Sclera/Episclera, Uvea/Iris, Vitreous, & Glaucoma.

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Presentation transcript:

Sclera/Episclera, Uvea/Iris, Vitreous, & Glaucoma

Baby picture of the day!

Glaucoma

Drainage system of the eye does not drain aqueous quickly enough (production is faster than drainage) Aqueous fluid builds up and intraocular pressure (IOP) increases Increased IOP puts pressure on the optic nerve, damages the nerve The damaged part of the optic nerve cannot carry visual information from the eye to the brain, so a visual field develops that corresponds to the damaged part of the optic nerve. Treatment involves decreasing intraocular pressure, either by decreasing aqueous production or increasing aqueous outflow.

Episcleritis Young adults Idiopathic mostly (some associated with systemic/ autoimmune disease) Unilateral red eye, usually no pain

Scleritis RarePainful! Non-necrotizing: diffuse or nodular Necrotizing: with or without inflammation Scleromalacia Perforans = necrotizing without inflammation (associated with rheumatoid arthritis)

Axenfeld’s Nerve Loop Posterior ciliary nerve loop visible in sclera Focal pigmented area Not a feeder vessel!

Anterior Uveitis Associated systemic disorders: UCRAP (ulcerative colitis, Crohn’s disease, reactive arthritis, ankylosing spondylitis, psoriatic arthritis) 50% idiopathic Breakdown of blood-aqueous barrier  flare (protein) into aqueous  hypopyon Pain, redness, photophobia (or asymptomatic of chronic) Consider: posterior synechiae, peripheral anterior synechiae, cystoid macular edema, PSC cataract

Posterior Uveitis Inflammation of choroid Consider: toxoplasmosis, sarcoidosis, syphilis, cytomegalovirus (CMV) Vitritis, “headlights in the fog”

Iris Coloboma Incomplete closure of the embryonic fissure inferiorly Inferior nasal Often occur with other colobomas

Iris Malignancy Irregular “feathery” margins Nevus

Asteroid Hyalosis Calcium-phosphate soaps in vitreous Asymptomatic, no effect on vision

Synchysis Scintillans Cholesterol crystals mobile in vitreous cavity Occurs after chronic uveitis, vitreous heme, or trauma

Posterior Vitreous Detachment (PVD) Prevalence = age after 50yo Risk factors: myopia, DM, surgery, inflammation, vitreous hemorrhage, trauma Posterior hyaloid (vitreous) detaches from the retina, liquid leaks through & pushes them apart Symptoms: floaters & photopsia Sign: Weiss ring Concerns: retinal detachment from vitreous traction

Preretinal/Vitreous Hemorrhages Cause: proliferative retinopathy (diabetes, sickle cell) Preretinal hemorrhage: no symptoms  Vitreous hemorrhage: sudden, painless vision loss