Clinical Pathology of the Eye

Vocabulary flashcards identifying ocular pathologies, their symptoms, clinical signs, and underlying causes based on the lecture notes.

Painful sudden loss of vision

• Optic neuritis • Retrobulbar neuritis • Anterior uveitis • Acute angle closure glaucoma • Orbital cellulitis • Microbial keratitis • Acanthamoeba keratitis • Chemical injury • Penetrating injury

painless sudden loss of vision

• Retinal detachment • Vitreous haemorrhage • Non-arteritic AION • Arteritic AION • Wet AMD • Diabetic maculopathy • Central serous retinopathy • CRAO • BRAO • CRVO • BRVO

gradual loss vision

• Refractive error (myopia/hyperopia/astigmatism) • Keratoconus • Cataract • Primary open angle glaucoma • Dry age-related macula degeneration • Retinitis pigmentosa • Diabetic retinopathy

painfull red eye

• Acute angle closure glaucoma • Anterior uveitis • Scleritis • Orbital cellulitis • Chemical injury • Penetrating injury • Microbial keratitis • Acanthamoeba keratitis

painless red eyee

• Episcleritis • Subconjunctival haemorrhage • Pterygium • Allergic conjunctivitis • Bacterial conjunctivitis • Viral conjunctivitis

Optic neuritis

Inflammation affecting the myelin lining of the optic nerve, associated with multiple sclerosis and causing painful sudden loss of vision, desaturation of red, and pain on eye movement.

• Inflammation which affects myelin lining of the optic nerve • Sxs- pain on eye movement, Desaturation of red, Pain worse when exercising/drinking tea/heated environment and reduced vision unilateral • WHO? Multiple sclerosis, infection/injury to ON • Signs- pain on motility, swollen optic nerve, desaturation of red on CV test, reduced VA, RAPD • Refer urgently to HES- Tx underlying condition, steroids for inflammation! • Layman's explanation: The ONH is the structure at the back of the eye which is responsible for carrying visual info from the eye to the brain. Inflammation of the nerve can cause a swelling appearance. This can lead to reduced vision, eye pain, fading of colour red. We call this optic neuritis. You have come in today with similar sxs and after examining your eyes it appears that you may have optic neuritis. I understand you were not expecting to hear this today, but its good that you have come in today and we have been able to pick this up. There is Tx for this so I would like to refer you to an eye Dr who will be able to carry out further tests and investigate what is causing this inflammation. They will treat the inflammation possibly using steroid drops. The Dr may put some drops into your eyes which will make your pupils larger, so they can examine the back of your eyes thoroughly. The drops will make your vision blurry so you wont be able to drive. So I would advice you to take someone with you or get a taxi. Do you have any questions?

Arteritic AION

Sudden painless loss of vision due to ischaemia of the optic nerve caused by inflammation of the artery supplying the ONH, often associated with Giant Cell Arteritis ($GCA$) or temporal arteritis.

• Lack of blood supply and ischaemia to optic nerve due to inflammation of artery supply the ONH • Sxs: Sudden monocular loss of vision, headache, tender scalp, pain on chewing , lethargic, nodular temporal artery, fever, joint/muscle pain • Signs: Pale swollen OD with/without splinter haem, RAPD, altitudinal VF defect • WHO? GCA (temporal arteritis)- Inflammation of medium sized blood vessels • Refer emergency to HES • Layman's explanation: You have come in today as you have noticed the vision in your eye to be blurry. The optic nerve head is a structure at the back of the eye which is responsible for carrying visual information from the eye to the brain. If blood flow to the nerve is reduced due to inflammation of an artery this also reduces the oxygen to the nerve.. This can cause vision to be blurry and also cause jaw pain and your scalp to feel tender. We call this arteritic anterior ischaemic optic neuropathy. You have come in today reporting similar sxs of reduced vision and pain in you jaw, it appears that you have AAION. I understand you were not expecting to hear this today the good thing is you have come in today and we have been able to pick this up. If this is left untreated it can potentially cause further damage to the nerve resulting in further vision loss. There is Tx available for this so I would like to refer you to an eye Dr who will investigate this further and carry out the appropriate Tx. Usually they give steroid to treat the inflammation and allow blood flow to the nerve. The Dr may also put some drops into your eyes which will make your pupils bigger. This is so they can have a good look at the back of your eye. The drops will make your vision blurry so you wont be able to drive, so I would advice you to take someone with you or get a taxi. Do you have any questions? • HES Tx- High dose corticosteroids

Non-arteritic AION

Sudden painless loss of vision caused by reduced blood supply to the optic nerve due to vascular reasons like blood pressure, diabetes, or raised cholesterol.

Papilloedema

Swelling of the optic disc secondary to raised intracranial pressure, characterized by elevated discs, blurring of margins, and venous engorgement.

Primary open angle glaucoma (POAG)

Optic neuropathy involving acquired atrophy of the optic nerve and loss of retinal ganglion cells, characterized by vertical elongation of the cup, thinning of the NRR, and nasal step/arcuate scotomas.

Acute angle closure glaucoma (AACG)

A painful red eye condition with reduced vision and haloes around lights caused by narrowed drainage channels and a rapid build-up of fluid pressure ($IOP$).

Dry age-related macula degeneration

Gradual painless loss of central vision characterized by the presence of drusen, hyper/hypo-pigmentation, and geographic atrophy.

Wet age-related macula degeneration

Sudden painless loss of central vision involving distortion on Amsler grids and signs such as exudates, haemorrhages, and Choroidal Neovascularisation ($CNV$).

Central serous retinopathy (CSR)

Sudden painless loss of vision common in young white men associated with stress, involving fluid leaking from the choroid vessel layer and a hyperopic shift in prescription ($Rx$).

Diabetic maculopathy

Sudden painless loss of central vision in diabetic patients characterized by exudates, haemorrhages, and Subretinal Fluid ($SRF$) in the macula.

Macula Hole

Sudden painless loss of vision or distortion characterized by a brick red full thickness hole at the macula.

Epiretinal membrane (Cellophane maculopathy)

Scar tissue that grows over and contracts on the macula, giving it a wrinkly appearance and causing distorted vision.

Branched retinal vein occlusion (BRVO)

Sudden painless loss of vision caused by a blockage in one of the bốn veins, resulting in flame and dot/blot haemorrhages in a specific quadrant.

Central retinal vein occlusion (CRVO)

Sudden blurry vision with a 'thunder' appearance of the retina due to the main vein being blocked, characterized by dilated tortuous vessels and macula oedema.

Branched retinal artery occlusion (BRAO)

Sudden painless loss of vision featuring retinal cloudiness or pallor in a quadrant due to arterial blockage, linked to atherosclerosis or $HBP$.

Central retinal artery occlusion (CRAO)

Sudden profound loss of vision ($HM$ or less) with a pale retina and a cherry red spot at the macula due to a main artery blockage.

Retinal detachment (RD)

Sudden painless loss of vision featuring flashing lights, floaters, and a shadow over vision, with clinical signs like elevation of the retina and a positive Shafer's sign.

Malignant Melanoma

A choroidal tumour appearing as a black, brown, or grey oval mass with orange lipofuscin pigment, which may require brachytherapy or enucleation.

Diabetic retinopathy (DR)

Retinal changes due to diabetes categorized as Background (microaneurysms), Pre-proliferative ($CWS$, $IRMA$), or Proliferative (neovascularisation).

Posterior vitreous detachment (PVD)

A common age-related condition where the vitreous humour shrinks and separates from the retina, causing floaters and flashing lights.

Anterior Uveitis

Inflammation of the uvea ($iris$, $ciliary body$, and $choroid$) causing a painful red eye, photophobia, limbal redness, and cells or flare in the anterior chamber.

Nuclear sclerosis

A type of cataract in the lens nucleus causing reduced contrast, blurry vision, and a myopic shift.

Scleritis

A sight-threatening painful red eye condition with deep boring pain and a deep violet-bluish hue that does not blanch with phenylephrine.

Episcleritis

Sudden onset unilateral painless red eye involving hyperaemia of episcleral vessels that do blanch with phenylephrine.

Subconjunctival haemorrhage

A painless red eye caused by a broken blood vessel beneath the conjunctiva, often following a Valsalva manoeuvre like coughing or sneezing.

Pinguecula

A benign white-yellow fat-like conjunctival thickening at the $3$ and $9$ o'clock positions caused by UV exposure.

Pterygium

A triangular fibrovascular growth progressing from the bulbar conjunctiva to involve the cornea, often Nasally and Bilaterally.

Acanthamoeba keratitis

A painful red eye infection caused by a microbe found in non-sterile water, common in soft contact lens wearers who use water for lens care.

Herpes simplex keratitis (HSK)

A painful red eye infection characterized by epithelial punctate lesions coalescing into a dendriform pattern or dendritic ulcer.

Hutchinson's sign

A sign in Herpes zoster ophthalmicus ($HZO$) where a rash involves the tip of the nose, indicating activation of the trigeminal nerve.

Keratoconus

A condition where the cornea thins and bulges outwards into a cone shape, causing increasing astigmatism and signs like Fleischer's ring or Munson's sign.

Anterior blepharitis

Inflammation of the lid margins involving either staphylococcal infection (collarets) or seborrheic scales and greasy lashes.

Meibomian gland dysfunction (MGD)

Posterior blepharitis where glands along the lid margins become blocked, leading to reduced lipid in tears and symptoms of dry eye.

Trichiasis

A condition where eye lashes are misdirected and point inwards toward the corneal surface, causing irritation and corneal abrasion.

Ectropion

A condition where the inferior lid margin turns outwards and is not in contact with the globe, leading to sore, watery eyes.

Entropion

Inversion of the lower eyelid, causing painful irritation as lashes rub against the cornea.

Basal cell carcinoma (BCC)

A painless pearly nodule on the eyelid with central ulceration and crusting, associated with sun exposure and fair skin.

Third nerve palsy

A condition causing a 'down and out' eye position, ptosis, and sometimes a dilated pupil if caused by a $PCA$ aneurysm.

Fourth nerve palsy

A condition resulting in vertical diplopia that is worse when looking downwards, presenting as hypertropia in primary gaze.

Sixth nerve palsy

A condition where the eye cannot abduct, leading to esotropia and side-to-side diplopia.

SEAL (Superior Epithelial Arcuate Lesion)

A thin white arcuate lesion on the superior cornea caused by stiff, high modulus contact lens materials rubbing against the eye.

Giant papillary conjunctivitis (GTPC)

Contact lens associated inflammation showing cobblestone-like papillae on the upper tarsal conjunctiva.

Contact lens acute red eye (CLARE)

A painful red eye upon waking caused by an inflammatory response to gram-negative bacteria under a contact lens.

Convergence insufficiency

Reduced ability to move eyes inwards together for near tasks, characterized by a reduced near point of convergence ($npc$) of $<10cm$.

Accommodative insufficiency

Inability to focus or maintain focus for close-up tasks, characterized by a reduced amplitude of accommodation ($AOA$).

Differential prism

Eyestrain or diplopia caused by a large difference in prescription ($Anisometropia$) between eyes when looking away from the lens centers.