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42 Cards in this Set
- Front
- Back
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subconjuctival blood from breaking of small capillaries. Caused by numerous factors including: hypertension, bleeding disorders, valsalva, trauma, aspirin overuse, some forms of conjunctivitis, or idiopathic (most common). Similar to a bruise under the skin.
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Sunconjunctival hemorrage
Tx: none |
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raised broad-based conjunctival vascular mass; benign. More commonly seen in inner canthus or fornix. Usually congential, or first appear in young years, and may enlarge with age. The only concern is cosmesis
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Capillary hemangioma
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bright red or purple masses and hemorrhages. Tumor of endothelial origin. Associated with AIDS. Probable herpes virus associated. If mucus membranes are involved in this tumor, usually implies a later manifestation of AIDS.
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Kaposi's Sarcoma
Tx: topical IFN a2b with or without IFN injection |
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Light pink to salmon colored lesions. May be benign (benign reactive lymphoid hyperplasia) or malignant (lymphoma). May appear in bulbar conjunctiva as fleshy gelatinous mass. Proliferation of the MALT tissue from palpebral conj onto bulbar
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Lymphoid tumor
Tx: MUST excise and biopsy for possible malignancy |
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small white to yellow calcium deposits usually 1-3 mm in size. May be seen in upper and lower palpebral conj. Pt is usually asymptomatic, but may cause irritation. May be single or multiple. Usually due to high levels of serum calcium that can be sue to PTH problems.
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Concretions (lithiasis)
Tx: none unless pt is experiencing irritation then cut and remove |
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Fluid-filled cysts, usually clear, seen everywhere in conj. May be filled with lymphatic fluid or with secretions from gland of Krause or Wolfring. Usually asymptomatic. Usually refill when drained.
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Retention cysts
Tx; none; if pts is highly symptomatic and the cysts are recurrent after drainage then you can surgically excise |
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Hyperplasia (overgrowth) of conj tissue, probably in response to some environmental irritation. Usually seen on sun-exposed areas of bulbar conj. May become inflamed. Usually asymptomatic but occasionally a cosmetic concern. May cause corneal dellen (area of non-wetting on cornea b/c interrupts normal blinking/wetting from lid). Looks like chicken fat.
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Pinguecula
Tx: AT, decongestant |
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- Basophilic degeneration of bulbar conj stroma which invades the cornea. Most are seen nasally. Triangular or wedge-shaped fleshy mass with the apex pointing toward the center of the cornea. Usually see an iron line preceding growth pattern (Stocker’s line). Often they become inflamed or irritated.
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Pterygium-
Tx: if irritated—AT, decongestant. Surgically excise if w/I 2 mm of ambient light pupil but will probably recur. Conjunctival sliding flap is best option. |
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Congenital tumors from mesoderm and ectoderm. Primarily composed of collagen. Raised circumscribed white to pale yellow lesions, usually located in inferior temporal limbal area. May have hair associated with the lesion. May involve the cornea, conj, and sclera (dual origin of mesoderm and ectoderm).
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Dermoid cysts
Tx: none, but excise if cosmesis is a problem |
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Blue to black ciliary nerve loops on sclera surface usually seen near limbus. Generally no symptoms. An anatomical variation only. Little black ring with blood vessel or nerve in the center. Pigment proliferation due to vessels or nerves perforating layers of sclera.
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Axenfeld loops
Tx: none |
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Black cell-circumscribed pigment lesions as a result of epinephrine or propine therapy (epinephrine is in the metabolic pathway of melanin)
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Adenochrome deposits
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Congenital subepithelial melanosis (increased density of melanocytes). Appears bluish in color b/c the pigmentation is in the dermis rather than in the epidermis. These tumors appear along the first and second division of cranial nerve V. More common in Japanese population.
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Nevus of Ota
Tx: follow the progression of the tumor annually by photodocumentation. |
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Usually congenital or may develop in early years. Smooth, flat surface lesion with well-circumscribed edges. May see cysts within the lesion (this virtually confirms benign nature). More commonly seen nasally. May grow during puberty
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Conjunctival nevus
tx: photodocument, refer for biopsy if lesion enlarges or grows threatening changes |
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spontaneous development of irregular, diffuse, flat patches of conj pigmentation. Asymptomatic. May develop into malignant melanoma with highest percentage of conversions into choroidal melanoma.
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Primary acquired melanosis
Tx: Photodocument every 3-6 months, refer for biopsy if suspicious |
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dark-skinned pts often have bilateral patches of pigment clustered in the interpalpebral and perilimbal areas. Stable throughout life and of no concern.
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Racial melanosis
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pigmented lesions that may resemble benign melanosis or nevus. May develop de novo or in areas of previous benign pigmentation. May be multiple lesions. These can spread to adjacent tissues.
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Conjunctival malignant melanoma
Tx: photodocument every 3-6 months. Refer for biopsy at first signs of threat (ABCD rules) |
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sessile (flat) or pedunculated (on a stalk) lesions with irregular surface. Usually seen in caruncle or fornix. Two forms: viral (recurrences common, more likely multiple lesions) and non-viral (single lesions more common, may be pigmented, and more likely to be cancerous).
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Papilloma
Tx: refer for biopsy |
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not a typical “tumor” b/c its not in the form of lump or bump. It may mimic chronic blepharitis. Consider a tissue biopsy if the pts has a high recurrence of blepharitis. Usually takes the form of intraepithelial dysplasia (abnormal cell changes), so it is extremely difficult to detect clinically. May arise de novo, but it is usually related to an underlying invasive tumor of meibomian or zeis gland or both.
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Sebaceous cell carcinoma
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third most common ocular tumor in older population (after melanoma and lymphoma). Higher risk characteristics= pale skin/iris, residing less than 30 degrees latitude from equator, Male. Related to UV-B exposure. Perhaps from abnormal stem cell development at the limbus. Lesions have many different presentations but generally are slightly elevated, sharply demarcated, plumage/firework appearance, and range in color. Generally seen at the limbus with in palpebral fissure opening.
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Ocular surface squamous neoplasia
Tx: Most have proper cellular analysis (“pap” type test, impression cytology, or biopsy). IFN-2b with or without injections. If the tumor is compleley confined to the epithelium than it is referred to as conjunctival intraepithelial neoplasia. |
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Order of the layers of the lens (anterior to center)
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lens capsule/epithelium, lens cortex, adult nucleus, fetal nucleus, embryonic nuclus
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partial dislocation of the lens resulting from zonular damage or zonular irregularity causing the lens to move out of normal position but stays behind the iris plane. Marfan’s syndrome (causes it to go up) and homocysteinurea (causes it to go down) are two systemic diseases commonly associated. May occur from trauma, hereditary factors or mesodermal diseases. (Marfan’s presents with long fingers, tall and high soft palate)
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Subluxation
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zolules become completely detached from lens capsules and lens moves into anterior chamber (causing acute angle closure glaucoma and endothelial damage) or posterior chamber (causing functional aphakia)
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Dislocation-
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peripheral flattening and indentation. Usually inferiorly. Almost always unilateral. May be missing zonules in that area.
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Coloboma
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lens is small and spherical in shape causing high myopia. Usually bilateral. Zonules are long and lax. Subluxation is common
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Microspherophakia
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Most common presentation is posteriorly. Half the lens is steeply spherical (one side of the lens is rounder than the other). Presents with oil droplet appearance in retroillumination.
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Lentiglobus
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Part of the lens is conical in shape. Often associated with cataract in the area of the cone. Often associated with Alport’s syndrome (disorder of the basement membrane characterized by progressive nephritis and deafness).
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Lenticonus
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threadlike white strand at the papillary border or in the A/C. May have pigment still attached. Remnant of the tunica vasculosa lentis
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Persistent papillary membrane
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- remnant pigment stuck on the front of the lens capsule. Located centrally in a spicular or star-like pattern. Remnant of the tunica vasculosa lentis
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Epicapsular star
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remnant of the hyloid artery in the center of the back of the lens. Remnant of the tunica vasculosa lentis
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Mittendorf’s dot
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subcapsular and cortex is effected. Can be anterior, posterior or both. If genetic, inherited as autosomal dominant. The larger and more posterior opacities interfere more with vision. Congenital in nature.
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Polar cataract
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appears as dots at the Y-suture. Considered a normalvariant. Congenital in nature
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Sutural cataract
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inner fetal nucleus is effected. Very small and congenital in nature.
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Pulverulent cataract
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blue-gray opacities that present as small flecks within the cortex. Congenital in nature.
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Cerrulean cataract
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- increased density of the nucleus of the lens from compression of the lens fibers as adult fibers continue to be lied down. Marked by a decrease in VA that is usually a shift towards myopia. Causes an increase in spherical aberrations. Pt complains of blur, poor hue discrimination and monocular diplopia. Age-related
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Nuclear sclerosis
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involves the cortical layers of the lens. Fluid is absorbed into the lens from the aqueous forming vacuoles causing separation of the lens fibers. The lens sutures may be split by the water forming clefts that opacify to form spokes. Usually more dense inferior nasally. Can be described as cuneiform (typical), culpiform (saucer-shaped in central posterior cortex), or coronary (crown shaped). Grading by using retro-illumination. Age-related
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Cortical cataract
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abnormal migration of epithelial cells under the capsule that eventually opacify. Iridescent sheen (polychromatic luster) in the immediate subcapsular area posteriorly is the first sign that eventually forms a white granularity. Thin area is involved. RAPID REDUCTION IN VA. Age-related
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Posterior subcapsular cataract
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a hypermature cataract whose nucleus has shrunken so much that it contracts and sinks to the bottom of the lens capsule giving a sunset appearance.
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Morgagnian cataract
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lens becomes swollen and imbibed with water. Can occur at any stage of cataracts.
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Intumescent cataract
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What intraocular disease can cause complicated cataracts
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uveitis (most common), fuch’s heterochromatic, degenerative ocular disease, ocular ischemias
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What extraocular forces can cause a complicated cataracts
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atopic dermatitis (most common), corticosteroids, other drugs, diabetes (characterized by snowflake and Christmas tree cataract), galactosemia, trauma (characterized by rosette-shaped cataract and vossius ring)
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Most common form of age-related cataracts
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nuclear sclerosis. PSC is least common
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thick cellophane-like layer of material from leaky iris vessels is deposited on the front surface of the lens capsule. Then the iris peels off this layer w/ normal papillary constriction and dilation. Pigment atrophy in the iris sphincter region may be seen, which may lead to increased pigmentation in the anterior angle and possibly an increase in IOP. Looks like a double bull’s-eye (will have a dimmed red reflex in the center and extreme periphery but normal red reflex between these areas).
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Pseudoexfoliation
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