structural eye disorders

Structural Eye DisordersJason Ryan, MD, MPH

Eye Structures

• Pupil/Iris

• Lens

• Sclera

• Conjunctiva

• Cornea

• Uvea

• Retina/Macula

Sclera and Cornea

Petr Novák, Wikipedia

Wikipedia/Public Domain

Sclera and Cornea

Blausen.com staff. "Blausen gallery 2014". Wikiversity Journal of Medicine.

Sclera

• Composed of collagen

• Rigid structure – stabilizes eyeball

• Extraocular muscles insertion site

• Avascular

• Nutrients from episclera and choroid


Scleritis

• Inflammation of sclera

• Dark red eyes

• Severe “boring” pain with eye movement

• Potentially blinding

Kribz/Wikipedia

Scleritis

• 50% cases associated with systemic disease

• Rheumatoid arthritis is most common

Phoenix119/Wikipedia

Episcleritis

• Acute inflammation

• Episclera layer only

• Usually idiopathic

• Tearing

• Localized redness

• Mild or no pain

• Usually self-limited

• Also associated with rheumatoid arthritis

Asagan/Wikipedia

Keratitis

• Corneal inflammation

• Bacterial/viral/fungal

• Contact lens wearers

• Pain/Photophobia

• Red eye

• Foreign body sensation

• Sight threatening disorderאיתן טל

Corneal Abrasion

• Common among contact lens wearers

• Painful (due to superficial cornea nerve endings)

• Visualized with fluorescein dye and blue light

• Can become infected with pseudomonas

• Often treated with ciprofloxacin eye drops

Chricres/Slideshare

HSV-1

• Causes herpes labialis

• Can also cause keratoconjunctivitis• Infection of cornea/conjunctiva

• Pain, redness, discharge

• Most ocular disease is recurrent HSV • Reactivation after establishment of viral latency

Conjunctiva

Lady Weaxzezz/Wikipedia

Conjunctivitis

• Viral, bacterial, allergic

• Conjunctival injection

• Discharge

• Commonest “red eye”

Joyhill09/Wikipedia

Conjunctivitis

• Viral causes (80%)• Adenovirus

• Measles

• HSV-1

• Bacterial causes • S. Aureus

• H. influenza

• Neisseria

• Chlamydia

Image courtesy of Joyhill09

Adenovirus

• 65% to 90% viral conjunctivitis

• Watery discharge

• Non-enveloped, DNA virus

• Also causes pharyngitis, pneumonia

Adenovirus

• Very stable - survive on surfaces

• Transmission:• Aerosol droplets

• Fecal-oral

• Contact with contaminated surfaces

Measles VirusRubeola

• Paramyxovirus

• Enveloped, RNA virus

• Cough, Coryza, Conjunctivitis

• Maculopapular rash

• Koplik spots in mouth


Bacterial Conjunctivitis

• Copious purulent discharge

• Adults:• Staph aureus, S pneumonia, H influenzae

• Children• H influenzae, S pneumoniae, and Moraxella catarrhalis

Neonatal Conjunctivitis

• Ophthalmia neonatorum

• Neisseria gonorrhea or Chlamydia

• Infection from passage through birth canal

• Untreated can lead to visual impairment

• Prophylaxis: Erythromycin ophthalmic ointment

Reactive Arthritis

• Autoimmune arthritis triggered by infection

• Intestinal infections• Salmonella, Shigella, Campylobacter, Yersinia, C. Difficile

• Chlamydia trachomatis

• Classic triad (Reiter's syndrome)• Arthritis

• Conjunctivitis (red eye, discharge)

• Urethritis (dysuria, frequency)

Allergic Conjunctivitis

• Bilateral, itchy, watery eyes

• Type I hypersensitivity reaction

• Histamine release

• Treatment: antihistamines

Eddie314/Wikipedia

Uvea


Uveitis

• Uveal coat inflammation• Iris, ciliary body, choroid

• White cells in uvea


UveitisTerminology

• Anterior uveitis• Iritis; Iridocyclitis

• Intermediate uveitis• Vitreous humor inflammation

• Posterior uveitis• Chorioretinal inflammation


UveitisSymptoms

• Anterior uveitis: pain, redness

• Posterior uveitis: painless, floaters, ↓ vision

UveitisCauses

• Can be infectious • Often agents that infect CNS

• HSV, CMV, Toxoplasmosis, Syphilis

• Often associated with systemic inflammatory disease

UveitisAssociations

• Ankylosing spondylitis

• Reactive arthritis

• Juvenile idiopathic arthritis

• Rheumatoid arthritis

• Sarcoid

• Psoriatic arthritis

• Inflammatory bowel disease

Hypopyon

• Inflammatory infiltrate in anterior chamber

• Seen in endophthalmitis• Inflammation of aqueous and/or vitreous humor

• Can be seen in keratitis, uveitis

• Bacterial or sterile

EyeMD (Rakesh Ahuja, M.D.).

Hyphema

• Blood enters anterior chamber

• May occur after trauma

• Can lead to permanent vision loss


structural eye disorders

Documents