DOCSLIB.ORG

Pigmented Lesions of the Choroid and Retina

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pigmented Lesions of the Choroid and Retina Clinical igmented lesions of the choroid and retina are commonly encountered Pigmented lesions of by optometrists in everyday practice. The increasing use of retinal Pimaging and indirect ophthalmoscopy the choroid and retina among community optometrists means more lesions will be identified. Important Chris Hemmerdinger and Professor Bertil Damato consider the clinical decisions must be made about the appearance of the lesion, the likely decisions involved in identifying and treating pigmented lesions of diagnosis and whether to monitor or the choroid and retina refer for a second opinion. In cases where an ophthalmological opinion is required, the priority of referral needs considering. Many texts and online resources are available to the practitioner to help with diagnosis. However, to research a lesion in a standard textbook requires the diagnosis. To help with such quandaries a web-based atlas of ocular tumours has been developed, categorising lesions by their position and colour rather than diagnosis (Figure 1 www.eyetumours. com). This article aims to summarise the important clinical features when seeing such patients and reviews the different pigmented lesions found in the choroid and retina. Figure 1 Eye lesions is often described as a ball of light history is also important; if there is a History tumour atlas which travels across the visual field; it history of malignancy, metastases must Careful history taking is an essential may be intermittent or constant. be considered. part of any clinical assessment. The Less common symptoms such as float- practitioner is required to extract all ers, caused by vitreous haemorrhage, or Examination relevant facts and document impor- pain due to raised intraocular pressure Any ophthalmic examination should tant negatives. As the history is taken or inflammation may be reported. It is include visual acuity, pupil reactions, before the examination, refinement important to enquire about past ocular intraocular pressure and anterior and of the history may be required subse- history as lesions may have been noticed posterior segment examination. Once quently. A balance of open and closed previously and imaged or referred to the a lesion has been identified it should be questioning will allow the practitioner hospital eye service. General medical examined through a dilated pupil with a to quickly and precisely obtain a full and binocular indirect viewing system. relevant history. Visual acuity may be affected by A comprehensive history includes posterior direct macular involvement, symptoms, ophthalmic history, general cataract, vitreous haemorrhage or medical history, a review of current retinal detachment. Intraocular pressure medications and family history. Many (IOP) may be elevated following vitre- patients presenting with retinal lesions ous haemorrhage, rubeosis or by lesions will be asymptomatic. They may be causing secondary angle closure. IOP attending for a routine eye examination may be reduced when there is an or be monitored for other conditions exudative detachment or with intraoc- such as diabetes. Patients attending for ular inflammation. Examination of routine examination will not usually the anterior segment examination require a dilated fundus examination, may reveal sentinel vessels (Figure 2), and screening all patients with a dilated Figure 2 Sentinel vessels segmental cataract, anterior chamber examination would be inefficient.1 inflammation or rubeosis. Sentinel However, once a lesion has been vessels are dilated episcleral vessels, identified it should be thoroughly which are feeder vessels to the tumour. examined. Symptomatic patients with Not all prominent episcleral vessels are an intraocular tumour may complain sentinel vessels, and it is useful to look of blurred vision, field loss, floaters, for asymmetry. Visual field loss may photopsia, metamorphopsia or pain. be noticed by the patient or picked up Blurred vision, field loss and metamor- during the examination. Such field loss phopsia may be caused by the lesion may be due to the lesion itself or second- itself or an associated retinal detach- ary to a retinal detachment. Posterior ment. Macular lesions will gener- segment examination of both eyes is ally have a more pronounced effect essential, with relevant features being on vision. Photopsia due to choroidal Figure 3 Lesion with depigmented ‘halo’ documented as described below. 22 | Optician | 15.08.08 opticianonline.net Clinical Documentation atrophy in pigmented scars should Figure 4 (a) Once a pigmented lesion is identified also be noted. A ring of RPE atrophy (a) flat lesion; it should be imaged and stored for surrounding a lesion tends to occur in (b) minimally comparisons at future consultations. An longstanding lesions, which may give thickened; annotated diagram should be included the appearance of a ‘halo’ around the (c) shallow in the notes documenting the level of lesion (Figure 3). dome; the lesion, colour, size, shape, position, ● Elevation – Viewing the lesion stere- (d) pronounced surface features, elevation, and the oscopically allows assessment of eleva- dome presence of any fluid. tion. Tumours should be classified as flat, ● Level of the lesion – The lesion and minimally thickened (<2mm), shallow any associated features such as haemor- dome or pronounced dome (Figure 4). (b) rhage may be choroidal, sub-retinal, Looking at blood vessel deflection may intra-retinal or pre-retinal. The level of give an indicator to those observers the lesion is essential for correct diagno- without stereopsis. sis, a stereoscopic view is invaluable in ● Sub-retinal fluid – The presence or assessing this, but other cues such as the absence of fluid should be noted. This retinal vasculature may help. may be surrounding the lesion or may ● Colour – Choroidal naevi gener- gravitate inferiorly. ally appear slate grey or brown. Melanocytomas are black. Congenital Lesions hypertrophy of the retinal epithelium is Choroidal naevus (c) brown or black. Sub-retinal haemorrhage Choroidal naevi are common, benign may appear red or brown. However, it lesions that are usually round or oval must be remembered that naevi and with fairly well defined although not melanomas may be amelanotic, and sharp borders (Figures 5 and 6). The there can be considerable variation in reported incidence of choroidal naevi the appearance of retinal lesions. ranges from 0.2 to 30 per cent.2-7 This ● Size – The lesion should be measured variation is due to different study in relation to the disc (disc diameters) populations. The largest population- or with the slit lamp beam and indirect based study; the Blue Mountains eye 7 lens. When measuring the lesion with study reported an incidence of 6.5 per (d) an indirect lens it is essential to record cent in a white population. The major- the lens used or calculate the size incor- ity (90 per cent) are pigmented, with porating the lens magnification factor. a characteristic, grey, ophthalmoscopic Both horizontal and vertical dimen- appearance. sions should be recorded. A typical choroidal naevus is asymp- ● Shape – The lesion may be regular tomatic, less than 5mm in diameter or irregular and the margins distinct and less than 1mm in thickness, with or diffuse. This may be represented by surface drusen, no orange pigment a diagram or annotated in the notes. (lipofuscin), not in direct contact with Certain lesions may have characteristic the disc and not associated with any sub- shapes such as the bear tracks of grouped retinal fluid. typical congenital hypertrophy of the As mentioned above, the presence of retinal pigment epithelium. drusen overlying the lesion (Figure 6) is ● Position – Ideally the lesion will indicative of chronicity, and is reassur- be imaged; however, when this is not ing. Lipofuscin (Figure 7) suggests RPE possible it is important to document dysfunction and should be viewed accurately the position of the lesion. suspiciously. Landmarks such as the disc, vascular Patients with typical naevi should be arcades and fovea are invaluable in locat- observed for any evidence of change. ing a lesion. Any contact with the optic The lesion and its relevant features must disc must be recorded. It is important to be clearly documented as described remember that the image is both later- above. Ideally the lesion should be ally and vertically inverted when using photographed, although it must be Figure 5 Typical choroidal naevus a binocular indirect ophthalmoscope. remembered that camera artefacts can ● Surface features – Drusen are a produce false impression of growth.8 If feature of chronicity and are reassur- the lesion is observed to increase in size, ing in that they indicate that the lesion the diagnosis of benign naevus must be is longstanding; the absence of drusen questioned although enlargement has over a dome-shaped, pigmented tumour been documented in naevi.9 is ominous. Orange pigment (lipofus- The main concerns with choroidal cin) implies retinal pigment epithe- naevi are visual impairment and malig- lium dysfunction and always requires nant growth. onward referral for ophthalmological The majority of naevi are asymp- opinion. Non-pigmented areas such tomatic; however, they may cause as lacunae in congenital hypertrophy reduced visual acuity, flashes, floaters Figure 6 Atypical choroidal naevus with of the retinal pigment epithelium or or visual field defects. Up to 11 per overlying drusen opticianonline.net 15.08.08 | Optician | 23 Clinical cent of naevi become symptomatic.10 Symptoms may be caused by serous retinal
Load more

Recommended publications
  • Permeability of the Retina and RPE-Choroid-Sclera to Three Ophthalmic Drugs and the Associated Factors
    pharmaceutics Article Permeability of the Retina and RPE-Choroid-Sclera to Three Ophthalmic Drugs and the Associated Factors Hyeong Min Kim 1,†, Hyounkoo Han 2,†, Hye Kyoung Hong 1, Ji Hyun Park 1, Kyu Hyung Park 1, Hyuncheol Kim 2,* and Se Joon Woo 1,* 1 Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; [email protected] (H.M.K.); [email protected] (H.K.H.); [email protected] (J.H.P.); [email protected] (K.H.P.) 2 Department of Chemical and Biomolecular Engineering, Sogang University, Seoul 04107, Korea; [email protected] * Correspondence: [email protected] (H.K.); [email protected] (S.J.W.); Tel.: +82-2-705-8922 (H.K.); +82-31-787-7377 (S.J.W.); Fax: +82-2-3273-0331 (H.K.); +82-31-787-4057 (S.J.W.) † These authors contributed equally to this work. Abstract: In this study, Retina-RPE-Choroid-Sclera (RCS) and RPE-Choroid-Sclera (CS) were prepared by scraping them off neural retina, and using the Ussing chamber we measured the average time– concentration values in the acceptor chamber across five isolated rabbit tissues for each drug molecule. We determined the outward direction permeability of the RCS and CS and calculated the neural retina permeability. The permeability coefficients of RCS and CS were as follows: ganciclovir, 13.78 ± 5.82 and 23.22 ± 9.74; brimonidine, 15.34 ± 7.64 and 31.56 ± 12.46; bevacizumab, 0.0136 ± 0.0059 and 0.0612 ± 0.0264 (×10−6 cm/s).
    [Show full text]
  • The Distribution of Immune Cells in the Uveal Tract of the Normal Eye
    THE DISTRIBUTION OF IMMUNE CELLS IN THE UVEAL TRACT OF THE NORMAL EYE PAUL G. McMENAMIN Perth, Western Australia SUMMARY function of these cells in the normal iris, ciliary body Inflammatory and immune-mediated diseases of the and choroid. The role of such cell types in ocular eye are not purely the consequence of infiltrating inflammation, which will be discussed by other inflammatory cells but may be initiated or propagated authors in this issue, is not the major focus of this by immune cells which are resident or trafficking review; however, a few issues will be briefly through the normal eye. The uveal tract in particular considered where appropriate. is the major site of many such cells, including resident tissue macro phages, dendritic cells and mast cells. This MACRO PHAGES review considers the distribution and location of these and other cells in the iris, ciliary body and choroid in Mononuclear phagocytes arise from bone marrow the normal eye. The uveal tract contains rich networks precursors and after a brief journey in the blood as of both resident macrophages and MHe class 11+ monocytes immigrate into tissues to become macro­ dendritic cells. The latter appear strategically located to phages. In their mature form they are widely act as sentinels for capturing and sampling blood-borne distributed throughout the body. Macrophages are and intraocular antigens. Large numbers of mast cells professional phagocytes and play a pivotal role as are present in the choroid of most species but are effector cells in cell-mediated immunity and inflam­ virtually absent from the anterior uvea in many mation.1 In addition, due to their active secretion of a laboratory animals; however, the human iris does range of important biologically active molecules such contain mast cells.
    [Show full text]
  • The Proteomes of the Human Eye, a Highly Compartmentalized Organ
    Proteomics 17, 1–2, 2017, 1600340 DOI 10.1002/pmic.201600340 (1 of 3) 1600340 The proteomes of the human eye, a highly compartmentalized organ Gilbert S. Omenn Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA Proteomics has now published a series of Dataset Briefs on the EyeOme from the HUPO Received: November 2, 2016 Human Proteome Project with high-quality analyses of the proteomes of these compartments Accepted: November 4, 2016 of the human eye: retina, iris, ciliary body, retinal pigment epithelium/choroid, retrobulbar optic nerve, and sclera, with 3436, 2929, 2867, 2755, 2711, and 1945 proteins, respectively. These proteomics resources represent a useful starting point for a broad range of research aimed at developing preventive and therapeutic interventions for the various causes of blindness. Keywords: Biomedicine / Biology and Disease-driven Human Proteome Project / End Blindness by 2020 / Eye proteome / EyeOme / Human Proteome Project See accompanying articles in the EyeOme series: http://dx.doi.org/10.1002/pmic.201600229; http://dx.doi.org/10.1002/pmic.201500188; http://dx.doi.org/10.1002/pmic.201400397 Proteomics has now published a series of four papers on compartments of the eye as shown in Fig. 1. As was noted [5], the human eye proteome [1–4]. Under the aegis of the Hu- it was not feasible to assess the quality of the data or estimate man Proteome Organization Biology and Disease-driven Hu- numbers of likely false positives in the heterogeneous studies man Proteome Project (HPP), the EyeOme was organized by from which these findings were summarized.
    [Show full text]
  • 98796-Anatomy of the Orbit
    Anatomy of the orbit Prof. Pia C Sundgren MD, PhD Department of Diagnostic Radiology, Clinical Sciences, Lund University, Sweden Lund University / Faculty of Medicine / Inst. Clinical Sciences / Radiology / ECNR Dubrovnik / Oct 2018 Lund University / Faculty of Medicine / Inst. Clinical Sciences / Radiology / ECNR Dubrovnik / Oct 2018 Lay-out • brief overview of the basic anatomy of the orbit and its structures • the orbit is a complicated structure due to its embryological composition • high number of entities, and diseases due to its composition of ectoderm, surface ectoderm and mesoderm Recommend you to read for more details Lund University / Faculty of Medicine / Inst. Clinical Sciences / Radiology / ECNR Dubrovnik / Oct 2018 Lund University / Faculty of Medicine / Inst. Clinical Sciences / Radiology / ECNR Dubrovnik / Oct 2018 3 x 3 Imaging technique 3 layers: - neuroectoderm (retina, iris, optic nerve) - surface ectoderm (lens) • CT and / or MR - mesoderm (vascular structures, sclera, choroid) •IOM plane 3 spaces: - pre-septal •thin slices extraconal - post-septal • axial and coronal projections intraconal • CT: soft tissue and bone windows 3 motor nerves: - occulomotor (III) • MR: T1 pre and post, T2, STIR, fat suppression, DWI (?) - trochlear (IV) - abducens (VI) Lund University / Faculty of Medicine / Inst. Clinical Sciences / Radiology / ECNR Dubrovnik / Oct 2018 Lund University / Faculty of Medicine / Inst. Clinical Sciences / Radiology / ECNR Dubrovnik / Oct 2018 Superior orbital fissure • cranial nerves (CN) III, IV, and VI • lacrimal nerve • frontal nerve • nasociliary nerve • orbital branch of middle meningeal artery • recurrent branch of lacrimal artery • superior orbital vein • superior ophthalmic vein Lund University / Faculty of Medicine / Inst. Clinical Sciences / Radiology / ECNR Dubrovnik / Oct 2018 Lund University / Faculty of Medicine / Inst.
    [Show full text]
  • Case Notes Hernia of the Choroid Treated by Scleral Grafting Followed by Direct Suturing of the Sclera* by P
    Br J Ophthalmol: first published as 10.1136/bjo.38.2.126 on 1 February 1954. Downloaded from Brit. J. Ophihal. (1954) 38, 126. CASE NOTES HERNIA OF THE CHOROID TREATED BY SCLERAL GRAFTING FOLLOWED BY DIRECT SUTURING OF THE SCLERA* BY P. SIVASUBRAMANIAM AND T. HOOLE Eye Clinic, Civil Hospital, Jaffna, Ceylon Case Report A young man aged 18 had had a bluish-black lump on the " white " of the left eye for 8 years. He did not recall any injury to this eye and had had no inflammation. Examination.-A bluish-black sessile swelling was seen on the superonasal side of the left eyeball about 4 mm. from the limbus (Figure). The lump measured 6 x 4 mm., the long axis being more or less tangential to the limbus. The swelling was cystic, tense, slightly reducible, nonpulsatile, and non-transluminant. It was not movable over the globe, the conjunctiva over it was stretched and tenuous. Biomicroscopy revealed a deposit of fine iris pigment on the lens capsule at the lower part. There was no sign of active uveitis. Visual acuity was 6/6 in each eye. Digital tonometry indicated that the tension was equal in both eyes. The fundi were normal. The region of the ectasia was not accessible ophthalmoscopically. Wassermann reaction negative. Operations.-Scleral grafting and direct suturing of the scleral hiatus were performed copyright. at different times. The reports of Lister (1951) on scleral grafting prompted us to try this operation. (1) January 21, 1953.-Under retro-ocular novocaine and local anaesthesia the conjunc- tiva over the lump was neatly dissected and an upper flap was raised.
    [Show full text]
  • Eye External Anatomy of Eye Accessory Structures
    4/22/16 Eye Bio 40B Dr. Kandula External Anatomy of Eye Accessory Structures l Eyebrows l Levator Palpebrae Superioris - opens eye l Eyelashes l Ciliary glands – modified sweat glands l Small sebaceous glands l Sty is inflamed ciliary glands or small sebaceous glands 1 4/22/16 Terms: Lacrimal gland and duct Surface of eye Lacrimal puncta Lacrimal sac Nasolacrimal duct Nasal cavity Tears / Lacrimal fluid l a watery physiologic saline, with a plasma-like consistency, l contains the bactericidal enzyme lysozyme; l it moistens the conjunctiva and cornea, l provides nutrients and dissolved O2 to the cornea. Extrinsic Muscles of the Eye: Lateral/medial rectus Important to know Superior/inferior rectus actions and nerve Superior/inferior oblique supply in table 2 4/22/16 Extrinsic Eye Muscles • Eye movements controlled by six extrinsic eye muscles Four recti muscles § Superior rectus – moves eyeball superiorly supplied by Cranial Nerve III § Inferior rectus - moves eyeball inferiorly supplied by Cranial Nerve III § Lateral rectus - moves eyeball laterally supplied by Cranial Nerve VI § Medial rectus - moves eyeball medially supplied by Cranial Nerve III Extrinsic Eye Muscles Two oblique muscles rotate eyeball on its axis § Superior oblique rotates eyeball inferiorly and laterally and is supplied by Cranial Nerve IV § Inferior oblique rotates superiorly and laterally and is supplied by Cranial Nerve III Convergence of the Eyes l Binocular vision in humans has both eyes looking at the same object l As you look at an object close to your face,
    [Show full text]
  • Anatomy of the Periorbital Region Review Article Anatomia Da Região Periorbital
    RevSurgicalV5N3Inglês_RevistaSurgical&CosmeticDermatol 21/01/14 17:54 Página 245 245 Anatomy of the periorbital region Review article Anatomia da região periorbital Authors: Eliandre Costa Palermo1 ABSTRACT A careful study of the anatomy of the orbit is very important for dermatologists, even for those who do not perform major surgical procedures. This is due to the high complexity of the structures involved in the dermatological procedures performed in this region. A 1 Dermatologist Physician, Lato sensu post- detailed knowledge of facial anatomy is what differentiates a qualified professional— graduate diploma in Dermatologic Surgery from the Faculdade de Medician whether in performing minimally invasive procedures (such as botulinum toxin and der- do ABC - Santo André (SP), Brazil mal fillings) or in conducting excisions of skin lesions—thereby avoiding complications and ensuring the best results, both aesthetically and correctively. The present review article focuses on the anatomy of the orbit and palpebral region and on the important structures related to the execution of dermatological procedures. Keywords: eyelids; anatomy; skin. RESU MO Um estudo cuidadoso da anatomia da órbita é muito importante para os dermatologistas, mesmo para os que não realizam grandes procedimentos cirúrgicos, devido à elevada complexidade de estruturas envolvidas nos procedimentos dermatológicos realizados nesta região. O conhecimento detalhado da anatomia facial é o que diferencia o profissional qualificado, seja na realização de procedimentos mini- mamente invasivos, como toxina botulínica e preenchimentos, seja nas exéreses de lesões dermatoló- Correspondence: Dr. Eliandre Costa Palermo gicas, evitando complicações e assegurando os melhores resultados, tanto estéticos quanto corretivos. Av. São Gualter, 615 Trataremos neste artigo da revisão da anatomia da região órbito-palpebral e das estruturas importan- Cep: 05455 000 Alto de Pinheiros—São tes correlacionadas à realização dos procedimentos dermatológicos.
    [Show full text]
  • Destruction of Localized Lesion of Choroid Reference Number: CP.VP.20 Coding Implications Last Review Date: 12/2020 Revision Log
    Clinical Policy: Destruction of Localized Lesion of Choroid Reference Number: CP.VP.20 Coding Implications Last Review Date: 12/2020 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description: This policy describes the medical necessity requirements for destruction of localized lesion(s) of the choroid. Policy/Criteria I. It is the policy of health plans affiliated with Centene Corporation® (Centene) that the destruction of a localized lesion of the choroid is medically necessary for the following indications: A. Treatment of subretinal neovascular membranes as encountered in “wet” age-related macular degeneration, angioid streaks or other retinal disease processes involving violations of Bruch’s membrane allowing in-growth of abnormal neovascular tissue into the subretinal space. B. Subretinal neovascular membrane recurrences, which are immediately adjacent or contiguous with the first treated lesion, are well-known consequences of treating subretinal neovascular membranes. Background Choroidal neovascularization (CNV) describes the growth of new blood vessels that originate from the choroid through a break in the Bruch membrane into the sub–retinal pigment epithelium (sub-RPE) or subretinal space. Choroidal neovascularization is a major cause of visual loss. Destruction of the localized lesion of the choroid can be accomplished by using a laser or xenon arc. The choroid is a thin, vascular membrane lining the posterior eye between the retina and the sclera. Photocoagulation is performed without entering the posterior chamber. Intentionally destructive light is focused through a contact lens onto the choroidal lesion, which is destroyed in one session or in a series of sessions.
    [Show full text]
  • Download Our Coloboma Factsheet In
    Coloboma Factsheet Contents 3 What is Coloboma? 3 How do we see with our eyes? 3 Which parts of the eye can coloboma affect? 3 Iris 4 Lens zonules 4 Retina and choroid (chorioretinal) 4 Optic disc 4 Eyelids 4 What causes coloboma to form inside the eye? 5 Does coloboma affect vision? 5 Iris coloboma 5 Lens coloboma 5 Chorioretinal coloboma 6 How is coloboma diagnosed? 7 What is the treatment for coloboma? 7 Can coloboma lead to other eye health problems? 7 Glaucoma 8 Retinal detachment 8 Choroidal neovascularisation (new blood vessels) 8 Cataract 9 What other health problems can affect some children with coloboma? 9 Coping with sight problems relating to coloboma 10 Further help and support 10 Sources of support 11 Other useful organisations 12 We value your feedback 2 What is Coloboma? Coloboma means that part of one or more structures Choroid inside an unborn baby’s eye does not fully develop Iris during pregnancy. This underdeveloped tissue is Optic nerve normally in the lower part of the eye and it can be Optic Cornea small or large in size. A coloboma occurs in about 1 in disc 10,000 births and by the eighth week of pregnancy. Macula Lens Coloboma can affect one eye (unilateral) or both eyes zonules Pupil (bilateral) and it can affect different parts of the eye. As coloboma forms during the initial development of Choroid the eye, it is present from birth and into adulthood. Lens Retina How do we see with our eyes? Iris Light enters our eyes by passing through our cornea, our pupil, (the hole in the middle of the iris), and Diagram of cross section of eye (labels cornea, lens, iris, our lens so that it is sharply focused onto the retina vitreous humour, macula, retina, choroid, optic nerve) lining the back of our eye.
    [Show full text]
  • Corneal Anatomy
    FFCCF! • Mantis Shrimp have 16 cone types- we humans have three- essentially Red Green and Blue receptors. Whereas a dog has 2, a butterfly has 5, the Mantis Shrimp may well see the most color of any animal on earth. Functional Morphology of the Vertebrate Eye Christopher J Murphy DVM, PhD, DACVO Schools of Medicine & Veterinary Medicine University of California, Davis With integrated FFCCFs Why Does Knowing the Functional Morphology Matter? • The diagnosis of ocular disease relies predominantly on physical findings by the clinician (maybe more than any other specialty) • The tools we routinely employ to examine the eye of patients provide us with the ability to resolve fine anatomic detail • Advanced imaging tools such as optical coherence tomography (OCT) provide very fine resolution of structures in the living patient using non invasive techniques and are becoming widespread in application http://dogtime.com/trending/17524-organization-to-provide-free-eye-exams-to-service- • The basis of any diagnosis of “abnormal” is animals-in-may rooted in absolute confidence of owning the knowledge of “normal”. • If you don’t “own” the knowledge of the terminology and normal functional morphology of the eye you will not be able to adequately describe your findings Why Does Knowing the Functional Morphology Matter? • The diagnosis of ocular disease relies predominantly on physical findings by the clinician (maybe more than any other specialty) • The tools we routinely employ to examine the eye of patients provide us with the ability to resolve fine anatomic detail http://www.vet.upenn.edu/about/press-room/press-releases/article/ • Advanced imaging tools such as optical penn-vet-ophthalmologists-offer-free-eye-exams-for-service-dogs coherence tomography (OCT) provide very fine resolution of structures in the living patient using non invasive techniques and are becoming widespread in application • The basis of any diagnosis of “abnormal” is rooted in absolute confidence of owning the http://aibolita.com/eye-diseases/37593-direct-ophthalmoscopy.html knowledge of “normal”.
    [Show full text]
  • Eye Anatomy Slides File
    EYE ANATOMY & PHYSIOLOGY Dr. Cesar Carrillo [email protected] Sight For All **Disclaimer** The images contained in this presentaon are not my own, they can be found on the web Eye Anatomy and Physiology A thorough understanding of the anatomy and physiology of the eye, orbit, visual pathways, upper cranial nerves, and central pathways for the control of eye movements is a prerequisite for proper interpretaon of diseases having ocular manifestaons. Furthermore, such anatomic knowledge is essen;al to the proper planning and safe execu;on of ocular and orbital surgery Eye Anatomy and Physiology Objecves: Brief overview of eye anatomy and relevant physiology — Embriology — The Orbit, Cranial Nerves, Blood supply and Venous drainage — The Ocular Adnexa — The Extraocular muscles — The Conjunc;va, Sclera and Cornea — The Uveal tract — The Lens — The Re;na, Vitreous and Op;c Nerve — The Visual Pathway Embryology The eye is derived from three of the primi;ve embryonic layers: — Surface ectoderm, including its derivave the neural crest — Neural ectoderm — Mesoderm — Endoderm does not enter into the formaon of the eye — Mesenchyme is the term for embryonic connecve ssue. Ocular and adnexal connec;ve ;ssues previously were thought to be derived from mesoderm, but it has now been shown that most of the mesenchyme of all of the head and neck region is derived from the cranial neural crest Embryology Development of the structures of the head and neck occurs between 3-8 weeks of gestation — Eye develops as an ectodermal diverticulum from the lateral
    [Show full text]
  • Control of Retinal and Choroidal Blood Flow
    Eye (1990) 4, 319-325 Control of Retinal and Choroidal Blood Flow A. BILL and G. O. SPERBER Uppsala, Sweden Summary Earlier studies on the control of retinal and choroidal blood flow are reviewed and some recent observations on the effectsof light on retinal metabolism and retinal and choroidal blood flow in monkeys (Macaca fascicularis) are reported in preliminary form. The retina is nourished by the retinal blood vessels, where blood flow is auto­ regulated and the choroidal blood vessels where autoregulation is absent. Studies with the deoxygiucose method of Sokoloff indicate that flickering light tends to increase the metabolism of the inner retina, while constant light reduces the metab­ olism in the outer retina. Retinal blood flow in flickering light, 8 Hz, is higher than in constant light. The sympathetic nerves of the choroid are probably involved in a pro­ tective mechanism, preventing overperfusion in fight and flight situations with acute increments in blood pressure. The facial nerve contains parasympathetic vasodilator fibres to the choroid; the physiological significance of these fibres is unknown. The neuropeptides 'NPY, VIP and PHI are likely to be involved in autonomic reflexes in the eye. Choroidal and retinal blood flow choroidal and retinal circulation mainly via In most tissues, the control of the circulation autonomic nerves and report on some recent is complex because of the many factors influ­ observations on effects of light on retinal encing the vascular resistance: local myogenic metabolism and blood flow. responses, endothelium derived substances The blood flow, Q, in the intraocular tissues and local metabolic factors as well as circu­ as in other tissues depends on the local arterial lating substances and the autonomic nerves.
    [Show full text]