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Ophthalmology 422
Question | Answer |
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Ectropion General Facts | - Mostly canines - Breed related(Cocker Spaniel, Bloodhounds, Giant breeds) - Age related (older dogs that have weakened eyelid muscles) |
Ectropion - Secondary Problems | - Blepharospasm - Epiphora - Corneal ulceration - Corneal melanosis - Corneal vascularization |
Ectropion - Treatment | - often not necessary - lubrication - Antibiotic/steroid ointment - Wedge resection |
4 most common canine ocular neoplasias | - Meibomian adenoma (most common; age related) - Papilloma (puppies only) - melanoma(very old dogs) - lymphoma (secondary metastasis to the eyelids) |
Meibomian adenoma Clinical signs | - papilloma-like projection from eyelid margin - swelling of the affected gland - upper lid more commonly affected - variable size - blepharospasm if ulcerating - rarely metastasizes |
Meibomian adenoma Treatment | - Curettage and cryotherapy - wedge resection |
Most common feline ocular neoplasia | - squamous cell carcinoma (most common by far) - fibrosarcoma - mast cell tumor - basal cell carcinoma - lymphoma |
Feline eyelid squamous cell carcinoma Clinical signs | - ulcerative lesion - lower lid most common - white or lightly pigmented cats are predisposed (exacerbated by UV exposure) - metastasis occurs late |
Feline eyelid squamous cell carcinoma Treatment | - Radiation is most effective - Surgical excision (as an adjunct to radiation) - cryotherapy |
Equine ocular neoplasia | - squamous cell carcinoma (most common by far) - melanoma - sarcoid - fibrosarcoma - lymphoma |
Equine eyelid squamous cell carcinoma 3 locations | - eyelid - anterior surface of the third eyelid - lateral aspect of the limbus **equally distributed** |
How is the equine eyelid squamous cell carcinoma different from the feline? | - more proliferative mass (can be palpated) - non-ulcerative |
Equine breeds predisposed to squamous cell carcinoma | - draft breeds - appaloosas - paints |
Equine squamous cell carcinoma Treatment | - most difficult to treat (because usually not found until late stage) - surgical debulking - chemotherapy (cisplatin) |
Bovine ocular neoplasia | - squamous cell carcinoma (most common) |
Bovine squamous cell carcinoma 3 locations | - limbus (75%) - eyelid and third eyelid (25%) |
Stages of bovine eyelid squamous cell carcinoma | - thickening of eyelid skin - proliferative mass (malignant form) - Metastasis (to local salivary glands and lymph nodes) |
Bovine eyelid squamous cell carcinoma Treatment | - may not treat - economic decision - not all precursors progress - surgical debulking - cryotherapy |
Distichiasis general facts | - undifferentiated meibomian gland produces cilia - the cilia emerges from the meibomian gland duct - the cilia may contact the cornea or conjuntiva and cause irritation |
Distichiasis breeds | - American cocker spaniels - golden retrievers |
Distichiasis Treatment | - manual epilation to confirm diagnosis - remove cilia and wait to see if clinical signs resolve - with confirmation of the diagnosis, cryotherapy - warn O that it may depigment the area of treatment |
Ectopic cilia General Facts | - failure of differentiation of meibomian gland --> cilia grows out of the gland and through palpebral conjunctiva - usually happens in the upper lid at the 12 o'clock position |
Ectopic cilia Clinical signs | - usually 8-12mo of age - marked blepharospasm - epiphora - vertically linear superficial corneal ulcer - raised papilla |
Ectopic cilia Treatment | - excision - cryotherapy (to remove cilia producing tissue) |
Trichiasis General Facts | - hair from normal site in contact with cornea/conjunctiva - most frequently in dogs - brachycephalics - yorkies, poodles, breeds with long facial hair |
Trichiasis Clinical signs | - periocular hair touching ocular surface - most often it doesn't cause irritation - just wicks tears onto the face |
Trichiasis most common origin of hair | - medial canthus - nasal folds |
Trichiasis Treatment | - usually not indicated - cryotherapy - lid surgery (to roll the lids out) |
Traumatic eye injuries General facts | - abrasions --> first aid - full thickness lacerations --> Sx repair - lateral aspect of the upper lid is most frequently injured - if injury is medial, need to check the nasolacrimal duct patency |
Traumatic eye injuries causes | - Fight wounds - Environmental objects |
Traumatic eye injuries Treatment | - minimal debridement - 2 layer closure - orbicularis oculi m. - skin - ID and reconstruct inferior nasolacrimal system - systemic and topical antibiotics |
Traumatic eye injuries what layer is the primary holding layer when surgically closing a laceration? | - the orbicularis oculi m. |
Bacterial Blepharitis General Facts | - overgrowth of surface bacterial flora - enters the eyelid via the meibomian gland ducts - Staph and Strep most common bacteria - Hypersensitivity to staph toxins |
Bacterial blepharitis Clinical Signs | - eyelid swelling - blepharospasm - excoriation - alopecia - mucopurulent discharge - granuloma formation - usually bilateral (in dogs) - recurrence is common |
Bacterial blepharitis Treatment | - Topical antibiotic/steroid - Oral antibiotics - Oral prednisone (low anti-inflammatory dose for hypersensitivity component) - Warm compresses (pain relief and reduction of swelling) - Autogenous vaccines (recurrent/chronic cases) |
Chalazion General facts | - Older dogs - Obstruction of the meibomian duct - Accumulation of meibomian secretion - Rupture of the meibomian gland - Granulomatous reaction |
Chalazion Clinical Signs | - nodular swelling within the eyelid - No inflammation - No pain - Yellow white appearance through palpebral conjunctiva (viewed from underneath the eyelid) |
Chalazion Treatment | - incision through the palpebral conjunctiva - curettage of the glandular and granulomatous material - topical antibiotic/steroid |
Eyelid agenesis General Facts | - congenital condition - most commonly in cats |
Eyelid agenesis Clinical signs | - Absence of lateral 1/2 to 2/3 of the upper eyelid - always bilateral (but not symmetrical) - secondary trichiasis and exposure keratitis - (+/-) microphthalmos and persistent pupillary membrane |
Eyelid agenesis Treatment | - lubricants (reduce trichiasis irritation, reduce exposure) - cryotherapy (of trichiasis hairs) - blepharoplastic procedures (transplant part of the lower lid to the upper lid) |
Neonatal ophthalmia General facts | - infection under eyelids before opening - staph, strep, herpesvirus |
Ankyloblepharon | - adhesion of the ciliary edges of the upper and lower eyelids to each other - normal in dogs and cats 10-14days old |
neonatal ophthalmia clinical signs | - inflamed, distended eyelids - purulent discharge - conjunctival hyperemia - chemosis - (+/-) corneal ulceration |
Neonatal ophthalmia Treatment | - open eyelids (digital manipulation, blunt probe) - flush with dilute betadine solution - topical antibiotics |
Retained Spectacle General Facts | - in snakes - fused eyelids = spectacle - spectacle contains blood vessels and sheds regularly with skin (ecdysis) - abnormal if retained (not shed) |
Retained Spectacle clinical signs | - Dull, cloudy appearance - NOT the cornea |
Retained Spectacle Causes | - dry environment - systemic disease - mite or tick infestation - injury to the spectacle |
Retained Spectacle Treatment | - conservative (don't peel if off) - misting, soaking the spectacle - increase humidity - Add "furniture" to encourage normal shedding - address systemic disease |
4 primary layers of the cornea | - epithelium - stroma - Descemet's membrane - endothelium |
Corneal epithelium general facts | - 5-10cells thick - constant turnover - hydrophobic - won't take up fluorescein dye - mechanical barrier |
2 organisms that can directly infect the corneal epithelium | - feline herpesvirus - moraxella bovis |
Corneal stroma general facts | - 90% of the corneas thickness - lamellar arrangement of collagen fibers - hydrophilic - takes up fluorescein dye - readily susceptible to infection - densely innervated by CN V (outer half is innervated; inner half is not) |
Decemet's membrane General facts | - basement membrane of the corneal endothelium - very elastic - last barrier to perforation - produced throughout life - becomes thickened as animal ages - hydrophobic - won't take up flourescein dye |
Corneal endothelium | - monolayer of epithelium ("posterior corneal epithelium") - Na/K pump removes fluid from corneal stroma |
2 layers that control the hydration state of the cornea | - epithelium (hydrophobicity restricts tears from entering the stroma) - endothelium (Na/K pump actively transports fluid from stroma) |
5 factors that contribute to corneal transparency | 1. avascularity 2. relative dehydration 3. orderly arrangement of stromal collagen fibrils 4. lack of pigment 5. non-keratinized epithelium |
2 sources of nutrition for the cornea | 1. tears (for anterior cornea) 2. aqueous (for posterior cornea) |
3 functions of the cornea | 1. transmission of light 2. refraction of light 3. fibrous outer layer of eye protection |
Signs of corneal disease | - edema - cellular infiltrate - lipid/mineral deposits - fibrosis - precipitates - blood vessels - melanin - neoplasms |
corneal edema | - need to ID layer allowing edema (epithelium or endothelium) - entire cornea (diffuse) or sectional - epithelium affected --> sectional - endothelium affecthed --> diffuse, more severe - non-specific sign |
Corneal cellular infiltrate | - infection present = stromal abscess - specific sign |
Corneal lipid/mineral deposits | - usually cholesterol, other lipids, or Ca++ salts - non-specific sign |
Corneal fibrosis | - some past injury - non-specific |
Corneal precipitates | - accumulations of inflammatory cells and debris on the endothelial surface - always ssecondary to past or present anterior uveitis - specific sign - can cause corneal edema |
Corneal blood vessels | - always pathologic (response to injury) - diffuse or sectional? - tree-like with fine branching = superficial corneal vascularization - short non branching = deep corneal vascularization - takes 2-3days to initiate, then 1mm/day - non-specific sign |
Corneal melanosis | - response to chronic irritation/inflammation - varies by species - non-specific sign |
Corneal neoplasm | - rare in cats and dogs - common in horses and cattle |
Normal corneal ulcer healing | "slide and divide" - sliding (migration) of epithelial cells to cover the exposed stroma - formation of basement membrane between epithelium and stroma - mitosis to restore normal # of layers of the corneal epithelium |
Uncomplicated corneal ulcer Clinical signs | - epithelium only, no stromal loss - Heals within 7days - No change in stromal character (stromal melting) - No extensive vascularization |
uncomplicated corneal ulcer Treatment | - ABSOLUTELY NO TOPICAL STEROIDS - topical broad spectrum ABs - topical atropine - Ecollar - recheck 2-3days, then 7 days |
Complicated corneal ulcer Clinical signs | - increasing depth - stromal infiltrate (specific sign) - change in stromal character (specific sign) - corneal vascularization - hasn't healed in 7-10 days |
2 signs of a complicated corneal ulcer that are specific for infection | - stromal infiltrate - change in stromal character (stromal melting) |
Complicated corneal ulcer Common causes | - infection (bacterial, fungal, viral) - foreign bodies - exposure - entropion - ectopic cilia - persistent ulcer syndrome ("boxer" ulcer) - very common in SA practice |
Complicated corneal ulcer Diagnosis of infection | - cytology - C&S |
Complicated corneal ulcer Treatment | - referral is first choice - vigorous AB's/antifungals (q2hr) - topical serum - Ecollar - warm compresses - cage rest |
Complicated corneal ulcer Exposure Clinical signs | - most frequent with brachycephalics - centrally located - round firm edges |
Complicated corneal ulcer Treatment of exposure ulcer | - frequent AB ointment - (+/-) atropine - possibly tarsorrhaphy (closure of eyelids) |
Complicated corneal ulcer Persistent ulcer syndrome clinical signs | - middle aged or older - redundant epithelium around periphery - forms a sheet that floats in the tear film |
Complicated corneal ulcer Persistent ulcer syndrome Treatment | - corneal debridement with Q-tip - grid keratotomy - only in dogs - never in cats and horses - Medical Tx as uncomplicated |
why would you never do a grid keratotomy in a cat or horse with persistent ulcer syndrome? | because, in addition to stimulating basement membrane deposition, scoring the cornea will embed infectious material Cats - prone to herpes Horses - prone to infectious ulcers |
Chronic superficial keratitis general facts | - immune mediated - affects young adults - German shepherds predisposed - UV light alters stromal proteins and causes an immune response - lymphocyte migration --> cytokines --> inflammation - AKA pannus |
Chronic superficial keratitis clinical signs acute | - fibrovascular invasion just under the corneal epithelium in the ventrolateral cornea - plasmoma = third eyelid thickening |
Chronic superficial keratitis clinical signs chronic | - corneal melanosis - blindness |
Differential diagnoses for Chronic superficial keratitis | - KCS - Corneal ulceration |
Chronic superficial keratitis Treatment | - Topical steroids (neopolydex, prednisolone) - topical cyclosporine |
Exposure keratitis General facts | - usually brachycephalic dogs - eyelids don't meet fully in medial aspect - age related - weakening of the orbicularis oculi m. - Cats with eyelid agenesis - secondary to eyelid injury |
Exposure keratitis Clinical signs | - corneal vessels and melanosis medially - may lead to ulcers |
Exposure keratitis Causes | - conformation, breed related - eyelid agenesis - age related weakening of the orbicularis oculi m. - eyelid injury |
Exposure keratitis Treatment | - refer if ulcerated - treat underlying prob (agenesis, lid conformation problem) - topical AB/steroid ointment until keratitis controlled, then reduce - topical lubricating ointment long term |
Corneal degeneration General facts | - secondary to injury or inflammation - crystalline or chalky deposits under epithelium (Very superficial) - lipid and Ca salts - unilateral or bilateral - Painful/inflammatory - can lead to chronic recurrent ulceration - exclusively older pati |
Corneal degeneration Clinical signs | - roughened surface of cornea - blepharospasm - recurrent ulceration (from chalky deposits flaking off) |
Corneal degeneration Causes | - aberrant healing response - secondary to trauma, irritation, inflammation |
Corneal degeneration Treatment | - ABs for relief - keratectomy for permanent resolution |
Corneal Dystrophy General facts | - primary heritable defect - resembles corneal degeneration |
Corneal Dystrophy Clinical signs | - crystalline, ground-glass deposits - under corneal epithelium - bilateral, but not symmetric - no pain, no inflammation - no vision defect - seen in young patients (1-2yrs) |
Corneal Dystrophy Treatment | - not indicated - no pain - no vision defect |
Feline herpesvirus General facts | - FHV-1 infects corneal epithelial cells and conjunctival cells - May result in - corneal sequestrum - eosinophilic keratitis |
Feline herpesvirus clinical signs | - blepharospasm - epiphora - conjunctival hyperemia - chemosis - corneal vessels - Dendritic ulcers - focal pinpoint cellular infiltrate |
What clinical sign is pathognomonic for FHV-1 | - dendritic ulcers |
How are cats most commonly infected with FHV-1? Did an adult cat with an outbreak get FHV-1 from the new kitten in the household? | - in utero - No, the adult cat probably was infected with FHV-1 in utero and just had an outbreak in response to the stress of a new kitten in the household. |
Feline herpesvirus Treatment | - Topical antivirals (idoxuridine, cidofovir) - Oral L-lysine - TOPICAL STEROIDS ARE ABSOLUTELY CONTRAINDICATED! - treatment isn't curative, just shortens the course of the episode |
Corneal sequestrum General facts | - unique to domestic cats |
Corneal sequestrum Clinical signs | - distinctive dark brown plaque - necrotic stroma - NOT MELANIN - painful - can lead to rupture |
Corneal sequestrum Causes | - Herpesvirus plays a role, but is not the only factor - chronic exposure - as in brachycephalics |
Corneal sequestrum Treatment | - if there is a vascular response - will slough on its own - if no vascular response - keratectomy - conjunctival graft to the stromal bed |
Eosinophilic keratitis General facts | - most frequently in cats - also seen in horses - associated with herpesvirus |
Eosinophilic keratitis Clinical signs | - fibrovascular infiltrate with white "caseous" islands - nests of eosinophils |
Eosinophilic keratitis diagnosis | - clinical signs - fibrovascular infiltrate - caseous plaques - cytology - scrape white plaque and stain for eosinophils |
Eosinophilic keratitis Treatment | - Topical steroids and antivirals or - megesterol acetate |
Infectious Bovine Keratitis General facts | - common - economically significant - caused by moraxella bovis predominantly - Herefords are most affected breed - younger affected more than older |
Infectious Bovine Keratitis Clinical signs | - variable severity - initially unilateral - blepharospasm - epiphora - central stromal infiltrate - vigorous vascular response - perforation, phthisis bulbi possible |
Infectious Bovine Keratitis Treatment | - Can run its course without Tx - may rupture cornea and scar in - Penicillin - Ampicillin - Oxytetracycline (Tx of choice) |
Corneal neoplasia in dogs Genneral facts | - relatively rare compared to horses and cattle - limbal melanoma most common - hemangioma/sarcoma - lymphoma manifesting in corneal - squamous cell CA very rare |
Limbal melanoma Clinical signs | - Dark mass centered on limbus - extends to the sclera and cornea - unilateral - more aggressive in younger dogs - German shepherds predisposed - have to distinguish from anterior corneal melanoma growing into the sclera |
Corneal hemoangioma/sarcoma Clinical signs | - blood blisters - lateral aspect of the limbus |
Corneal lymphoma Clinical signs | - bilateral - 360 degree corneal vessels and white creamy infiltrate - eyelids swollen |
Treatment of corneal neoplasms Limbal melanoma, hemangioma/hemangiosarcoma, SCC | - require excision and adjunctive Tx - cryotherapy - radiation |
Treatment of corneal neoplasms Recurrent hemangiosarcoma | - enucleation |
Treatment of corneal neoplasms Lymphosarcoma | - treat symptomatically |
Corneal neoplasia in cats General facts | - limbal melanoma/cytoma most common - still rare - Dx and Tx same as dog |
corneal neoplasia in horses | - limbal scc most common |
Three common locations for equine limbal squamous cell carcinoma | 1. eyelids 2. anterior surface of the third eyelid 3. overlying the lateral aspect of the limbus |
primary causes of limbal SCC in horses | - UV light - breed predisposition - draft horses - appaloosas |
Equine limbal SCC Treatment | - keratectomy (cytoreductive) - adjunctive - cryotherapy - radiation - high success rate |
Corneal neoplasia in cows General facts | - SCC by far the most common - important economic loss |
2 locations of bovine SCC | - limbus (75%) - bulbar conjunctiva |
Bovine corneal SCC Clinical signs | - starts as a plaque and progresses - metastasis late to regional lymph nodes and parotid salivary gland |
Bovine corneal SCC causes | - increasing age - females may be predisposed - breed - Herefords (have light periocular pigmentation) - UV exposure - nutritional status |
Bovine corneal SCC Treatment | - same as horse, but may elect for enucleation for economic reasons |
Corneal dermoid General facts | - congenital - Choristoma = normal tissue in an abnormal location - mostly in dogs but also seen in cats, horses, cattle - breed predisposition (GSD, St. Bernard, Dachshund) |
Corneal dermoid clinical signs | - choristoma - located laterally - at the lateral limbus - can involve the lateral canthus |
Corneal dermoid Treatment | - keratectomy - reconstruct lateral canthus |
Components of the lacrimal system | - lacrimal gland - gland of the third eyelid - meibomian glands - goblet cells - lacrimal drainage apparatus |
Components of the lacrimal system that are responsible for production of the tear film | - lacrimal gland - gland of the third eyelid - meibomian glands - goblet cells |
Lacrimal glands and ducts - position - innervation - function | - dorsolateral in orbit - innervated by lacrimal nerve (parasympathetic) - produces aqueous portion of tear film (nutrition and immunologic agents) - |
parasympathomimmetic drugs _________ tear production | increase |
parasympatholytic drugs __________tear production | decrease |
Gland of the third eyelid -position -innervation -function | - located on posterior surface of the third eyelid - parasympathetically innervated - produces aqueous portion of the tear film |
Meibomian glands -location -function | - located in radial fashion within eyelids - ducts are landmark of eyelid margin - produce lipid portion of tear film - prevents evaporation - provides film like quality to tears |
Three layers of tear film, where they are produced, and what function they serve | 1.superficial- lipid -meibomian gland -prevents evaporation; film like quality 2.middle- aqueous -gland of the third eyelid -lacrimal glands -nutrition; immunological 3.inner- mucous -Goblet cells -anchors tear film |
Goblet cells of the lacrimal system - location - function | - located in conjunctiva, (most numerous in the fornix) - produces mucous portion of tear film - anchors tear film to corneal epithelium |
Nasolacrimal drainage apparatus | - lacrimal puncta (superior and inferior) - canaliculi - nasolacrimal duct - nasal puncta |
Which species only has inferior lacrimal puncta | rabbits |
Functions of the lacrimal system | - provide nutrition to the ocular surface - remove metabolic wastes and debris - provide lubrication to ocular surface |
General signs of disease of the lacrimal system | - tear production problems - quantitative - qualitative - tear drainage problems - epiphora - discharge |
Lacrimal system diagnostics | - schirmer tear test - fluoroscein dye - nasolacrimal flush |
Schirmer tear test | - measures aqueous tear production |
Fluoroscein dye passage | - tests patency of nasolacrimal duct - potential for false negatives (animal may swallow the flush; especially brachycephalics) - if + test, duct is patent |
Nasolacrimal flush | - can locate and relieve obstructions |
Keratoconjunctivitis sicca General facts | - reduction aqueous portion of tear film - most common in dogs |
Keratoconjunctivitis sicca Clinical signs | - mucoid discharge - blepharospasm - conjunctival hyperemia - 360 degree corneal vessels (cornea trying to get nutrition elsewhere) - corneal melanosis |
Keratoconjunctivitis sicca Causes | - immune mediated (75% in dogs) - drug therapy - TMS - atropine - general anesthesia - etodolac (severe and permanent) - iatrogenic (removal of gland of third eyeld) - trauma to lacrimal nerve - infectious (CDV) |
Keratoconjunctivitis sicca Diagnosis | - clinical signs - confirm with schirmer tear test |
Keratoconjunctivitis sicca Treatment | knowing underlying cause doesn't affect how you treat, just how long... - topical cyclosporine - topical AB/steroid - client education |
Developmental drainage obstruction General facts | - imperforate punctum and micropunctum (most common) - canalicular atresia rare - most common in dogs - nasal imperforate punctum is seen in horses |
Developmental drainage obstruction Clinical signs | - depends on if obstruction is complete or not - dogs have epiphora from birth - poor passage of fluoroscein dye - NL flush - nothing from inferior punctum (dogs) - nothing from nasal punctum (horses) - horses have chronic purulent discharge |
Developmental drainage obstruction Treatment | Easy and effective Sx Dogs - flush superior punctum and look for bleb where inferior punctum should be - incise conjunctiva over imperforate punctum - topical AB/steroid Horses - place cannula and thread down - excise skin covering nasal punctum |
Foreign body obstruction of lacrimal drainage General facts | - plant awns (foxtails) - sand - seasonal variation |
Foreign body obstruction of lacrimal drainage Clincal signs | - Painful - Blepharospasm - mucopurulent discharge - medial canthal swelling - negative fluoroscein dye passage - NL flush diminished or negative |
Foreign body obstruction of lacrimal drainage Treatment | - vigorous flushing (+/-) anesthesia - dislodge/retrieve foreign body - cannulate NL system and leave in place for 3-4wks - topical AB/steroid |
Inflammatory obstruction of lacrimal drainage General facts | - inflammatory debris without foreign body - descending infection - stagnant tear drainage |
Inflammatory obstruction of lacrimal drainage Clinical signs | - mucopurulent discharge - no medial canthal swelling - not painful - negative fluoroscein dye passage - NL flush easy and often produces mucoid or mucopurulent plug |
Inflammatory obstruction of lacrimal drainage Causes | - infection of the most proximal lacrimal drainage apparatus |
Inflammatory obstruction of lacrimal drainage Treatment | - NL flush (+/- betadine solution) - topical AB/steroid |
Anatomy of the iris | Anterior border layer Stroma Posterior epithelial layer Corpora nigra |
Anterior border layer of the iris | - fibroblasts - melanocytes - no continuous epithelial layer |
Stroma of the iris | - blood vessels - collagen fibers - fibroblasts - chromatophores - melanocytes |
Muscles of the iris | sphincter muscle - smooth muscle - stronger than dilator - innervated by CNIII - parasympathetic innervation Dilator muscle - smooth muscle - sypathetic innervation - continuous with outer, pigmented, ciliary body epithelium |
Posterior epithelial layer of the iris | - densely pigmented (melanin) - continuous with inner, non-pigmented, ciliary epithelium |
Corpora nigra | - found in most herbivores - cystic dilation of the posterior iris epithelium |
Ciliary body epithelium | Inner, non-pigmented (NPE) - extension of sensory retina - junctions of these cells make up the Blood Aqueous Barrier (BAB) Outer, pigmented epithelium - extension of retinal pigmented epithelium |
Blood-aqueous barrier | - ciliary body vessels (epithelial portion) - iridal vessels (endothelial portion) - prostaglandins |
Ciliary body vessels | - located in iridal stroma - fenestrated, leak plasma - junctional complexes along the lateral borders of the NPE |
Iridal vessels | - non-fenestrated capillaries |
Prostaglandins of the BAB | - released after initiating event of anterior uveitis - interfers with the junctional complexes at the lateral borders of the NPE - compromises the BAB |
Functions of the anterior uvea | - regulate light entry by changing pupil size - accomodation - production of aqueous |
General signs of disease of the anterior uvea | - change in appearance of the iris - change in aqueous - secondary effects on the cornea and lens |