Ocular Pathology

Front 1

Back 1

trachoma

Front 2

Back 2

cataract

Hint 2

opacification of crystalline lens
anterior subcapsular - fibrous plaque beneath anterior capsule, metaplastic anterior lens epithelial cells
posterior subcapsular - posterior migration of lens epithelium, "bladder of Wedl" cell formation, interfers w/ near vision, flares
Cortical Degeneration - fragmentation of lens fibers, Morgagnian globules
Nuclear Sclerosis - inevitable growth and development of lens, old lens fibers degenerate, blue-yellow color defects

Front 3

Back 3

HTN retinopathy

Hint 3

HTN --> vasospasm --> muscular and endothelial necrosis and vascular incompetence --> retinal edema --> exudates --> disc edema

Front 4

Back 4

diabetic retinopathy

Hint 4

pericyte loss - sorbitol plays a role
thickened basement membrane
capillary nonperfusion --> VEGF --> neovascularization (proliferative)
microaneurysms
hemorrhages, hard exudates, retinal edema
Cataracts
aldose reductase
predisposition to infections (mucormycosis)

Front 5

Back 5

retinitis pigmentosa

Front 6

Back 6

retinopathy of prematurity

Front 7

Back 7

chronic papilledema

Hint 7

systemic htn, increased intracranial pressure, decreased intraocular pressure, increased intraocular pressure, increased intraorbital pressure, hypercapnia (basically a change in pressure in any direction anywhere)
--> blockage of axoplasmic flow at lamina cribrosa
swollen nerve head, narrowing of physiological cup, lateral displacement of peripapillary retina, Paton's folds of outer retina

Front 8

Back 8

hemorrhage in papilledema

Front 9

Back 9

optic atrophy

Front 10

Back 10

glaucoma

Hint 10

cupping of optic nerve, death of retinal ganglion cells and optic nerve axons
elevation of intraocular pressure
blockage of aqueous outflow
open or closed angle variants
insidious loss of vision

Front 11

Back 11

phthisis bulbi

Front 12

Back 12

malignant melanoma

Hint 12

most common intraocular tumor in white adults
iris, choroidal, ciliary tumors
choroidal have mushroom configuration
25% fatal in spindle clel variations, 66% fatal in epithelioid cell variants
mets to liver

Front 13

Back 13

retinoblastoma

Hint 13

most common intraocular tumor in children
average age at dx - 18 months
tumor arises from and destroys retina
Flexner-Wintersteiner rosettes
Rb gene on chromosome 13 (typically bilat presentation)

Front 14

Back 14

Central Renal Artery Occlusion

Hint 14

sudden severe visual loss
cherry red spot
early - coag necrosis, pyknosis, edema of inner layers
late - inner ischemic retinopathy
atherosclerosis, emboli, vasculitis (r/o Giant Cell in elderly pts!!!)

Front 15

Back 15

Diabetic Retinopathy

Hint 15

pericyte loss - sorbitol plays a role
thickened basement membrane
capillary nonperfusion --> VEGF --> neovascularization (proliferative)
microaneurysms
hemorrhages, hard exudates, retinal edema
Cataracts
aldose reductase
predisposition to infections (mucormycosis)

Front 16

Back 16

Diabetic Retinopathy

Hint 16

pericyte loss - sorbitol plays a role
thickened basement membrane
capillary nonperfusion --> VEGF --> neovascularization (proliferative)
microaneurysms
hemorrhages, hard exudates, retinal edema
Cataracts
aldose reductase
predisposition to infections (mucormycosis)

Front 17

Back 17

Diabetic Retinopathy

Hint 17

pericyte loss - sorbitol plays a role
thickened basement membrane
capillary nonperfusion --> VEGF --> neovascularization (proliferative)
microaneurysms
hemorrhages, hard exudates, retinal edema
Cataracts
aldose reductase
predisposition to infections (mucormycosis)

Front 18

Back 18

Neovascularization

Hint 18

seen in diabetic retinopathy

Front 19

Back 19

Retinoblastoma

Hint 19

most common intraocular tumor in children
average age at dx - 18 months
tumor arises from and destroys retina
Flexner-Wintersteiner rosettes
Rb gene on chromosome 13 (typically bilat presentation)

Back 20

Retinoblastoma

Hint 20

most common intraocular tumor in children
average age at dx - 18 months
tumor arises from and destroys retina
Flexner-Wintersteiner rosettes
Rb gene on chromosome 13 (typically bilat presentation)

Front 21

Back 21

Retinoblastoma

Hint 21

most common intraocular tumor in children
average age at dx - 18 months
tumor arises from and destroys retina
Flexner-Wintersteiner rosettes
Rb gene on chromosome 13 (typically bilat presentation)

Front 22

Back 22

cataract

Hint 22

opacification of crystalline lens
anterior subcapsular - fibrous plaque beneath anterior capsule, metaplastic anterior lens epithelial cells
posterior subcapsular - posterior migration of lens epithelium, "bladder of Wedl" cell formation, interfers w/ near vision, flares
Cortical Degeneration - fragmentation of lens fibers, Morgagnian globules
Nuclear Sclerosis - inevitable growth and development of lens, old lens fibers degenerate, blue-yellow color defects

Front 23

Back 23

Central Retinal Artery Occlusion

Hint 23

sudden severe visual loss
cherry red spot
early - coag necrosis, pyknosis, edema of inner layers
late - inner ischemic retinopathy
atherosclerosis, emboli, vasculitis (r/o Giant Cell in elderly pts!!!)

Front 24

Back 24

coat's dz

Front 25

Back 25

copper wiring

Front 26

Back 26

cotton wool spots

Hint 26

DM, collagen vascular dz, AIDS
microinfarcts of nerve fiber layer s/p occlusion of precapillary arterioles
blockage of axoplasmic flow
cytoid bodies (swollen axons w/ eosinophilic nucleoid)

Front 27

Back 27

cotton wool spots

Hint 27

DM, collagen vascular dz, AIDS
microinfarcts of nerve fiber layer s/p occlusion of precapillary arterioles
blockage of axoplasmic flow
cytoid bodies (swollen axons w/ eosinophilic nucleoid)

Front 28

Back 28

cytoid body

Hint 28

seen in cotton wool spots
swollen axons w/ eosinophilic nucleoid composed of dammed organelles

Front 29

Back 29

glaucoma

Hint 29

cupping of optic nerve, death of retinal ganglion cells and optic nerve axons
elevation of intraocular pressure
blockage of aqueous outflow
open or closed angle variants
insidious loss of vision

Front 30

Back 30

glaucoma

Hint 30

cupping of optic nerve, death of retinal ganglion cells and optic nerve axons
elevation of intraocular pressure
blockage of aqueous outflow
open or closed angle variants
insidious loss of vision

Front 31

Back 31

glaucoma

Hint 31

cupping of optic nerve, death of retinal ganglion cells and optic nerve axons
elevation of intraocular pressure
blockage of aqueous outflow
open or closed angle variants
insidious loss of vision

Front 32

Back 32

hard exudate

Hint 32

pools of eosinophilic lipoproteinacous material in outer plexiform layer
may be phagocytized by macrophages (Gitter cells)
circinate retinopathy - ring of exudates reflecting radial orientation of henle fibers
Macular star - also showing orientation of henle fibers

Front 33

Back 33

hemorrhage and exudate

Front 34

2 types present ... what are they?

Back 34

hemorrhage (flame and dot)
*types on next slide

Hint 34

flame or splinter - tracks along nerve fiber axons
blot of dot - deep retinal layers
scaphoid - boat shaped - flat, top fluid level
Sub retinal - dark colored, similar to choroidal melanoma
Roth Spot - white centered hemorrhage - bacterial endocarditis

Front 35

Back 35

inner ischemic retinal atrophy

Hint 35

seen in central renal a. occlusion

Front 36

Back 36

malignant HTN

Hint 36

HTN --> vasospasm --> muscular and endothelial necrosis and vascular incompetence --> retinal edema --> exudates --> disc edema

Front 37

Back 37

malignant melanoma

Hint 37

most common intraocular tumor in white adults
iris, choroidal, ciliary tumors
choroidal have mushroom configuration
25% fatal in spindle clel variations, 66% fatal in epithelioid cell variants
mets to liver

Front 38

Back 38

malignant melanoma

Hint 38

most common intraocular tumor in white adults
iris, choroidal, ciliary tumors
choroidal have mushroom configuration
25% fatal in spindle clel variations, 66% fatal in epithelioid cell variants
mets to liver

Front 39

Back 39

mucormycosis

Hint 39

typically only seen in diabetic pts b/c of immunocomp

Front 40

Back 40

rentinal detachment

Front 41

Back 41

retina

Front 42

"Dry" Age Related Macular Degeneration

Back 42

Retinal Pigmented Epithelium and outer retina Degeneration, pigment clumping

Front 43

"Wet" Age Related Macular Degeneration

Back 43

Changes in Bruch's Membrane
PAS pos focal calcification
Drusen - marker for stressed RPE cells
tx: inject anti-VEGF Ab

Front 44

Thyroid Ophthalmopathy

Back 44

unilateral or bilateral exophthalmos
elargement of extraocular muscles

Front 45

cavernous hemangioma

Back 45

can affect orbit (not in lecture, no details in syllabus)

Front 46

Orbital Rhabdomyosarcoma

Back 46

most common malignant orbital tumor of childhood
on ddx of all kids w/ orbital dz
rapid growth mimics inflammation
average age of onset = 8 yrs