Inflammation

Front 1

Tears--immunoglobulins

Back 1

IgA>>> IgG, IgM; IgE=allergy; IgA,G,M,E & D are in conj subepi

Front 2

T1 inflammatory response

Back 2

Ab mediated (Ab+ Mast-->histamine, LT) (i.e. hayfever)

Front 3

T2 inflammatory response

Back 3

cytotoxic Ab mediated (e.d. OCP)

Front 4

T3 inflammatory response

Back 4

immune complex mediate/zonal granulomatous inflammation (Ab+free floating Ag are deposited as complex which activates complement cascade) (phacoanaphylaxis)

Front 5

T4 inflammatory response

Back 5

T cell mediated; granulomatous response (i.e. sarcoid or TB); K allograft rejection (also, T2)

Front 6

Pars planitis /intermediate uveitis

Back 6

MS (5-25%) (of which 80%=bilateral), Lyme, sarcoid, TB, syphilis; snowbanking, band keratopathy, AC & vit cell; Assoc w/ PSC, synechiae, ERM, retinal phlebitis, CME (most common cause of visual loss w/ pars planitis); floaters may be only symptom
Complications: calcific band keratopathy, peripheral retinal NVE, VH, TRD

Front 7

Snow bank

Back 7

made of fibroglial & vascular components

Front 8

Snow balls

Back 8

made of epithelioid cells & multinuclead giant cells

Front 9

Posterior uveitis

Back 9

Sympathetic ophthalmia, VKH, serpiginous, etc

complication=CNVM

Front 10

Sympathetic ophthalmia

Back 10

Dalen fuch’s nodules (excrescences at level of Bruch’s); bilateral granulomatous inflammation & panuveitis (EXCEPT choriocapillaris sparing (unlike VHK); typically in 1st year but can occur years later

Front 11

GCA

Back 11

ischemia (AION or PION); typically ischemia of nasal short posterior ciliary artnonperfusion of nasal retina
ERG=decreased B wave amplitude

Front 12

Conjunctival cicatrization

Back 12

SJS, OCP, atopic keratoconjunctivitis, chemical burns, trachoma, SqCCa, infectious conjunctivitis, scleroderma, meds (antivirals, miotics, epi, timolol), radiation, rosacea

if unilateral—think post op or conj carcinoma

Front 13

OCP

Back 13

IgA is bound to conj basement membrane (seen w/ immunofluorescent stains); bilateral, chronic conjunctivitis leads to subconj fibrosis & dec goblet cells, which lead to obstruction of lacrimal ducts & accessory glands leading to sym/ankylo-blepharon --> keratinization of conj epi + corneal NV & scarring

Front 14

OCP Path & treatment

Back 14

Path: lymphocytes, plasma cells & eos on conj scrapings

Tx=cyclophosphamide or in milder cases-dapsone

Front 15

SJS (Erythema multiforme major)

Back 15

assoc w/ sulfa drugs, mycoplasma pneumonia, coxsackievirus, echovirus, influenza

pathophys: vasculitic process-->macular bulls eye rash, vesicular mucous membrane lesions

Front 16

Superior limbic keratoconjunctivitis

Back 16

superior tarsal pap rxn & keratinization & sup bulbar conj redundancy;
50% may be assoc w/ hypothyroid

Front 17

SLK treatment

Back 17

TX=0.5%-1% silver nitrate solution (not stick), pressure patch, scraping, bulbar conj resection (curative) or cauterization, bandage contact lens

Front 18

GPC

Back 18

>1mm pap; DDx=contact lens (soft>RGP>PMMA), prosthesis, atopic keratoconj, vernal or sutures;
may have assoc large follicles in upper palpebrae, hyperemia & mucus d/c; ?rare association w/ limbal follicles (like Vernal)

Front 19

GPC TX

Back 19

TX=mast cell stabilizers, steroids, lens hygiene or changing CL brand

Front 20

Phlyctenulosis

Back 20

allergic T4 hypersensitivity response nodular inflammation of the peri-limbal tissues; composed of lymphocytes, histocytes and plasma cells; etiology: delayed hypersens rxn to : TB & Staph aureus > Coccidioides (a soil-based fungus common in the southwestern U.S.), Chlamydia, acne rosacea, some varieties of interstitial parasites & Candida; most common (60%) in women during their first and second decades who live in crowded areas;

Front 21

Conjunctival phlyctenulosis

Back 21

1 to 3mm hard, triangular, slightly elevated, yellowish-white nodule surrounded by a hyperemic response near inf limbus; Bilateral

Front 22

corneal phlyctenulosis

Back 22

start perilimbal as a white mound, with a radial pattern of vascularized conjunctival vesselsmigrates to center as a gray-white, superficial ulcer

Front 23

Atopy

Back 23

T1 hyperactive immune system that reacts to allergens (**eczema**, seasonal/vernal, asthma, GPC) (NOTE: Phlyctenulosis=T4, therefore, not atopic);

Front 24

Atopy treatment

Back 24

for atopic keratoconjunctivitis, must Tx w/ PO antihistamine

Front 25

Horner Trantas dots

Back 25

vernal conjunctivitis; focal limbal infiltrates of eosinophils;

Front 26

Shield ulcer

Back 26

due to vernal keratoconjunctivitis (palpebral > limbal);

Front 27

Reiters

Back 27

“cant see (iridocyclitis, pap conj w/ K NV, ?CME), cant pee (keratoderma blennorrhagicum), cant climb a tree (nonerosive oligoarthritis)