea**
Describe the pathophysiology of central retinal artery occlusions (CRAO) (3) Can be caused by: 1)Stenosis secondary to atherosclerosis, 2) emboli 2ry to cardiac abnormalities, 3)thrombosis 2ry to primary disease of the blood vessel (giant cell (temporal) arteritis). MOST COMMONLY OCCUR AT THE LIMINA CRIBROSA
What is the cause of cotton-wool patches seen on fundoscopic exam? Aggregates of swollen axons that form due to degenerated mitochondria and dense bodies in lysosomes caused by IMPAIRED BLOOD FLOW TO THE AXONS (central retinal artery occlusion)
What is the cause of pallor observed on retina during fundoscopy? intracellular edema of the ganglion layer of the macula due to central retinal artery occlusion
what is the cause of a cherry red spot observed on retina during fundoscopy? Ischemia thinning of the fovea due to central retinal artery occlusion leads to transluceny, The red spot is the choroidal vessels below the thinning retina, which are still perfused. (this blood did not come through the lamina cribrosa
WHat is amaurosis fugax? small retinal emboli leading to transient unilateral blurred vision which only last for a few minutes.
Major risk factors for central retinal VEIN occlusion? diabetes and HTN
WHat is the fundoscopic presentation of central retinal vein occlusion flame hemorrhages,swelling and edema
How does central retinal VEIN occlusion lead to ischemia The occlusion causes hemorrhaging and inefficient delivery / exchange of blood. Hemorrhageic infarct and ischemia.
A central retinal artery occlusion will appear (Pale or red?) while a central retinal vein occlusion will appear (pale or red?) central retinal artery = pale. Central retinal vein = red.
What is retinitis pigmentosa? What is the etiology? KEy symptoms a variety of BILATERAL progressive, DEGENERATIVE retinopathies characterized clinically by NIGHT BLINDNESS and TUNNEL VISION due to DEATH OF PHOTORECEPTORS IN THE ORDER OF RODS to CONES (sensory layer becomes pigmented layer due to pigmentmoving in
Degenerative retinopathy featuring night blindness and retinopathy? retinitis pigmentosa
Describe key features of age-related macular degeneration (ARMD) progressive loss of CENTRAL VISION vaused by **degenerative and neovascular** changes in the macula. Early ARMD (dry type): protein lipid masses (drusen) in the choroid beneath RPE WITH NO LOSS OF VISUAL ACUITY. Late ARMD (wet): Atrophy RPE
What are the two stages of ARMD (age related macular degeneration Early ARMD (dry type): protein lipid masses (drusen) in the choroid beneath RPE WITH NO LOSS OF VISUAL ACUITY. Late ARMD (wet): Atrophy RPE and GROWTH OF NEW BLOOD VESSELS.
WHat are drussen? Protein/lipid masses that form in the choroid beneath the RPE in Age related macular degeneration
A Dischiform scar found on fundoscopic examination is a manifestation of what disease? LATE STAGE (wet) Age related macular degeneration. This is formed due to RPE fibrous metaplasia in this disease
Describe the fundoscopic presentation of early and late stage age related macular degeneration Early (dry stage) Drusen ( fat/protein deposits on retina). Late stage: Dischiform scar that occurs due to RPE fibrous proliferation
Contrast and open angle glaucoma from a closed angle glaucoma with regards to site of blockage: Open angle: Blockage of the trabecular meshwork. Closed angle: Shallowing of ANTERIOR CHAMBER (closure of angle between iris and cornea) leading to blockage of schlemm's canal (glaucoma worstened with darkness (((Pupil dilation worstens condition)
Pt has glaucoma that worstens with darkness... what type glaucoma? Acute attack of primary CLOSED angle glaucoma. The pupil dilation causes the iris to obstruct the pupil.
What is the role of the trabecular meshwork acts as "the holes of the drain" that lead into the canal of schlemm. They are located after the iridocorneal angle.
What is the most common PRIMARY malignancy of the eye in adults ? uveal malignant melanoma. (most COMMONLY OCCURS IN THE CHOROID!!) (also note: the most common eye malignancy overall is a metastatic neoplasm)
Describe the key features of uveal malignant melanoma Arises from melanocytes in any part of the eye with choroid being the most common site
What are the two types of uveal malignant melanomas and their prognosis? 1) Spindle cell melanomas. GOOD PROGNOSIS (90% 10 year survival if excised completely). These cells show little pleomorphism and few mitoses. 2) epithelioid melanomas: Large cells WITH PLEOMORPHISM and many mitoses. 35% 10 yr survival.
Excised orbital melanomas are often associated with: late manifestation RECURRENCE of metastatic disease.
What is the lamina cribrosa? the entry point of blood vessels into the optic disc. It is the most common site of thrombosis/occlusion in central retinal artery/vein occlusion
Orbital invasion is a feature of what type of uveal malignant melanoma? Epitheloid. Metastatic recurrence is commonly observed phenomenon following excision of these tumors.
Created by: Semester4