Wing Oc Pharm

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Response of tissue to injury

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: "-itis" conditions

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Anti-inflammatory response is intended to be a protective response to destroy,

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dilute or wall off the injurious agent. It facilitates the immune response and subsequent removal of antigenic material and damaged tissue

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_____________ first line of defense, immediate protection but is nonspecific, lacks memory and does not require central processing

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a. Innate immunity -

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T/F Inate immunity involves nonspecific phagocytosis by neutrophils in the first 6-24-hour period, followed by monocytes in the 24-48 hour phase. It contributes to adaptive immunity.

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T

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_________defense response to specific antigens, retains memory of previous antigenic encounters, ability to distinguish self from non-self. Takes several days to develop because of role of antigen-presenting cells, activation and proliferation of lymphocytes and synthesis of more cytokines and antibodies. Get phagocytosis with opsonization.

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Adaptive or acquired immunity -

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When treating anterior segment disease, we are really treating__________

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the inflammation

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___________- edema fluid with a high protein concentration, which frequently contains inflammatory cells.

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Exudate:

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Serous exudate -

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implies primarily protein, as seen clinically in the aqueous "flare" within the anterior chamber if inflammation is present

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(2) Fibrinous exudate -

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high fibrin content as a result of activation of the coagulation system, as seen in "plasmoid" aqueous, typically related to blood clotting but can see in iritis if protein leaks into anterior chamber – becomes thicker and very viscous, cells appear suspended in aqueous.

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_______ exudate - composed mostly of red blood cells, as seen in hyphema

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Sanguineous

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________ exudate – Associated with acute inflammation. Contains prominent cellular components, usually neutrophils; frequently associated with pyogenic bacterial infections. Seen in hypopyon. Settles down due to gravity.

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Purulent

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_________- - a condition in which there is a purulent exudate and significant liquefactive necrosis, the equivalent of pus. Seen in hordeola and corneal ulcers. Implies destruction of tissue. It is rich in cells and tissue components.

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(5) Suppurative inflammation

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_______ inflammation of one or more ocular coats of the eye and an adjacent intraocular cavity (e.g.,vitreous, retina and uvea). Usually acute and infectious in cause. Commonly seen after cataract surgery.

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a. Endophthalmitis:

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two complications due to cataract surgery

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endopthalmitis and panopthalmitis

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_________ consists of an endophthalmitis that involves the sclera and spreads to orbital structures

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b. Panophthalmitis:

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Acute Inflammation is characterized by relatively_____duration, exudation of fluid and plasma proteins into the tissue, and emigration of leukocytes (mainly _______ in the first 24 hours).

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short neutrophils

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2. Classic, "cardinal" signs of Acute Inflammation :

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redness, swelling, heat, pain and loss of function (rubor, tumor, calor, dolor and function loss, respectively).“HOT EYE”

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Acute Inflammation vascular response:

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Transient vasoconstriction, followed by vasodilation with vascular permeability

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Vasodilation of pre-capillary arterioles - increases blood flow to tissues, opening of capillary beds, which delivers more____________to the site.

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neutrophils

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T/F Nuetrophils proliferate at site of injury

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FALSE

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_____ are responsible for chemotasis. .

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. Neutrophils are responsible for chemotasis. Neuotrophils have 1 and 2 degree granules: Lyzozymses, defensins, lactoferrin, serine proteases, metallproteinsases (collagenases  responsible for corneal melt).

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_________- responsible for corneal melt

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collagenases

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• IL-1

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has a pro-inflammatory effect by stimulating prostaglandin production in fibroblasts and endothelial cells, cause secretion of proteases from phagocytes, and stimulating the release of other cytokines such as tumor necrosis factor-alpha and IL-6.

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___________act on hypothalamic temperature control system to cause fever, and on hepatocytes, resulting in production of C-reactive protein.

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IL-1 and IL-6

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What causess vasodilator, increases vascular permeability and release of neutrophils into tears?

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substance P

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2 types of chronic inflammation:

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Non-granulomatous inflammation and granulomatous inflammation

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Non-granulomatous inflammation

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a.       characterized by: lymphocytes, plasma cells, and macrophages that release IL-1

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granulomatous inflammation

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See Giant cells and epitheloid cells (granulomas)

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"

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Macrophages

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common causes of granulomatous ocular inflammation.

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saccadosis, tuberculousis, type 3 hypersensitivity diseases

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pannus

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(superificial connective tissue that contains blood vessels on its surface).

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Band keratopathy – deposition of calcium phosphates; mainly in __________

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Bowman's layer

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b. "Phthisical" eye -

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when this term is used clinically refers to blind hypotonous eyes that are soft, partially collapsed, and often described as having a cuboidal shape due to rectus muscle traction. The eye shrinks and there is a disorganization and destruction of intraocular structures. Results in a small eye.

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c. Phthisis bulbi

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a pathologic diagnosis used to describe eyes that are markedly atrophic and disorganized and have thickened folded sclera. The interior of The eye is filled with scar tissue and The intraocular structures are unrecognizable