Sclera/Episclera, Sclera/Episclera, Uvea/Iris, Uvea/Iris,

Vitreous, & Vitreous, & GlaucomaGlaucoma

Baby picture of Baby picture of the day!the day!

GlaucomaGlaucoma

Drainage system of the eye does not drain Drainage system of the eye does not drain aqueous quickly enough (production is faster aqueous quickly enough (production is faster than drainage)than drainage)

Aqueous fluid builds up and intraocular Aqueous fluid builds up and intraocular pressure (IOP) increasespressure (IOP) increases

Increased IOP puts pressure on the optic Increased IOP puts pressure on the optic nerve, damages the nervenerve, damages the nerve

The damaged part of the optic nerve cannot The damaged part of the optic nerve cannot carry visual information from the eye to the carry visual information from the eye to the brain, so a visual field develops that brain, so a visual field develops that corresponds to the damaged part of the optic corresponds to the damaged part of the optic nerve.nerve.

Treatment involves decreasing intraocular Treatment involves decreasing intraocular pressure, either by decreasing aqueous pressure, either by decreasing aqueous production or increasing aqueous outflow.production or increasing aqueous outflow.

EpiscleritisEpiscleritis

Young adultsYoung adults

Idiopathic mostly Idiopathic mostly (some associated (some associated with systemic/ with systemic/ autoimmune autoimmune disease)disease)

Unilateral red eye, Unilateral red eye, usually no painusually no pain

ScleritisScleritisRareRare

Painful!Painful!

Non-necrotizing: Non-necrotizing: diffuse or nodulardiffuse or nodular

Necrotizing: with or Necrotizing: with or without inflammationwithout inflammation

Scleromalacia Scleromalacia Perforans = necrotizing Perforans = necrotizing without inflammation without inflammation (associated with (associated with rheumatoid arthritis)rheumatoid arthritis)

Axenfeld’s Nerve Axenfeld’s Nerve LoopLoop

Posterior ciliary Posterior ciliary nerve loop visible in nerve loop visible in sclerasclera

Focal pigmented Focal pigmented areaarea

Not a feeder vessel!Not a feeder vessel!

Anterior UveitisAnterior UveitisAssociated systemic Associated systemic disorders: UCRAP disorders: UCRAP (ulcerative colitis, (ulcerative colitis, Crohn’s disease, reactive Crohn’s disease, reactive arthritis, ankylosing arthritis, ankylosing spondylitis, psoriatic spondylitis, psoriatic arthritis)arthritis)

50% idiopathic50% idiopathic

Breakdown of blood-Breakdown of blood-aqueous barrier aqueous barrier flare flare (protein) into aqueous (protein) into aqueous hypopyonhypopyon

Pain, redness, Pain, redness, photophobia (or photophobia (or asymptomatic of chronic)asymptomatic of chronic)

Consider: posterior Consider: posterior synechiae, peripheral synechiae, peripheral anterior synechiae, anterior synechiae, cystoid macular edema, cystoid macular edema, PSC cataractPSC cataract

Posterior UveitisPosterior UveitisInflammation of Inflammation of choroidchoroid

Consider: Consider: toxoplasmosis, toxoplasmosis, sarcoidosis, syphilis, sarcoidosis, syphilis, cytomegalovirus cytomegalovirus (CMV)(CMV)

Vitritis, “headlights Vitritis, “headlights in the fog”in the fog”

Iris ColobomaIris ColobomaIncomplete closure Incomplete closure of the embryonic of the embryonic fissure inferiorlyfissure inferiorly

Inferior nasalInferior nasal

Often occur with Often occur with other colobomasother colobomas

Iris MalignancyIris MalignancyIrregular “feathery” Irregular “feathery” marginsmargins

Nevus Nevus

Asteroid HyalosisAsteroid HyalosisCalcium-phosphate Calcium-phosphate soaps in vitreoussoaps in vitreous

Asymptomatic, no Asymptomatic, no effect on visioneffect on vision

Synchysis Synchysis ScintillansScintillans

Cholesterol crystals Cholesterol crystals mobilemobile in vitreous in vitreous cavitycavity

Occurs after chronic Occurs after chronic uveitis, vitreous uveitis, vitreous heme, or traumaheme, or trauma

Posterior Vitreous Posterior Vitreous Detachment Detachment

(PVD)(PVD)Prevalence = age after Prevalence = age after 50yo50yo

Risk factors: myopia, DM, Risk factors: myopia, DM, surgery, inflammation, surgery, inflammation, vitreous hemorrhage, vitreous hemorrhage, traumatrauma

Posterior hyaloid Posterior hyaloid (vitreous) detaches from (vitreous) detaches from the retina, liquid leaks the retina, liquid leaks through & pushes them through & pushes them apartapart

Symptoms: floaters & Symptoms: floaters & photopsiaphotopsia

Sign: Weiss ringSign: Weiss ring

Concerns: retinal Concerns: retinal detachment from vitreous detachment from vitreous tractiontraction

Preretinal/Preretinal/Vitreous Vitreous

HemorrhagesHemorrhagesCause: proliferative Cause: proliferative retinopathy retinopathy (diabetes, sickle cell)(diabetes, sickle cell)

Preretinal Preretinal hemorrhage: no hemorrhage: no symptoms symptoms

Vitreous Vitreous hemorrhage: hemorrhage: sudden, painless sudden, painless vision lossvision loss