1 - Retinal Disorders Flashcards
Describe a retinal detachment
Separation of RPE from neurosensory retina
Branches of Ophthalmic artery
CL MS LSE
CRA Lacrimal Muscular Supraorbital LPCA SPCA Ethmoid
Cilioretinal artery arises from
SPCA
Innerv of retinal vessels
Autoregulated = no ANS innervation
- constant flow, unaffected by systemic changes
- choriocap is innerv by ANS
Fenestrations: retinal vessels vs choriocap
R: tight junctions
C: highly fenestrated
Outer BRB
- what/where
- damage example
TJ between:
- RPE cells
- RPE and Bruch’s
Damage example: AMD
- macula doesn’t have all layers = no supply from CRA, only from choriocap
- unhealthy lifestyle -> buildup of lipofuscin in RPE -> drusen -> over time disrupts RPE layer = poor transportation -> outer retinal layers don’t get enough O2/nutrition -> NV
Inner BRB
- what/where
- damage example
Pericytes and TJ between endo cells
-each endo has 1 pericyte
Glial cells (astrocytes and Muller)
Damage ex: DM or HTN
-pericyte loss -> TJ disruption -> intraretinal hemorrhage and NV (prolif ret)
Case ex:
- 30 yo pregnant female
- feels like blind spot over OS (-) pain, photophobia
- Amsler grid = slightly wavy OS
DDX?
Maculopathy
You dx a pt with CSCR
- what do you do
- what factor is most strongly assoc with this condn
RTC 1-2mo
Corticosteroid use (NOT PERSONALITY TYPE A)
You dx a pt with CME
-what do you do
Bromfenac 0.09% QID (NSAIDs to control inflammation - may resolve on own, but don’t take that chance)
Fundus exam reveals rentinal pallor, arterial attenuation, and cherry red spot
- primary ddx
- management options
CRAO
CBC, ESR, CRP, platelet Carotid artery eval Cardiac eval F/U eye exam in 2 weeks -look for NV (develops in 2-4 wks), if there, refer for PRP or anti-VEGF injections
Differentiate between ischemic CRVO, non-ischemic CRVO, and NPDR
Ischemic: more bleeding, macular edema, may induce CRAO
Non-ischemic: mild symptoms (attenuation)
NPDR: vessel bleeding, bilateral
You dx a pt with non-ischemic CRVO
-what do you do
CBC
Cardiac eval
Send home with Amsler grid and F/U in 1mo
(Usually self-limiting condn)
Case
- complaints: decr vision OS, getting worse, eye pain, amaurosis fugax (transient vision loss)
- you see: iris rubeosis, PERRLA (-) APD, SAFE, Full, normal Amsler
- BCVA: 20/20 OD, 20/40 OS
DDX?
OIS - dot/blot is typical finding, anterior seg involvement
CRVO vs OIS posterior seg
C: tortuosity
O: dilated, not tortuous
