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Flashcards Pathology
Flashcards Pathology
What is the term for epithelium growing on both sides of the cornea?;"● Epithelium
growing on both sides of the cornea is
termed epithelial downgrowth
● Most commonly seen from multiple prior surgeries
such as ECCE and PKP"
What are the characteristic findings in Granulomatosis with Polyangiitis (GPA) and
what vessels are involved?;"● Chronic sinusitis
● Saddle Nose deformity
● Granulomatous inflammation with necrosis
● Small and medium size blood vessels are usually
involved"
What is the most common extraocular tumor that spreads into the eye via direct
extension?;"● Squamous Cell Carcinoma of the Conjunctiva
○ Typically mucoepidermoid carcinoma or
spindle cell variant"
What was the main conclusion of the LARGE choroidal melanoma trial?;"● Adjunctive
radiotherapy did not improve overall
survival"
What was the main conclusion of the MEDIUM choroidal melanoma trial?;"● Mortality
was similar between brachytherapy and
enucleation groups
● Histologically confirmed metastases were found in
approximately 10% patients treated with
enucleation"
What was the main conclusion of the SMALL choroidal melanoma trial?;"● Mortality
was 1% at 5 years with observation only"
What cell type produces the myelin sheath of the optic nerve?;"● Oligodendrocyte"
What function do astrocytes have?;"● Support and nutrition to the optic nerve and
retina"
What are the similarities and differences between the pathology of pterygia and
pingueculae?;"● Similarities:
○ Both have fragmented stromal collagen with
basophilic “elastotic” degeneration
○ Degeneration is due to chronic UV light
exposure
● Differences:
○ Pterygia = involves the cornea and
destruction of Bowman’s layer
<img src='https://aao-resources-enformehosting.s3.amazonaws.com/resources/
Residents/Flashcards/images/content/pathology_18.png'>"
What are the favorable and unfavorable risk factors in conjunctival melanoma?;"●
Favorable:
○ Epibulbar
● Unfavorable
○ Location:
■ Palpebral, caruncle, eyelid margin,
fornix (non-limbal)
○ Invasion into deeper tissues
○ Thickness > 1.8 mm
○ Pagetoid or full thickness intraepithelial
spread
○ Lymphatic invasion
○ Mixed cell type
○ De novo origin
○ Residual involvement at the surgical margin"
What is a Mittendorf dot and where is it most commonly located?;"● Remnant of the
hyaloid artery of primary vitreous
at its attachment to the tunica vasculosa lentis
● Most commonly located inferonasally"
What are the criteria of the Reese Ellsworth Classification for retinoblastoma?
What is it useful for?;"● Classification by:
○ Number
○ Size
○ Location
○ Presence or absence of vitreous seeding
● Used after external beam radiation for RB lesions,
does not give prognostic information"
What is the presentation of a ciliary body melanoma?;"● Can range from completely
asymptomatic to visual loss, photopsias, and visual field loss"
What are the average ages of retinoblastoma diagnosis in patients with family
history and patients without family history with unilateral or bilateral
disease?;"● Positive family history: 8 months
● Negative family history, bilateral disease: 12
months
● Negative family history, unilateral disease: 24
months"
Where are Koeppe iris nodules located and what conditions are they associated
with?;"● Located at the pupillary margin
● Associated with granulomatous uveitis:
○ Sarcoidosis
○ Tuberculosis
○ Syphilis
○ Lyme"
What condition are cerebellar hemangioblastomas associated with and what other
problems are associated with this condition?;"● Von Hippel Lindau Syndrome
● Also associated with retinal hemangioblastomas
and increased risk of renal cell carcinoma and
pheochromocytoma"
What is the structure of the cells in the outer plexiform layer and what pathology
can this result in?;"● The outer plexiform layer is composed of neuronal
synapses that are obliquely oriented AKA the nerve
fiber layer of Henle
● The oblique orientation in this area accounts for
flower-like (petalloid) pattern of leakage seen on
IVFA for macular edema"
What histologic features of choroidal melanoma are associated with increased rate
of metastasis?;"● High mitotic index
● High cell proliferation
● Complex microvascular patterns
● Tumor infiltration
● Lymphocytes
● Trisomy 8
● Monosomy 3
● Predominance of epithelioid cells"
What makes up the primary, secondary, and tertiary vitreous?;"● Primary: hyaloid
artery, vasa hyaloidea propia,
mesenchymal cells, tunica vasculosa lentis
● Secondary: adult vitreous body; replaces primary
around 9th week of gestation
● Tertiary: zonular fibers"
What features are unique to sarcoid lesions of the optic nerve compared to sarcoid
lesions of the eye itself?;"● Sarcoid granulomas of the optic nerve may have
necrosis (caseating granulomas or noncaseating)"
What are the features of choroidal melanoma on A scan and B scan?;"● A scan: low
amplitude internal reflections
● B scan: mushroom shaped mass or dome shaped;
can see invasion through Bruch’s membrane"
What are the two growth patterns of retinoblastoma?;"● Endophytic: grow from the
retinal surface and
project into the vitreous cavity; more associated
with vitreous seeding
● Exophytic: grow underneath the retina and toward
sclera; more associated with serous RD"
What corneal dystrophies are associated with TGFB1 mutations?;"● TGFB1 mutations
cause abnormal keratoepithelin
● LARGE
○ Lattice (Type 1)
○ Avellino
○ Reis-Bucklers and Thiel-Behnke
○ Granular (Groenouw type 1)
○ Empty"
Rank the stromal corneal dystrophies from highest to lowest rate of recurrence.;"●
Lattice > Granular > Macular"
What percentage of patients with very ischemic CRVO develop NVI/NVA and what is the
most important predictive factor?;"● High, up to 60%
● Over a mean of 3-5 months after the onset of
symptoms
● Most important predictive risk factor is poor visual
acuity"
What is Meretoja syndrome? What gene mutation is it associated with? How does it
present?;"● Also known as lattice corneal dystrophy type 2, but
is not a true dystrophy due to the systemic
involvement
● Caused by mutation of gelsolin gene
● Presentation: corneal lattice-like changes with
systemic amyloidosis, masked facies,
dermatochalasis, lagophthalmos, pendulous ears,
dry/lax skin, cranial/peripheral nerve palsies,
orthostasis hypotension, cardiac conduction
abnormalities, problems with perspiration"
What are the similarities and differences of Reis-Bucklers Corneal Dystrophy and
Thiel-Behnke Corneal Dystrophy?;"● Both are due to TGFB1 mutations
● Reis-Bucklers: autosomal dominant, painful
recurrent erosions, 1st/2nd decade, affects
Bowman’s layer, more common to have recurrent
erosion episodes and more severe stromal scarring
● Thiel Behnke: also affects Bowman’s layer; has
curly fibers on electron microscopy"
What is the appearance of an eosinophil and what pathology are they most commonly
associated with?;"● Bilobed nucleus with abundant intracytoplasmic
eosinophilic granules
● Found in allergic reaction-type process like vernal
keratoconjunctivitis"
What intraocular location is the most common site to have metastases?;"● Bilobed
nucleus with abundant intracytoplasmic
eosinophilic granules
● Found in allergic reaction-type process like vernal
keratoconjunctivitis"
What are Dalen-Fuchs nodules and what conditions are they found in?;"● Small,
discrete yellowish infiltrate at the level of
the RPE
● Made up of aggregates of inflammatory cells,
usually epithelioid histiocytes, that collect between
the RPE and Bruch’s membrane
● Seen in sympathetic ophthalmia and VKH"
What neoplasm is most likely to spread systemically with fine needle aspiration
biopsy?;"● Retinoblastoma"
What is deposited in band keratopathy and what layer is it deposited in? What are
the risk factors for band keratopathy? What is the treatment for band
keratopathy?;"● Calcium hydroxyapatite deposits in Bowman’s
membrane
● Systemic risk factors: hypercalcemia
(hyperparathyroidism, excessive vitamin D intake,
renal failure, milk-alkali syndrome, Paget disease,
sarcoidosis)
● Ocular risk factors: chronic uveitis, phthisis bulbi,
end-stage glaucoma, anterior mosaic dystrophy,
silicone oil tamponade
● Medication induced: steroid phosphate,
pilocarpine containing, mercury based
preservatives
● Rx: EDTA with superficial debridement"
What is the process by which a retinal scar is formed?;"● For example: after PRP
● Laser demarcation is produced by glial cells (Muller
cells and fibrous astrocytes)
● The internal limiting membrane and Bruch’s
membrane provide plans for glial scarring
● RPE cells undergo fibrous metaplasia giving rise to
dense black clumps seen in retinal scars"
What is Masson trichrome used to stain?;"● Hyaline in corneal stroma, for example
in granular
dystrophy"
What substance does Alcian blue stain and what pathology is this associated
with?;"● Stains acid mucopolysaccaride in corneal stroma
blue
● Used to diagnose Macular dystrophy"
What are the three attachment sites of the uveal tract to the sclera?;"● Scleral
spur
● Internal ostia of vortex veins
● Peripapillary tissue
● This explains the dome-shaped configuration of
choroidal hemorrhages"
What are the risk factors for a nevus being a malignant melanoma?;"● TFSOM
● Thickness
● Subretinal fluid
● Symptoms
● Presence of orange pigment
● Juxtapapillary location (within 2 disc diameters)
● Absence of drusen or RPE changes
● Hot spots on IVFA
● Homogeneity on ultrasound
● Large size
● Flat lesion diameter of < 10 mm is nearly always
benign"
What is the treatment for primary acquired melanosis?;"● Excision with cryotherapy"
What is the difference between UBM and B scan?;"● UBM = high resolution (40
microns), high
frequency (50 MHz) penetrates less (4 mm)
● B scan = lower frequency, decreased resolution,
penetrates deeper (4 cm)"
What is the other name for type 2 granular corneal dystrophy?;"● Avellino
dystrophy"
What is the other name for type 3 granular dystrophy?;"● Reis Buckler dystrophy"
What virus causes molluscum contagiosum? What is the presentation? What is seen on
pathology?;"● Caused by the pox virus
● Exam shows dome-shaped, waxy nodules with
central umbilication
● Microscopic exam shows abundant granular
eosinophilic cytoplasm with small peripheral
nuclei; Henderson-Patterson corpuscleseosinophilic
inclusion bodies"
What is the histologic appearance of Peters anomaly? How often is Peters anomaly
bilateral? How often is it associated with systemic abnormalities? What are some of
these abnormalities?;"● Histologically shows localized absence of corneal
endothelium and Descemet’s membrane beneath
an area of stromal irregularity
● Associated with iridocorneal adhesions
● Bilateral > 50% of the time
● Associated with systemic abnormalities > 50% of
the time
● Associated with:
○ Axenfeld-Rieger syndrome
○ Congenital rubella
○ Microphthalmia with linear skin defects
○ Pfeiffer syndrome
○ Kivlin Syndrome
○ Trisomies 13-15"
What locations of ocular melanoma have the best and worst prognosis? What are the
most common and least common locations for uveal melanoma? What are the associated
mortality rates of these locations?;"● Best prognosis: Iris
● Worst prognosis: ciliary body
● Most common location: choroid
● Least common location: iris
● Mortality rates:
○ Iris = 1-4%
○ Conjunctiva = 25%
○ Choroid = 12-50%
○ Ciliary Body = 30-50%"
What are the layers of the choroid?;"● Three main layers (inner to outer)
○ Choriocapillaris
○ Stroma
○ Lamina fusca (suprachoroidal layer)
● Can also be divided as follows:
○ Bruch’s membrane
○ Vascular layers (choriocapillaris, Sattler’s
layer - medium sized vessels, Haller’s layer -
large vessels)
● The choroid is thickest in the posterior pole (0.25
mm) and thinnest anteriorly and peripherally (0.10
to 0.15 mm)"
What are the most common non-ocular tumors located outside the field of any
radiation treatment that occur in Rb survivors?;"● Osteosarcoma and cutaneous
melanoma"
What is the pathology of anterior basement membrane dystrophy? What are some of the
complications of this dystrophy?;"● Pathology shows redundant epithelial basement
membrane, encysted degenerated epithelial cells
● One of the most common hereditary corneal
dystrophies
● Often bilateral
● Complications:
○ Recurrent erosions due to poor adhesion of
corneal epithelium from thickening
basement membrane
○ Problems with LASIK flap creation"
What is the pathology of sebaceous carcinoma?;"● Foamy cytoplasm within tumor cells
● Pagetoid spread = tumor cells that spread through
the epithelium without well-defined borders of the
area of involvement
● Very similar to chronic blepharoconjunctivitis or
chalazion"
What are absolute ethanol or methanol media used for?;"● Crystals (e.g. corneal
urate crystals)"
What is Saccomanno medium used for?;"● Liquid specimens or smears (e.g. vitreous
biopsies, fine needle aspirates)"
What are the acellular layers of the cornea?;"● Bowman’s - made of collagen
● Descemet - true basement membrane, collagen
type IV, continuously produced by endothelium,
thickness increases with age"
What is the pathologic appearance of Dalen Fuchs nodules and what conditions are
they found in?;"● Located between RPE and Bruch’s membrane
● Compared of lymphocytes and epithelioid
histiocytes
● Seen in VKH and SO"
What are the indications for enucleation for treatment of retinoblastoma?;"● Tumor
that is > 50% of the globe
● Optic nerve involvement
● Anterior segment involvement"
What do Langhans giant cells look like on pathology and what conditions are they
associated with?;"● Horseshoe shaped ring of nuclei around the cell
● Seen in giant cell arteritis and sarcoidosis
<img src='https://aao-resources-enformehosting.s3.amazonaws.com/resources/
Residents/Flashcards/images/content/pathology_112.png'>"
What do Touton giant cells look like on pathology and what conditions are they seen
in?;"● Ring of nuclei that are surrounded by foamy ring of
lipid
● Seen in xanthogranulomatous disease
○ Juvenile X-linked xanthogranuloma
○ Adult onset xanthogranuloma
○ Adult onset asthma
○ Periocular xanthogranuloma
○ Necrobiotic xanthogranuloma
○ Erdheim Chester Disease
<img src='https://aao-resources-enformehosting.s3.amazonaws.com/resources/
Residents/Flashcards/images/content/pathology_113.png'>"
What does foreign body giant cells look like on pathology?;"● Haphazard arrangement
of nuclei within the cells
<img src='https://aao-resources-enformehosting.s3.amazonaws.com/resources/
Residents/Flashcards/images/content/pathology_114.png'>"
What is persistent fetal vasculature (PFV)?;"● PFV is when the primary vitreous
does not regress
leading to fibrovascular mass that produces
tractional forces on variety of ocular structures
● Exert traction on ciliary process thus elongating
them (characteristic PFV)
● How to distinguish from retinoblastoma:
○ PFV are often microphthalmic
○ Retinoblastoma eyes are normal size"
What are the most common presenting signs of retinoblastoma in the US in patients <
5 years old? > 5 years old?;"● < 5 years old: leukocoria and strabismus
● > 5 years old: leukocoria and decreased vision"
What structure divides the lacrimal gland into the orbital and palpebral lobes?;"●
Levator palpebrae aponeurosis
● If biopsy of lacrimal gland is needed, biopsy orbital
part because the excretory ducts pass through
palpebral portion"
What does a retinal cavernous hemangioma look like on pathology? What does the IVFA
show?;"● Pathology shows thin-walled, dilated vascular
channels
● IVFA shows slow filling of the lesion with pooling of
dye in the upper part of the vascular space. There
is no leakage on the IVFA"
What does a choroidal hemangioma show on IVFA?;"● IVFA shows large choroidal
vessels seen in the arterial phase and late staining of the lesion
<img src='https://aao-resources-enformehosting.s3.amazonaws.com/resources/
Residents/Flashcards/images/content/pathology_122_A.png'>
<img src='https://aao-resources-enformehosting.s3.amazonaws.com/resources/
Residents/Flashcards/images/content/pathology_122_B.png'>"
What is the appearance of a retinal hemangioblastoma on IVFA?;"● Rapid AV phase
with rapid filling of the tumor; massive leakage of dye into the tumor can also
occur
<img src='https://aao-resources-enformehosting.s3.amazonaws.com/resources/
Residents/Flashcards/images/content/pathology_123.png'>"
What is the appearance of the IVFA in Coats disease?;"● Telangiectatic vessels with
leakage of dye into the vitreous
<img src='https://aao-resources-enformehosting.s3.amazonaws.com/resources/
Residents/Flashcards/images/content/pathology_124.png'>"
Where are the Muller cell nuclei located?;"● Inner nuclear layer
● Project process in both anterior and posterior
direction
● Form inner limiting membrane (a true basement
membrane)
● Form the outer limiting membrane (not a true
basement membrane, represents adherens
junctions between Muller cells and photoreceptor
cell inner segments)"
What are the types of Iridocorneal endothelial (ICE) syndrome?;"● Essential Iris
Atrophy
● Cogan-Reese Syndrome
● Chandler’s Syndrome
● Classic presentation: middle aged caucasian
woman with unilateral glaucoma whose pupil is
also slightly irregular
● Pathology shows Descemet’s membrane
abnormally covers anterior iris surface"
What intraocular metastases have the best prognosis for patient survival?;"● Breast
cancer
● Metastatic carcinoid tumors"
What is the sequence of events for age-related PVD?;"● Liquified vitreous enters a
shallow separation of
perifoveal cortical vitreous through a cortical tear
and detaches the vitreous overlying the macula =
partial PVD (asymptomatic)
● Separation of vitreous from optic disc margin
(symptomatic and Weiss ring)
● Occasionally vitreous traction at posterior margin
of the vitreous base can cause retinal break"
What is the epithelial lining of the inner portion of the ciliary body?;"● Lined by
double layer of epithelial cells
○ Inner non-pigmented (faces posterior
chamber) and outer pigmented layer (faces
ciliary muscle)"
What are the most common primary tumor sites that give rise to intraocular
metastases in men and women?;"● Men:
○ 1st - lung
○ 2nd - unknown
● Women
○ 1st - breast
○ 2nd - lung"
What is true exfoliation of the lens?;"● Lamellar delamination of the lens capsule
leads to
splitting of anterior capsule
● Lens capsule is thickened and superficial portion of
anterior lens capsule splits from deeper layer
● Main risk factor: intense infrared radiation"
What is the shape of bleeding in the nerve fiber layer?;"● Flame shaped"
What is the shape of blood in the inner plexiform, inner nuclear, or outer
nuclear?;"● Dot blot, circular"
What is the shape of bleeding in the sub-hyaloid or sub-ILM space?;"● Boat shaped"
What is the pattern of fluid in the outer plexiform layer?;"● Petaloid/star shaped"
What is the most common association with sclerocornea? What is the typical course
of sclerocornea? What are the genetics behind sclerocornea?;"● 80% of sclerocornea
associated with cornea plana
● Sclerocornea is nonprogressive and
noninflammatory
● Ranges from involving the periphery to affecting
the entire cornea
● Most severe form is inherited, autosomal recessive
● 50% of the cases are sporadic"
In the Collaborative Ocular Melanoma (COM) Trial, what is the definition of a large
choroidal melanoma? What were they studying in large melanomas? What were the
results?;"● Large choroidal melanoma:
○ > 16 mm basal diameter
○ > 10 mm apical height
● Compared enucleation alone vs external beam
radiotherapy followed by enucleation
● Findings:
○ Adjunctive radiotherapy did not impact
overall survival
○ Primary enucleation alone is sufficient to
manage large melanomas"
In the Collaborative Ocular Melanoma (COM) Trial, what is the definition of a small
choroidal melanoma? What were they studying in small melanomas? What were the
results?;"● Small choroidal melanoma:
○ 4-8 mm basal diameter
○ 1-2.4 mm apical height
● Studied mortality in small choroidal melanomas
● Findings:
○ Melanoma specific mortality of 1% at 5 years"
What are the predictive factors for malignant transformation of a choroidal nevus
to a melanoma?;"● TFSOM-UHHD
○ Thickness > 2 mm
○ Fluid, subretinal
○ Symptoms: flashes and floaters, decreased
visual acuity
○ Orange pigment
○ Margin within 3 mm of the optic disc
○ Ultrasound hollowness
○ Halo absence
○ Drusen absence
● Monitoring:
○ If no features: monitor q6 months initially and
then annually if no changes
○ 1-2 features: monitor q4-6 months
○ 3 or more features: refer to ocular melanoma
center"
What are the three main groups of retinal ganglion cells?;"● Tonic cells stimulated
by L or M cones
○ Project to the parvocellular layer of the
lateral geniculate nucleus (LGN)
○ Important in high resolution and color vision
● Tonic cells stimulated by S cones
○ Designed to detect successive color contrast
○ Excited by short waves entering and long
waves leaving their receptive fields
● Phasic cells
○ Larger, less concentrated in the govea
○ Project to the magnocellular layer of the LGN
○ Important for the detection of movement"
What is a pleomorphic adenoma and how should they be managed?;"● Benign epithelial
tumor of the lacrimal gland
● Recurrent pleomorphic adenomas can lead to
adenoid cystic carcinoma (malignant)
● Incisional biopsies should not be performed
because can recur if the capsule is incised
○ Recurrences can be very difficult to remove"
What layer of the cornea makes Descemet’s membrane? What are the layers of
Descemet’s membrane? What substance makes up Descemet’s membrane?;"● Produced by
corneal endothelium constantly
throughout life, thus it becomes thicker with age
● Anterior banded zone and posterior nonbanded
zone
● Made of Type IV collagen (it is a true basement
membrane)"
What does an adenoid cystic carcinoma look like on histology? What is the
prognosis? What is the management?;"● Swiss cheese (“cribriform”) pattern on
histology
<img src='https://aao-resources-enformehosting.s3.amazonaws.com/resources/
Residents/Flashcards/images/content/pathology_165.png'>
● Usually in women
● Highly malignant with significant pain and poor
prognosis
● Exenteration is recommended with removal of
adjacent bone"
What is Oil red O stain used for and what does it help diagnose?;"● Used to stain
fresh tissue specimens
● Stains lipid
● Helpful in identifying sebaceous cell carcinoma"
What location of basal cell carcinoma is likely to invade into the orbit?;"● Medial
canthus"
What is the most common cell origin for optic nerve glioma? What is the histologic
appearance of an optic nerve glioma? What are optic nerve gliomas associated with?
What is the typical prognosis? What are the treatment options?;"● Pilocytic
astrocyte
● Histology shows Rosenthal fibers (enlarged, deeply
eosinophilic filaments)
● Associated with neurofibromatosis type 1
● Slow growing, with long term survival
● Typically observed unless progressive visual loss or
growth more posterior into the CNS
● Treatment of gliomas itself can result in vision loss
in the affected eye"
What are the most common sites of conjunctival melanoma metastasis?;"● Head and
neck lymph nodes
● They act more like cutaneous melanomas"
What is the most common type of isotope used for brachytherapy to treat choroidal
melanoma?;"● Iodine 125"
Where are goblet cells most commonly found? What is their function?;"● Most common
in the fornices and inferonasal
bulbar conjunctiva (near the medial canthus)
● Produce mucin (the deep layer of the tear film)"
What are the functions of the mucin produced by goblet cells?;"● Fills spaces
between microvilli of corneal epithelial
cells to provide uniform surface
● Lower surface tension of tear film and stabilize it
● Lubricate the eyelids as they traverse the globe
during blinking
● Trap foreign bodies on the surface of the eye
● Converts the hydrophobic surface of the corneal
epithelium to a hydrophobic one which allows for
an even distribution of the tear film"
What is the most common location of squamous cell carcinoma of the eyelid?;"● Lower
eyelid
● Arise in sun damaged skin"
What is a Fuchs adenoma? What does it look like on pathology?;"● Benign mass of the
ciliary body epithelium
● Usually an incidental finding of autopsy and does
not cause problems
● Histology shows a glistening white, irregular mass
that is made up of a benign proliferation of
nonpigmented ciliary epithelium and accumulation
of basement membrane material"
What are the indications for frozen sections?;"● Determine whether margins are
clear of tumor
cells
● Provide fresh tissue for molecular genetics
● Determine whether representative tissue has been
biopsied for diagnosis
● Ensure tissue conservation (Mohs surgery)
● Definitive diagnosis of a lesion requires permanent
sections, not a frozen section"
What cultures can be used for anaerobic bacteria?;"● Anaerobic blood agar
● Phenylethyl alcohol agar in anaerobic chamber
● Phenylethyl alcohol agar in anaerobic chamber
● Thioglycollate broth
● Chopped meat broth"
What cultures can be used for acanthamoeba?;"● Non-nutrient agar with bacterial
overlay (E. coli or
Enterobacter aerogenes)
● Blood agar
● Buffered charcoal-yeast extract agar"
What are the common associations and symptoms of the different types of
cataracts?;"● Nuclear: second sight, greater impairment of
distance than near vision; seen after hyperbaric
oxygen therapy
● PSC: decreased vision with near more than
distance; seen after prednisone usage
● PSC/Cortical: glare
● PSC/cortical/nuclear: monocular diplopia
● Cortical: common in African Americans, cortical
clefts occur with extreme glucose shifts
● Sunflower: seen in Wilson’s disease
● Christmas tree: Myotonic dystrophy"
What is the most common cause of fungal keratitis in the US?;"● Fusarium
● Most occur in southern US
● Treatment is natamycin 5% until cultures are back
(commercially available)"
What organisms is Amphotericin B used to treat?;"● Used for candida and aspergillus
● Made by a compounding pharmacy"
What are the strongest point of sclerouveal attachment?;"● Major emissarial canals
● Anterior base of the ciliary body
● Juxtapapillary region"
What part of the sclera merges with the dura of the optic nerve sheath?;"● Outer
two-thirds of the sclera"
What is Meesmann corneal dystrophy? What does histology show? What are the genetic
associations?;"● Epithelial corneal dystrophy that shows punctate,
blister-like, round to oval opacities within the
corneal epithelium, best seen on retroillumination
● Typically presents early in life with mild foreign
body sensation and slight decreased visual acuity
● Histology shows coarse basement membrane,
fibrillogranular material within epithelial cells and
cysts = “peculiar substance”
● Mutations of KRT3 or KRT12
● Autosomal dominant inheritance"
During the dissection of an enucleated globe, What is the desired section of the
majority of the specimen?;"● Pupil-optic nerve (PO section)"
What is the appropriate method for processing with formalin fixative?;"● Do not
open the eye prior to soaking in formalin
● Entire eye should be suspended in formalin for at
least 12 hours prior to processing (usually > 24
hours)"
What are the risk factors for posterior subcapsular cataract?;"● Chronic topical
steroids
● Ionizing radiation
● Chronic vitritis
● Posterior migration of lens epithelial cells from the
equator, during which time the cells swell to 5x the
normal size. These are called bladder cells/Wedl
cells"
What pathology are Rosenthal fibers associated with?;"● Optic nerve gliomas"
What pathologies are psammoma bodies associated with?;"● Optic nerve meningioma
● Pituitary prolactinoma"
What is the most common type of malignant intraocular (or orbital) tumor?;"●
Metastases"
What is the most common type of primary malignant intraocular tumor in adults?;"●
Choroidal melanoma"
What is the most common route from which retinoblastoma spreads outside the eye?;"●
Optic nerve"
What are the two types of lymphoma that spread to the eye?;"● Primary central
nervous system lymphoma
○ Significantly more common
○ Involves the retina and vitreous
● Visceral or nodal lymphoma
○ Involves the uveal tract (posterior choroid,
iris) like other systemic mets
● Histology of intraocular lymphoma shows
non-Hodgkin B cell"
What are Henderson-Patterson corpuscles and what are they associated with?;"●
Eosinophilic inclusion bodies
● Seen in molluscum contagiosum"
What is a dermoid cyst? What causes it? Where are they most commonly located?;"●
Cyst lined by stratified squamous epithelium with keratinization
● May contain keratin and hair (choristoma)
● Wall of cyst has adnexal structures: sebaceous glands, sweat glands, hair
follicles
● Rupture of cyst produces prominent granulomatous inflammatory reaction
● Result of abnormal embryonic epithelial nest that becomes entrapped
● Most often in superotemporal orbit near frontozygomatic suture
<img src='https://aao-resources-enformehosting.s3.amazonaws.com/resources/
Residents/Flashcards/images/content/pathology_216_A.png'>
<img src='https://aao-resources-enformehosting.s3.amazonaws.com/resources/
Residents/Flashcards/images/content/pathology_216_B.png'>"
What is the most common organism causing infectious crystalline keratopathy?;"●
Strep viridans"
“Disinsertion of the longitudinal muscle of the ciliary body from the scleral spur”
describes what anterior chamber pathology?;"● Cyclodialysis"
A tear between the longitudinal and circular fibers of the ciliary muscle describes
what anterior chamber pathology?;"● Angle recession"
What is the most common benign orbital tumor in adults?;"● Cavernous hemangioma"
What is the most common benign orbital tumor in children?;"● Capillary hemangioma
● Other sources say benign cystic lesions
(epidermoid or simple epithelial cysts)"
What were the criteria for intervening on carotid stenosis per the “North American
Symptomatic Carotid Endarterectomy Trial?”;"● Amaurosis fugax or hemispheric TIAs
with 70-99%
carotid stenosis benefitted from carotid
endarterectomy to reduce risk of future stroke
● Endarterectomy for complete occlusion carotid
artery has low success rate for re-establishing flow
and high mortality
● Asymptomatic carotid stenosis is less reliable"
What is Waardenburg Syndrome and what are the classic findings?;"● Rare genetic
disorder due to abnormal neural crest
migration
● Presentation:
○ Sensorineural deafness
○ Dystopia canthorum
○ Heterochromia
○ White forelock of hair arising from anterior scalp
○ Hirschprung Disease"
What is the Goldmann-Witmer Coefficient? What is it used for?;"● Test that compares
intraocular antibody
production to serum as measured by ELIZA or radioimmunoassay
<img src='https://aao-resources-enformehosting.s3.amazonaws.com/resources/
Residents/Flashcards/images/content/pathology_232.png'>
● GW ratio > 3 is diagnostic of local antibody
production to a specific microbial pathogen"
What are the ocular adverse effects of reactive oxygen species?;"● Cataract
● ARMD
● Diabetic Retinopathy
● Glaucoma"
What is the classic histologic appearance of Ghost cell glaucoma?;"● Ghost cells
(small, khaki-colored RBCs) with Heinz bodies
<img src='https://aao-resources-enformehosting.s3.amazonaws.com/resources/
Residents/Flashcards/images/content/pathology_239.png'>"
What are paradoxical pupils and what are the causes?;"● Constriction in response to
darkness
● Causes:
○ Retinal dystrophies
○ Optic neuropathies"
Rank the risk for systemic lymphoma from lowest to highest based on the following
locations: eyelid, orbital, conjunctiva.;"● Conjunctiva < orbital < eyelid
● Bilateral involvement also increases the risk of
systemic disease greatly
● Risk of systemic disease increases for decades after
original lesion is diagnosed"
What is the typical course of a keratoacanthoma?;"● Rapid growth over 4-8 weeks
● History of spontaneous regression over several months
● Considered to be a variant of differentiated
squamous cell carcinoma
● Possibility of perineural invasion and metastases
<img src='https://aao-resources-enformehosting.s3.amazonaws.com/resources/
Residents/Flashcards/images/content/pathology_249_A.png'>
<img src='https://aao-resources-enformehosting.s3.amazonaws.com/resources/
Residents/Flashcards/images/content/pathology_249_B.png'>"
What determines the color of the iris?;"● The size and number of melanin pigment
granules
in the anterior stromal melanocytes"
What are the similarities and differences of MHC class I and class II?;"●
Similarities:
○ Both are heterodimers
○ Both are made up of alpha and beta chains
○ Alpha subunits for both are encoded by the
MHC gene
● Differences:
○ Beta subunit in MHC I is encoded by beta-2
microglobulin gene and is constant across all
MHC I molecules
○ Beta subunit in MHC II is encoded by the
MHC gene"
What are the regulators for anterior chamber associated immune deviation
(ACAID)?;"● Transforming growth factor beta (TGF-beta) and
vasoactive intestinal peptide (VIP)"
What syndrome are RPE hamartomas associated with?;"● Familial Adenomatous Polyposis
● Autosomal dominant
● Develop colon cancer"
What is an apocrine hidrocystoma?;"● Cyst arising from the glands of Moll (AKA cyst
of
Moll)
● Appears blue or translucent and transilluminates"
What is the histologic definition of the macula?;"● Where the ganglion cell layer
is thicker than a
single cell"
What are the features of a phthisical globe?;"● Think “SAD” Shrinkage, Atrophy, and
Disorganization
● Low IOP due to shrinkage of the eye
● Intraocular ossification occurs late: osseous
metaplasia of the RPE with bone formation"
What is the differential for macular drusen in patients younger than 50 years of
age?;"● Familial dominant drusen
● Cuticular drusen
● Large colloid drusen
● Sorsby macular dystrophy
● Membranoproliferative glomerulonephritis type 2
● Malattia leventinese"
What is the role of insulin-like growth factor in the eye?;"● Responsible for
abnormal hyperplastic response of
lens epithelium and corneal endothelium observed
in inflammatory conditions"
What is the role of fibroblast growth factor in the eye?;"● Accelerates corneal
wound repair after surgery,
chemical burns, or ulcers"