Vijesh Patel Diseases of the eye The eye consists of 2 chambers o Anterior: Conjunctiva, cornea, iris, lens o Posterior:

Vitreous humour, retina, choroid, sclera, optic nerve Adnexal structures of the eye o Conjunctiva wraps on the inside of the eyelid to the eye ball Bulbar conjunctiva = on the eye Palpebra conjunctiva = on the eye lid o Sebaceous glands Meibomian glands = inside of eye lid Zeis glands = close to eye lash
Epi Diseases of the eye Xanthalesma (Form of xanthoma) Stye (Hodelum) Chalazion Hyperlipidemea Can occur in normal people too Pathogenesis / Antibodies Foamy M Inflammation of margin of the eye Staph infection Sterile granulomatous inflammation - After ruptured obstructed meibomian gland **connect line b/w tragus + corner of mouth - Above = BCC; Below = SCC Resemble meibomian glands - Abundant lipid + foamy cytoplasm Redness of conjunctiva Photophobia Sand in eye foreign body feeling Waking up with eyelashes stuck Lots of white fluid exudate Clear fluid exudate Cobble stone appearance under palpebral conjunctiva - Redness + stringy discharge S/S Yellow colour on medial side of eye lid H. externum = zeis gland H. internum = meibomian gland - Seen by everting the eyelid Firm nodule - Less painful *

Rx Pull the eyelash + drain + antibiotics

Tumors of eye

Basal cell carcinoma Sebaceous carcinoma

Conjunctivitis

Bacterial Viral / Pink eye Allergic / Vernal

Strep or Staph Adenovirus Seasonal occurrence of chronic inflammation Chlamydia trchomatous - Type ABC Now you cant see - Smear shows chlamydial elementary body

Chlamydia

Stage 1: Conjuntival follicles Stage 2: Pannus Stage 3: Cicatrisation

Inward turning of the eyelid

Palpebral conjunctiva w/ follicles Blood vessels extend to cornea Entropion inward rolling Trichiasis hair irritating the slcera Wing like extension of fibrovascular tissue - Nasal side (Medial) - Cornea affected = visual impairment (not blindness) Yellowish nodules - Lateral side - Cornea not affected BLUE SCLERA Rx Surgical correction - Cosmetic

Stage 4: Corneal damage Pterygium

#1 cause of blindness worldwide Chronic exposure to sunlight

Pinguecula

Chronic exposure to sunlight - Degeneration of collagen Normal in Asian children Down syndrome otherwise Osteogenesis imperfecta

Osteogenesis imperfect

Vijesh Patel Normal anatomy of cornea Non-stratified squamous epithelium Bowmans membrane Stroma THICKEST (9/10) o Collagen arrangement is unique to allow transparency Descemets membrane Endothelium o Keeps the cornea in a dehydrated state o Provide nourishment for the cornea
Epi Diseases of the eye Corneal abrasion Corneal ulceration Herpes (MCC)

If injured it will loss the transparency and cause blindness

Pathogenesis / Antibodies Superficial loss of epithelium Abrasion of beyond bowmans membrane and into stromal layer - Visualize w/ fluoresin stain

S/S Photophobia + Pain Opacities (Leukomas) form - Affects vision only if pupil is obstructed Tree root like branching

* Regeneration without vision problems

Dendritic corneal ulcer Keratitis Descemetocele Hypopyon Stromal (interstitial) keratitis Wilsons disease (Keyser Fleisher rings)

Herpes (MCC) Herpes (MCC)

Syphillis

Infection Ulceration of the descements layer through the epidermis Collection of pus in anterior chamber Inflammation of corneal stroma - Not the epidermis Copper overload - Copper deposited in Descements membrane

Opacities Inverted triangle shape

Hyperlipidemia (Archus Senilus) Corneal degradation and dystrophy Band keratopathy

Elderly patients History of MI Exposure to sunlight Hyper PTH Juvenile RA Downs syndrome Marfans syndorome Calcium deposition in the Bowmans membrane Over activation of enzyme destroy middle layer of stroma

Keyser Fleisher rings - Golden yellow pigmentation Neurological symptoms - Parkinsonism, athetosis Archus Senilus - White limbus of cornea White spots around the limbus are not continuous Conical cornea - Astigmatism - Corneal hydrops

Keratoconus

Fuchs endothelial dystrophy Stromal dystrophy

Vijesh Patel Lens Consists of 4 layers o Capsule o Epithelium Cuboidal cells found only on the anterior surface only o Cortex Formed after birth o Nucleus Formed before birth Remains suspended by the ciliary ligaments attached to the cillary muscle
Epi Diseases of the lens Cataracts Nuclear cataracts (old people) - Most common Cortical cataracts (diabetes) Posterior subcapsular cataracts Glaucoma Primary - genetic cause Secondary - some underlying disease Tumor (Melanomas) Morgagni cataract Phacolytic glaucoma Iridocyclitis - Irritation of the iris + ciliary body Anterior synechea - Angle is stuck closed Iritis, Cyclitis, Iridocyclitis & Choroiditis Anterior chamber inflamed Posterior chamber inflamed Pathogenesis / Antibodies Immature cataracts (partial disease), mature cataracts (complete), hypermature / morgagnian (degradation), phacolytic glaucoma (OAG b/c of occlusion of trabecular meshwork) Normally AH made in posterior chamber moves to anterior chamber Drained by angle of iris and sclera w/ trabecular meshwork Trabecular meshwork is damaged or occluded - Less drainage of the fluid Irideoscleral angle is closed - Less drainage of the fluid - Caused by inflammation fibrosis S/S Loss of transparency Perception affected - Blue Brown / Yellow Leukoria white reflex * Frequently changes glasses Rx Replace lens

1. Open

2. Closed

DIABETES - Scarring

Fibrosis

Uveal tract lesion Uveitis 1. Infectious uveitis Endopthalmitis Panopthalmitis 2. Non-infectious uveitis Sarcoidosis Sympathetic opthalmitis

Autoimmune disease after a penetrating deep injury - Sequestered HSR granulomas MOST COMMON Deposited in the choroid - Men = Lung cancer - Women = Breast cancer Choroid mass growing into chamber Mainly spindle cells Large cytoplasm + round nucleus

Normal eye is affected as well (Immune response)

Rx Enucleation Immunosuppressive drugs

Uveal neoplasms 1. Malignancies

2. Melanoma a. Spindle variant b. Epitheliod variant

Older people NOT related to sunlight exposure

Mushroom shaped growth Complications: - Retinal detachment - Glaucoma

Prognosis is better than a cutaneous melanoma Prognosis = - Iris melanoma Prognosis = - Choroid & ciliary body

Vijesh Patel Retinal diseases Bruchs membrane: between the retina and the choroid Macula: the point with the highest acuity found 2 cup spaces temporally highest density of rods + cones
Epi Diseases of the retina Hypertensive retinopathy Pathogenesis / Antibodies Hyaline deposition into the vessel wall - Exudate found (Benign HTN) Hyalinization leads to AV nicking - Arteriole blocks off a venuole - If this gets more severe there is ischemia (Malignant HTN) (Malignant HTN) Superficial hemorrhage - Occur parallel to long axis Deeper hemorrhage - Occur perpendicular to long axis Cells undergo necrosis + degeneration - Ischemic injury - Leakage of plasma proteins Extravasated lipid / protein Raised intracranial pressure S/S *

Grade 1 narrowing of arterial walls Copper wires Silver wires Grade 2 plus focal arteriolar spasms Grade 3 plus Flame hemorrhage Dot / Blot hemorrhage Cotton-wool spots

Yellow spots w/ fluffy borders

Hard waxy exudates Grade 4 plus Papilledema (Grade 3)

(Malignant HTN) Tumor Head trauma HTN

Optic disk is swollen - Pink + blurry border

Diabetic retinopathy 1. Non-proliferative (Background)

Arteriolar hyalinization - Capillary BM thickening - Microvasculature obstruction - Capillary microaneurysms

(Possibly trypsin degradation)

Hemorrhage, serous & hard exudate, macular edema

2. Proliferative

Sever hypoxia + ischemia VEGF - Leads to neovascularization

Age related macular degeneration (ARMD) 2 types: 1. Atrophic (Dry) / Drusen

Most common cause of irreversible visual impairment Risk: Smoking + HTN Deposition in the Bruchs membrane (b/w retina and choroid) - Atrophy of retinal pigment epithelium (RPE) Neovascularization occurs and there is a lot of immature vessels - Hemorrhage Inherited form of retinal degeneration - Atrophy of RPE - Loss of rods (light) and cones RB tumor suppressor gene mutation - Small blue round cells Flexner winter-steiner rosettes - with central lumen Homer-Wright rosette - no central lumen

Complications: - Vitreous hemorrhage - Fibrosis (Retinitis proliferans) - Retina detach - Secondary close angle glaucoma - BLINDNESS Loss of central vision

See the crowd not the sport

Macular deposits

2. Exudative (Wet)

Retinitis pigmentosa

GENETIC DISEASE - No inflammation

Retinal pigments around vessels - Waxy pallor color of retina Night blindness Tunnel vision Mass on posterior retina - Proptosis if advanced Leukokoria - Amouratic cats reflex

Retinoblastoma

Most common eye malignancy in children less than 2

Spontaneous regression

1. Sporadic 2. Hereditary

Unilateral Bilateral

Optic nerve neuropathies

Optic nerve lesions Multiple Sclerosis Papilledema Optic atrophy (Glaucoma) Malignant HTN (Grade 4) Degeneration of white matter - No inflammation Raised ICP pushes the optic nerve into the eye Raised IOP pushes the optic nerve out of the eye

Flattening and loss of the optic cup Blood vessels appear pushed to one side - Disappear and re-emerge