Anterior eye structures disorders

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Anterior eye structures disorders

  1. 1. EyeAnteriorStructuresPathlogiesandDisorders<br />Fielmann<br />Optometrist<br />IrinaJagilovich<br />e-mail: irina.jagilovica@gmail.com<br />
  2. 2. DISORDERS OF LASHES<br />1. Trichiasis<br />2. Metaplastic lashes<br />3. Distichiasis<br />4. Phthiriasispalpebrarum<br />5. Madarosis<br />6. Poliosis<br />
  3. 3. MadarosisDecrease in number or complete loss of lashes<br />Local causes<br /><ul><li> Chronic anterior</li></ul> lid margin disease<br /><ul><li>Infiltrating tumours
  4. 4. Burns, radiotherapy</li></ul> or cryotherapy<br />
  5. 5. Poliosis<br />Premature localized whitening of hair<br />Ocular associations<br /> Chronic anterior blepharitis<br /> Sympathetic ophthalmitis<br />Systemic associations<br />Vogt-Koyanagi-Harada <br /> syndrome<br />Waardenburg syndrome<br />
  6. 6. Distichiasis<br /><ul><li>Second row of lashes arising from meibomian gland orifices
  7. 7. Congenital</li></li></ul><li>Trichiasis<br />Most frequently affects lower lidof normal lashes<br /> Most frequently affects lower lid<br />Inferior punctateepitheliopathy<br />
  8. 8. Phthiriasispalpebrarum<br /> Infestation of lashes by pubic crab louse and its ova (nits)<br /> Typically affects children in poor hygenic conditions<br />
  9. 9. Staphylococcal blepharitis<br />Chronic irritation worse in mornings<br />Hyperaemia and telangiectasia of anterior<br /> lid margin<br />Scarring and hypertrophy if longstanding<br />Scales around base of lashes <br /> (collarettes)<br />
  10. 10. Complications of staphylococcal blepharitis<br />poliosis<br />madarosis<br />trichiasis<br />Recurrent styes<br />Marginal keratitis<br />Tear film instability<br />
  11. 11. Seborrhoeicblepharitis<br />Shiny anterior lid margin<br /> Greasy scales <br />Hyperaemia of lid margin<br />Lashes stuck together<br />
  12. 12. Meibomianitis<br /> Inflamed and blocked<br />meibomiangland orifices<br />Meibomian cyst formation<br />
  13. 13. Meibomianseborrhoea<br />Oil globules over meibomian gland orifices<br />Oily and foamy tear film<br />
  14. 14. Herpes simplex<br />Signs<br /><ul><li>Crops of small vesicles
  15. 15. Rupture and crust
  16. 16. Heal without scarring</li></ul> after 7 days<br />Complications<br /><ul><li>Follicular conjunctivitis
  17. 17. Keratitis</li></ul>Treatment - topical<br />antivirals<br />
  18. 18. BENIGN EYELID LESIONS<br />1. Nodules<br /><ul><li>Chalazion
  19. 19. Acute hordeola</li></ul>Molluscumcontagiosum<br />Xanthelasma<br />2. Cysts<br /><ul><li> Cyst of Moll
  20. 20. Cyst of Zeiss
  21. 21. Sebaceous cyst
  22. 22. Hidrocystoma</li></ul>3. Tumours<br /><ul><li>Viral wart
  23. 23. Keratoacanthoma
  24. 24. Naevi
  25. 25. Capillary haemangioma
  26. 26. Port-wine stain
  27. 27. Pyogenicgranuloma
  28. 28. Cutaneous horn</li></li></ul><li>Signs of chalazion (meibomian cyst)<br />Painless, roundish, firm lesion <br />within tarsal plate<br />May rupture through conjunctiva <br />and cause granuloma<br />
  29. 29. Molluscumcontagiosum<br />Painless, waxy, umbilicated nodule<br />May be multiple in AIDS patients<br />Chronic follicular conjunctivitis<br />Occasionally superficial keratitis<br />
  30. 30. Xanthelasma<br />Common in elderly or those withhypercholesterolaemia<br />Yellowish, subcutaneous plaques containing cholesterol and lipid<br />Usually bilateral and located medially<br />
  31. 31. Eyelid cysts<br />Cyst of Moll<br />Translucent<br />On anterior lid margin<br />Cyst of Zeis<br />Opaque<br />On anterior lid margin<br />
  32. 32. Viral wart (squamous cell papilloma)<br />Most common benign lid tumour<br />Raspberry-like surface<br />
  33. 33. Keratoses<br />Seborrhoeic<br />Actinic<br />Common in elderly<br />Affects elderly, fair-skinned individuals<br />Discrete, greasy, brown lesion<br />Most common pre-malignant skin lesion<br />Flat ‘stuck-on’ appearance<br />Rare on eyelids<br />Flat, scaly, hyperkeratotic lesion<br />
  34. 34. Keratoacanthoma<br />Uncommon, fast growing nodule<br />Acquires rolled edges and keratin-filled crater<br />Involutes spontaneously within 1 year<br />
  35. 35. Naevi<br /> Elevated<br />Flat, well-circumscribed<br />Has both intradermal<br /> and junctional<br /> components<br /> May be non-pigmented<br /> Pigmented<br /> No malignant potential<br /> Low malignant potential<br />
  36. 36. MALIGNANT EYELID TUMOURS<br />1. Basal cell carcinoma<br />2. Squamous cell carcinoma<br />3. Meibomian gland carcinoma<br />4. Melanoma<br />5. Kaposi sarcoma<br />
  37. 37. Basal Cell Carcinoma - Important Facts<br />1. Most common human malignancy<br />2. Usually affects the elderly<br />3. Slow-growing, locally invasive<br />4. Does not metastasize<br />5. 90% occur on head and neck<br />6. Of these 10% involve eyelids<br />7. Accounts for 90% of eyelid malignancies<br />
  38. 38. Nodular basal cell carcinoma<br /> Shiny, indurated nodule<br /> Slow progression<br /> Surface vascularization<br /> May destroy large portion of eyelid<br />
  39. 39. Ulcerative basal cell carcinoma(rodent ulcer)<br />Chronic ulceration<br />
  40. 40. Sclerosing basal cell carcinoma<br />Indurated plaque with loss of lashes<br />Spreads radially beneath normal <br /> epidermis<br />May mimic chronic blepharitis<br />
  41. 41. Squamous cell carcinoma<br />Nodular<br />Ulcerative<br />Less common but more aggressive than BCC<br />No surface vascularization<br />
  42. 42. Meibomian gland carcinoma<br />Hard nodule; may<br />mimic chalazion<br />Very large tumour<br />Diffuse thickening of lid margin and loss of lashes<br />Conjunctival invasion; may<br />mimic chronic conjunctivitis<br />
  43. 43. Melanoma<br />Plaque with irregular<br /> outline<br />Blue-black nodule with<br />normal surrounding skin<br />May be non-pigmented<br />Variable pigmentation<br />
  44. 44. Kaposi sarcoma<br />Vascular tumour occurring in patients with AIDS<br />Usually associated with advanced disease<br />Very sensitive to radiotherapy<br />
  45. 45. Entropion & ectropion<br />
  46. 46. Horner syndrome<br />Caused by oculosympatheticpalsy<br />Usually unilateral mildptosis and miosis, anisocoria<br />Normal pupillary reactions<br />
  47. 47. Important causes of Horner syndrome<br />Central<br />(first order neurone)<br />Posterior hypothalamus<br /><ul><li>Brainstem disease</li></ul> (vascular, demyelination)<br /><ul><li> Spinal cord disease</li></ul> (syringomyelia, tumours)<br />Pre-ganglionic<br />(second order neurone)<br />Superior cervical<br />ganglion<br /><ul><li>Intrathoracic lesions</li></ul> (Pancoasttumour, aneurysm)<br /><ul><li> Neck lesions</li></ul> (glands, trauma)<br />Post-ganglionic<br /> (third order neurone)<br /><ul><li> Internal carotid artery disease</li></ul>Ciliospinal centre of <br />Budge( C8 - T2 )<br /><ul><li> Cavernous sinus mass</li></li></ul><li>Simple bacterial conjunctivitis<br />Subacute onset of mucopurulent<br />discharge<br />Crusted eyelids and conjunctival<br />injection<br />
  48. 48. Signs of conjunctivitis<br />Usually bilateral, acute watery<br />discharge and follicles<br />Subconjunctivalhaemorrhages and<br />pseudomembranes if severe<br />
  49. 49. Signs of keratitis<br />Focal, subepithelialkeratitis<br />Focal, epithelial keratitis<br />May persist for months<br />Transient<br />
  50. 50. Progression of vernal conjunctivitis<br /> Diffuse papillary hypertrophy, most marked on superior tarsus<br /> Formation of cobblestone papillae<br />
  51. 51. Limbal vernal<br />Trantas dots<br />Mucoid nodule<br />
  52. 52. CONJUNCTIVAL TUMOURS<br />1. Benign<br /><ul><li>Naevus
  53. 53. Papilloma
  54. 54. Epibulbardermoid
  55. 55. Lipodermoid</li></ul>2. Pre-malignant<br /><ul><li> Primary acquired melanosis ( PAM )
  56. 56. Intraepithelial neoplasia (carcinoma in situ)</li></ul>3. Malignant<br /><ul><li> Melanoma
  57. 57. Squamous cell carcinoma
  58. 58. Kaposi sarcoma
  59. 59. Lymphoma</li></li></ul><li>Naevus<br />Most frequently juxtalimbal<br />Presents in first two decades<br />Sharply demarcated and slightly <br />elevated<br />30% are almost non-pigmented<br />
  60. 60. Melanoma<br />
  61. 61. Papilloma<br />Pedunculated<br />Sessile<br /><ul><li> Presents in middle age
  62. 62. Presents in childhood or early adulthood
  63. 63. Not caused by infection
  64. 64. Infection with papilloma virus
  65. 65. Single and unilateral
  66. 66. May be multiple and bilateral</li></li></ul><li>Epibulbardermoid<br />Signs<br />Association<br /><ul><li> Presents in childhood
  67. 67. Occasionally Goldenhar</li></ul> syndrome<br /><ul><li> Smooth, soft mass
  68. 68. Usually juxtalimbal</li></li></ul><li>Lipodermoid<br /><ul><li>Presents in adulthood
  69. 69. Soft, movable, subconjunctival mass
  70. 70. Most frequently at outer canthus</li></li></ul><li>Intraepithelial neoplasia<br />(carcinoma in situ)<br />Signs<br />Progression<br /><ul><li> May become vascular and extend onto </li></ul> cornea<br /><ul><li>Presents in late adulthood
  71. 71. Juxtalimbal fleshy avascular mass
  72. 72. Malignant transformation is uncommon</li></li></ul><li>Primary acquired melanosis (PAM)<br />Signs<br />Types<br />PAM without atypia is benign<br />Presents in late adulthood<br />Unilateral, irregular areas of flat, <br />brown pigmentation<br />PAM with atypia is pre-malignant <br />May involve any part of conjunctiva<br />
  73. 73. Conjunctival melanoma<br />From naevus<br />Primary<br />From PAM with atypia<br />Very rare<br />Most common type<br />Solitary nodule<br />Sudden appearance of <br />nodules in PAM<br />Frequently juxtalimbal<br /> but may be anywhere<br />Sudden increase in size <br />or pigmentation<br />
  74. 74. Squamous cell carcinoma<br />Progression<br />Signs<br /><ul><li>Arises from intraepithelial</li></ul>neoplasia or de novo<br /><ul><li> Slow-growing
  75. 75. May spread extensively
  76. 76. Presents in late adulthood
  77. 77. Rarely metastasizes
  78. 78. Frequently juxtalimbal</li></li></ul><li>Kaposi sarcoma<br /><ul><li> Affects patients with AIDS
  79. 79. Vascular, slow-growing tumour of low malignancy
  80. 80. Very sensitive to radiotherapy
  81. 81. Most frequently in inferior fornix</li></li></ul><li>Lymphoma<br /><ul><li> Usually presents in adulthood
  82. 82. Benign or malignant
  83. 83. Salmon-coloured, subconjunctival infiltrate</li></li></ul><li>PERIPHERAL CORNEAL INFLAMMATION<br />1. Marginal keratitis<br />2. Rosaceakeratitis<br />3. Phlyctenulosis<br />4. Acute stromalkeratitis<br />
  84. 84. Marginal keratitis<br />Progression<br />Subepithelial infiltrate <br />separated by clear zone<br />Vascularization<br />followed by resolution<br />Circumferential spread<br />
  85. 85. Rosaceakeratitis<br /><ul><li>Affects 5% of patients with acne rosaeca
  86. 86. Bilateral and chronic</li></ul>Progression<br />Peripheral inferior<br />vascularization<br />Subepithelial infiltration<br />Thinning and <br />perforationif severe<br />
  87. 87. Phlyctenulosis<br /><ul><li> Uncommon, unilateral - typically affects children
  88. 88. Severe photophobia, lacrimation and blepharospasm</li></ul>Conjunctivalphlycten<br />Corneal phlycten<br /><ul><li> Small pinkish-white nodule </li></ul> near limbus<br /><ul><li> Usually transient and resolves </li></ul> spontaneously<br /><ul><li> Starts astride limbus
  89. 89. Resolves spontaneously or extends</li></ul> onto cornea<br />
  90. 90. Acute stromalkeratitis<br /><ul><li> Uncommon, usually unilateral
  91. 91. Associated with non-necrotizing scleritis</li></ul>Progression<br />Superficial or mid-stromal infiltration<br />Opacification and vascularization<br />
  92. 92. CORNEAL INFECTIONS<br />1. Bacterial keratitis<br />2. Fungal keratitis<br />3. Acanthamoebakeratitis<br />4. Infectious crystalline keratitis<br />Herpes simplex keratitis<br />-Epithelial<br /> -Disciform<br />6. Herpes zoster keratitis<br />
  93. 93. Bacterial keratitis<br /><ul><li> Contact lens wear
  94. 94. Chronic ocular surface disease
  95. 95. Corneal hypoaesthesia</li></ul>Expanding oval, yellow-white, <br />dense stromal infiltrate<br />Stromal suppuration and <br />hypopyon<br />
  96. 96. Fungal keratitis<br />Frequently preceded by ocular trauma with organic matter<br />Greyish-white ulcer which may be <br />surrounded by feathery infiltrates<br /> Slow progression and occasionally <br />hypopyon<br />
  97. 97. Acanthamoebakeratitis<br /><ul><li> Contact lens wearers at particular risk
  98. 98. Symptoms worse than signs</li></ul>Perineuralinfiltrates<br /> (radial <br />keratoneuritis)<br /> Small, patchy <br />Anteriorstromal<br />infiltrates<br /> Ulceration, ring <br />abscess& small, <br />satellite lesions<br />Stromal<br />opacification<br />Treatment<br />
  99. 99. Infectious crystalline keratitis<br /><ul><li> Very rare, indolent infection (Strep. viridans)
  100. 100. Usually associated with long-term topical steroid use
  101. 101. Particularly following penetrating keratoplasty</li></ul> White, branching, anterior stromal crystalline deposits<br />
  102. 102. Herpes simplex epithelial keratitis<br /><ul><li>Dendritic ulcer with terminal </li></ul>bulbs<br /><ul><li> May enlarge to become </li></ul>geographic<br /><ul><li> Stains with fluorescein</li></li></ul><li>Herpes simplex disciformkeratitis<br />Signs<br />Associations<br />Central epithelial and stromaloedema<br />Occasionally surrounded by <br />Wesselyring<br />Folds in Descemet membrane<br />Small keratic precipitates<br />
  103. 103. Herpes zoster keratitis<br />Nummular keratitis<br />Acute epithelial keratitis<br />Develops in about 50% within <br />2 days of rash<br />Develops in about 30% within <br />10 days of rash<br />Small, dendritic or stellate<br />epithelial lesions<br />Multiple, fine, granular deposits <br />just beneath Bowman membrane<br />Tapered ends without bulbs<br />Halo of stromal haze<br />May become chronic<br />Resolves within a few days<br />
  104. 104. CORNEAL DEGENERATIONS<br />1. Age-related<br /><ul><li>Arcussenilis
  105. 105. Vogt white limbal girdle
  106. 106. Crocodile shagreen
  107. 107. Cornea guttata</li></ul>2. Lipid keratopathy<br /><ul><li> Primary
  108. 108. Secondary</li></ul>3. Band keratopathy<br />4. Spheroidal degeneration<br />5. Salzmann nodular degeneration<br />
  109. 109. Arcussenilis<br /><ul><li> Innocuous and extremely common in elderly
  110. 110. Occasionally associated with hyperlipoproteinaemia
  111. 111. Peripheral border separated </li></ul> from limbus by clear zone<br /><ul><li> Bilateral, circumferential bands </li></ul> of lipid deposits<br /><ul><li>Diffuse central and sharp </li></ul> peripheral border<br /><ul><li> Clear zone may be thinned </li></ul> ( senile furrow)<br />
  112. 112. Vogt white limbal girdle<br />Innocuous and very common in elderly<br />Bilateral<br />White, crescentic line along nasal and <br />temporal limbus<br />Type 1 - separated from limbus by clear zone<br />Type 2 - not separated by clear zone<br />
  113. 113. Crocodile shagreen<br /><ul><li> Uncommon and innocuous
  114. 114. Usually bilateral</li></ul>Polygonal stromal opacities separated by <br /> clear space<br /> Most frequently involve anterior stroma<br /> (anterior crocodile shagreen)<br />Occasionally involve posterior stroma<br /> (posterior crocodile shagreen)<br />
  115. 115. Cornea guttata<br /><ul><li> Common, bilateral and usually innocuous
  116. 116. Rarely progression to Fuchs dystrophy</li></ul>Tiny dark spots on central endothelium<br />
  117. 117. Lipid keratopathy<br />Primary<br />Secondary<br />Common, secondary to previous <br />disciformkeratitis<br />Rare, occurs spontaneously in <br />avascular cornea<br />Unilateral stromal deposits with <br />vascularization<br />Usually unilateral stromal deposits<br /> without vascularization<br />
  118. 118. Band keratopathy<br /><ul><li> Common, unilateral or bilateral depending on cause
  119. 119. Subepithelial calcification</li></ul>Progression<br />Central spread of calcification<br />Interpalpebrallimbalopacification<br />Small holes within calcified area<br /> Separated by clear zone<br />
  120. 120. CORNEAL DYSTROPHIES<br />1. Anterior<br /><ul><li> Cogan microcystic</li></ul>..<br /><ul><li> Reis-Bucklers
  121. 121. Meesmann
  122. 122. Schnyder</li></ul>2. Stromal<br /><ul><li> Lattice I, II, III
  123. 123. Granular I, II, III (Avellino)
  124. 124. Macular</li></ul>3. Posterior<br /><ul><li> Fuchs endothelial
  125. 125. Posterior polymorphous</li></li></ul><li>Cogan microcystic dystrophy<br /><ul><li> Most common of all dystrophies
  126. 126. Neither familial nor progressive
  127. 127. Recurrent corneal erosions in about 10% of cases</li></ul>Dots<br />Cysts<br />Fingerprints<br />Maps<br />
  128. 128. Signs of Cogan dystrophy<br />Microcysts<br />Dots<br />Maps<br />Fingerprints<br />
  129. 129. Reis-Bucklers dystrophy<br />..<br />Onset - early childhood with recurrent corneal erosions<br /> Honeycomb appearance<br />Superficial polygonal opacities<br />keratoplastyif severe<br />
  130. 130. Meesmann dystrophy<br />Onset - first decade with mild visual symptoms<br /><ul><li> Tiny, epithelial cysts, maximal centrally
  131. 131. Clear in retroillumination
  132. 132. Grey in direct illumination</li></ul>Treatment- not required<br />
  133. 133. Schnyder dystrophy<br />Onset - second decade with visual impairment<br />Subepithelial ‘crystalline’ opacities<br />Treatment- excimer laser keratectomy<br />
  134. 134. Lattice dystrophy type I<br />Onset - late first decade with recurrent corneal erosions<br />Progression<br /> Fine, spidery, branching lines within<br /> stroma<br />Later general haze may submerge <br />lesions<br />Treatment - penetrating keratoplasty if severe<br />
  135. 135. Granular dystrophy type I<br />Onset - first decade with recurrent corneal erosions<br />Progression<br />Eventual confluence<br />Initial superficial and<br />central crumb-like opacities <br />Later deeper and <br />peripheral spread but<br />limbus spared<br />Treatment - penetrating keratoplasty if severe<br />
  136. 136. Fuchs endothelial dystrophy<br />Onset - old age<br />Progression<br /> Eventually bullous <br /> keratopathy<br />Later central stromal <br /> oedema<br />Gradual increase in <br />cornea guttata with <br />peripheral spread<br />Treatment- penetrating keratoplasty if advanced<br />
  137. 137. CORNEAL ECTASIAS<br />1. Keratoconus<br />2. Keratoglobus<br />3. Pellucid marginal degeneration<br />
  138. 138. Morphological classification of keratoconus<br />Nipple cone<br />Oval cone <br />Globus cone <br />Small and steep curvature<br />Larger and ellipsoidal<br />Largest<br />
  139. 139. Signs of keratoconus<br />Bilateral in 85% but asymmetrical<br />Prominent corneal nerves<br />Oil droplet reflex<br />Vogt striae<br />Bulging of lower lids<br /> on downgaze<br />Munson sign <br />Fleischer ring & scarring<br />Acute hydrops<br />
  140. 140. Keratoglobus<br />Onset usually at birth<br />Bilateral protrusion and thinning of entire cornea <br />Associations - Leber congenital amaurosis and blue sclera<br />
  141. 141. Pellucid marginal degeneration<br /><ul><li> Onset between 20 and 40 years
  142. 142. Bilateral crescent-shaped inferior corneal thinning</li></li></ul><li>EPISCLERITIS AND SCLERITIS<br />1. Episcleritis<br /><ul><li> Simple
  143. 143. Nodular</li></ul>2. Anterior scleritis<br /><ul><li>Non-necrotizing diffuse
  144. 144. Non-necrotizing nodular
  145. 145. Necrotizing with inflammation
  146. 146. Necrotizing without inflammation</li></ul> ( scleromalaciaperforans )<br />3. Posterior scleritis<br />
  147. 147. Applied anatomy of vascular coats<br />Scleritis<br />Episcleritis<br />Normal<br /><ul><li> Maximal congestion of </li></ul> deep vascular plexus<br /><ul><li> Radial superficial </li></ul> episcleralvessels<br /><ul><li> Maximal congestion </li></ul> of episcleral vessels<br /><ul><li>Deep vascular plexus </li></ul> adjacent to sclera<br /><ul><li> Slight congestion of </li></ul>episcleral vessels<br />
  148. 148. Simple episcleritis<br /><ul><li> Common, benign, self-limiting but frequently recurrent
  149. 149. Typically affects young adults</li></ul>Simple sectorialepiscleritis<br />Simple diffuse episcleritis<br /><ul><li> Seldom associated with a systemic disorder</li></li></ul><li>Nodular episcleritis<br /><ul><li> Less common than simple episcleritis
  150. 150. May take longer to resolve
  151. 151. Treatment - similar to simple episcleritis</li></ul>Localized nodule which can be moved <br />over sclera<br />Deep scleral part of slit-beam <br />not displaced<br />
  152. 152. Diffuse anterior non-necrotizing scleritis<br /><ul><li> Relatively benign - does not progress to necrosis
  153. 153. Widespread scleral and episcleral injection</li></li></ul><li>Complications of uveitis<br />Posterior synechiae - 30%<br />Cataract -20%<br />Glaucoma due to PAS - 15%<br />Band keratopathy - 10%<br />
  154. 154. UVEAL TUMOURS<br /> 1. Iris melanoma<br /> 2. Iris naevus<br /> 3. Ciliary boy melanoma<br /> 4. Choroidal melanoma<br /> 5. Choroidalnaevus<br /> 6. Choroidalhaemangioma<br /><ul><li> Circumscribed
  155. 155. Diffuse</li></ul> 7. Choroidal metastatic carcinoma<br /> 8. Choroidal osseous choristoma<br />9. Melanocytoma<br />
  156. 156. Iris Melanoma<br /> 1. Very rare - 8% of uveal melanomas<br /> 2. Presentation - fifth to sixth decades<br /> 3. Very slow growth<br /> 4. Low malignancy<br /> 5. Excellent prognosis<br />
  157. 157. Iris melanoma<br />Usually pigmented nodule at <br /> least 3 mm in diameter<br />Invariably in inferior half of iris<br />Occasionally non-pigmented<br />Surface vascularization<br />Angle involvement may <br /> causeglaucoma<br />Pupillarydistortion, ectropion<br />uveaeand cataract<br />
  158. 158. Differential diagnosis of iris melanoma<br /> Adenoma of pigment<br /> epithelium<br /> Large iris naevus distorting<br /> pupil<br />Leiomyoma<br />Ciliary body melanoma<br /> eroding iris root<br /> Metastasis to iris<br /> Primary iris cyst<br />
  159. 159. Iris naevus<br />Diffuse<br />Typical<br /><ul><li>Pigmented, flat or slightly elevated
  160. 160. May cause ipsilateralhyperchromic</li></ul>heterochromia<br /><ul><li>Diameter usually less than 3 mm
  161. 161. Occasionally mild distortion of pupil </li></ul>anectropionuvea<br /><ul><li> May be associated with </li></ul>Cogan-Reese syndrome<br />
  162. 162. Ciliary body melanoma<br /><ul><li> Rare - 12% of uveal melanomas
  163. 163. Presentation - 6th decade
  164. 164. May be discovered by chance
  165. 165. Prognosis - guarded</li></li></ul><li>Anterioruveitis<br />Symptoms:acute iritis causes a sudden onset of unilateral photophobia, redness, pain and blurred vision. In chronic anterior uveitis symptoms may initially be absent or mild.<br />Signs:Circumcorneal injection and a small pupil in acute iritis. <br />Keratic precipitates may be small in acute iritis or large and mutton fat in granulomatous inflammation. Hypopyon and a fibrinousexudate. <br />
  166. 166. Anterioruveitis<br />Posterior synechiae<br />Hypopyon<br />
  167. 167. Acute anterior uveitis in young adults<br /><ul><li> Majority are men
  168. 168. 45% are positive for HLA-B27
  169. 169. Initially no systemic disease
  170. 170. Minority subsequently develop ankylosing spondylitis</li></ul>Fibrinousexudate<br /> Residual pigment on lens<br />
  171. 171. 4. Behçet disease<br />5.Vogt-Koyanagi-Harada syndrome<br />7. Tubulointerstitialnephritis<br />5<br />5<br />IMPORTANT SYSTEMIC ASSOCIATIONS OF UVEITIS<br />1. Spondylarthropathies<br />2. Juvenile idiopathic arthritis<br />3. Sarcoidosis<br /><ul><li> Systemic features
  172. 172. Ocular features
  173. 173. Systemic features
  174. 174. Ocular features</li></ul>6. Inflammatory bowel disease<br /><ul><li> Ulcerative colitis
  175. 175. Crohn disease</li></li></ul><li>ACQUIRED CATARACT<br />1. Classification of age-related cataract<br /><ul><li> Morphological
  176. 176. According to maturity</li></ul>2. Other causes of cataracts<br /><ul><li> Diabetes
  177. 177. Myotonic dystrophy
  178. 178. Atopic dermatitis
  179. 179. Trauma
  180. 180. Drugs
  181. 181. Secondary (complicated)</li></ul>3. Surgery<br /><ul><li> Large incision extracapsular extraction
  182. 182. Phacoemulsification</li></li></ul><li>Classification of Age-related Cataract<br /> According to Morphology<br />1. Subcapsular<br /><ul><li> Anterior
  183. 183. Posterior</li></ul>2. Nuclear<br />3. Cortical<br />4. Christmas tree<br />
  184. 184. Subcapsular cataract<br />Anterior<br />Posterior<br />
  185. 185. Nuclear cataract<br />Progression<br /><ul><li>Exaggeration of normal nuclear</li></ul> ageing change<br /><ul><li> Increasing nuclear opacification
  186. 186. Causes increasing myopia
  187. 187. Initially yellow then brown</li></li></ul><li>Cortical cataract<br />Progression<br />Progressive radial spoke-like opacities<br />Initially vacuoles and clefts<br />
  188. 188. Christmas tree cataract<br />Polychromatic, needle-like opacities<br />May co-exist with other opacities<br />
  189. 189. Classification according to maturity<br />Immature<br />Mature<br />Hypermature<br />Morgagnian<br />
  190. 190. Other causes of cataract - diabetes<br />Juvenile<br />Adult<br /><ul><li>Cortical and subcapsular</li></ul> opacities<br /><ul><li>White punctate or snowflake</li></ul> posterior or anterior opacities<br /><ul><li> May progress more quickly</li></ul>thanin non-diabetics<br /><ul><li> May mature within few days</li></li></ul><li>Other causes of cataract - atopic dermatitis<br /><ul><li>Cataract develops in 10% </li></ul> of cases between 15-30 years<br /><ul><li> Anterior subcapsular plaque</li></ul> (shield cataract)<br /><ul><li>Bilateral in 70%
  191. 191. Wrinkles in anterior capsule
  192. 192. Frequently becomes mature</li></li></ul><li>Causes of traumatic cataract<br />Concussion <br /> ‘Vossius’ ring from<br /> imprinting of iris pigment<br /> Flower-shaped<br />Penetration<br />Other causes <br /><ul><li> Ionizing radiation
  193. 193. Electric shock
  194. 194. Lightning</li></li></ul><li>Drugs<br />Chlorpromazine<br />Systemic or topical steroids<br />- initially posterior subcapsular<br />- central, anterior capsular granules<br /><ul><li> Long-acting miotics</li></ul>Other drugs<br /><ul><li>Amiodarone
  195. 195. Busulphan</li></li></ul><li>Secondary (complicated) cataract<br />Posterior subcapsular<br />Glaukomflecken<br /><ul><li> Chronic anterior uveitis
  196. 196. Follows acute angle-closure glaucoma
  197. 197. High myopia
  198. 198. Central, anterior subcapsular</li></ul> opacities<br /><ul><li> Hereditary fundus dystrophies</li></li></ul><li>Lenticonus<br />Posterior<br />Anterior<br /><ul><li>Posterior axial bulge
  199. 199. Anterior axial bulge
  200. 200. Unilateral - usually sporadic
  201. 201. Associated with Alport syndrome
  202. 202. Bilateral - familial or in Lowe</li></ul> syndrome<br />
  203. 203. ECTOPIA LENTIS<br />1. Acquired<br />2. Isolated familial ectopialentis<br />3. Associated with systemic syndromes<br /><ul><li>Marfan syndrome
  204. 204. Weill-Marchesani syndrome
  205. 205. Homocystinuria </li></ul>4. Treatment options<br />
  206. 206. Acquired ectopialentis<br />Stretched zonules<br />Trauma<br /><ul><li>Buphthalmos
  207. 207. Megalocornea</li></ul>Anterior uvealtumours<br />Degenerate eye<br />
  208. 208. Ocular features of Marfan syndrome<br />Upward subluxation<br />Lattice <br />degeneration<br />Axial myopia<br />Zonuleusually intact<br />Angle anomaly and <br />glaucoma<br />Blue sclera<br />Cornea plana<br />
  209. 209. Weill-Marchesani syndrome<br />Ocular features<br />Systemic features<br />Short stature<br />Microspherophakia<br />Short stubby fingers (brachydactyly)<br />Usually anterior lens subluxation<br />Mental handicap<br />Angle anomaly and glaucoma<br />
  210. 210. Homocystinuria<br /><ul><li> Defect in cystathio beta-synthase</li></ul>Systemic features<br />Ocular features<br />Malarflush and fine, fair hair<br />Downward lens subluxation<br />Marfanoidhabaitus<br />Disintegration of zonule<br />Increased platelet stickiness<br />Mental handicap<br />
  211. 211. Treatment Options for EctopiaLentis<br />1. Spectacle correction<br /><ul><li> For induced astigmatism
  212. 212. For aphakic portion</li></ul>2. Nd:YAG laser zonulysisto displace lens out of visual axis<br />3. Surgical removal<br /><ul><li> Associated cataract
  213. 213. Lens-induced glaucoma
  214. 214. Endothelial touch
  215. 215. When other methods are inappropriate</li></li></ul><li>Refrerencfes<br />Jack J Kanski. ClinicalOphtalmology. A Systemicapproach<br />Jack J Kanski. IllustratedTutorials<br />

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