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MD4001 Week 5 > 3. Pathology of the eye > Flashcards

3. Pathology of the eye Flashcards

1
Q

Causes for abnormal red reflex?

A
  • Anything obstruc5ng the path of light from the front to the back of the eye
  • Corneal Scar
  • Cataract
  • Vitreous Haemorrhage
  • Retinoblastoma
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2
Q

US of retinoblastoma

A

Calcified

appears white

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3
Q

Bilateral retinoblastoma presents later than unilateral. True or false

A

False

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4
Q

What is the knudson 2 hit hypothesis for retinoblastoma?

A

Familial form
• Those with a family history tended to present EARLIER in childhood and often had BILATERAL multi-focal disease

Sporadic (more common)
• Those without a family history presented LATER and only had a SINGLE eye involved

Tumour Suppressor Gene(TSG) – ANTI-ONCOGENE

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5
Q

Optic nerve is 15% nasal to the ….

A

Fovea

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6
Q

Optic disc appearance

A

Margin: Defined
Clour: Orange/yellow
Cup: pale hole at centre

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7
Q

What is the cup of retina?

A

The optic disc has a center portion called the “cup” which is normally quite small in comparison to the entire optic disc. In people with glaucoma damage, because of increased pressure in the eye and/or loss of blood flow to the optic nerve, these nerve fibers begin to die.

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8
Q

Optic atrophy (e.g. in MS) leads to optic disc appearance of…

A

Pale

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9
Q

Causes of swollen disc?

A

• Pseudo swelling
– Small Discs
– Drusen

•  Genuine swelling
•  Raised ICP 
–  SOL
–  IIH
–  Hydrocephalus
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10
Q

Causes of swollen disc?

A

• Pseudo swelling
– Small Discs
– Drusen

•  Genuine swelling
•  Raised ICP 
–  SOL
–  IIH
–  Hydrocephalus
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11
Q

What is Re5nopathy of Prematurity (ROP)?

A
  • Blinding neovascular re5nal condition driven by hormones including VEGF
  • Its therefore like Age Related Macular Degeneration & Diabetic Retinopathy
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12
Q

What 3 aspected of optic disc must be commented on?

A

Margin, colour, cup

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13
Q

Muscles of the eye

A

6 extra-ocular muscles
• 2 horizontal recti (medical and lateral)
• 2 vertical recti (superior and inferior)
• 2 oblique (superior and inferior)

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14
Q

S/S of CN III palsy?

A 
•  Oblique diplopia
•  Eye is ‘down & out’
•  Diplopia every where
•  Pupil dilated and ptosis
•  Can be associated with
an aneurysm – needs urgent brain imaging and angiogram

If headache too, need to exclude aneurysm of posterior communicating artery

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15
Q

S/S of CN IV palsy?

A 
•  Oblique diplopia
•  Head tilt *** towards normal side
•  Worse away from
the side of the
palsy if unilateral
•  Common after
head injury
•  Bilateral - might be
congenital
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16
Q

S/S of CN VI palsy?

A
  • Horizontal diplopia
  • Worse in far distance
  • Worse towards the side of the palsy if unilateral
  • Bilateral - concerned that raised intracranial pressure is present

ICP risk if bilateral

17
Q

AMD?

A

AGE RELATED MACULAR DEGENERATION (AMD)

18
Q 
AMD:
Epidem?
Types?
Symptoms?
Treatment?
A

Most common cause of blindness >65 years in high- income countries

Two types; dry and wet

Symptoms
• Progressive reduction in visual acuity.
• Metamorphopsia may suggest wet AMD

Treatment; rehabilitation and anti-VEGF injections

19
Q

Diabetic retinopathy:
Epidem?
Results in?
MoA

A
  • Main cause of blindness in working age in ‘western’ countries
  • Growing cause of blindness in low and middle income countries

Result:
• Damage to retinal micro-vasculature
• Blindness due to:
– Growth of new vessels: Leading to vitreous haemorrhage, tractional retinal detachment and rubeotic glaucoma
– Leakage of fluid from damaged vessels: Causes Macular oedema with loss of central visual acuity

MoA

  1. Glycosylation of vessels
  2. Hypoxia
  3. VEGF release
  4. New vessels are formed
  5. Neovascularisation and leakage
  6. Macular oedema, vitreous haemorrhage, retinal detachment and rubeotic glaucoma
20
Q

Pathophysiology of diabetic eye?

A
  1. Chronic hyperglycaemia
  2. Glycosylation of protein/basement membrane 3. Loss of pericytes
  3. Reduced O2 transport = tissue hypoxia
  4. Vaso-proliferative factors produced (VEGF)
  5. Neo-vascularisation and leakage
  6. Macular oedema, vitreous haemorrhage, retinal detachment and rubeotic glaucoma
21
Q

Classification of diabetic retinopathy?

A
  1. No retinopathy
  2. Non-proliferative retinopathy
    – Mild
    – Moderate
    – Severe
  3. Proliferative retinopathy
22
Q

Signs of non-proliferative diabetic retinopathy?

A
  • Microaneurysms
  • Dot & blot haemorrhages
  • Hard exudates
  • Cotton wool spots
  • Abnormalities of venous calibre
  • Intra-retinal microvascular abnormalities (IRMA)
23
Q 
For the following diabetic retinopathy, what is the approach?
1. No retinopathy
2. Non-proliferative retinopathy
–  Mild
–  Moderate
 –  Severe
3.  Proliferative retinopathy
A 
(Screen )
1. No retinopathy
2. Non-proliferative retinopathy
–  Mild
(Refer to ophthalmology)
–  Moderate
 –  Severe
(Treat)
3.  Proliferative retinopathy
24
Q

Classifications of maculopathy?

A
  • No maculopathy
  • Observable maculopathy
  • Referable maculopathy
  • Clinically significant maculopathy
25
Q 
For the following diabetic maculopathy, what is the approach?
•  No maculopathy
•  Observable maculopathy
•  Referable maculopathy
•  Clinically significant maculopathy
A 
Continue to screen-
•  No maculopathy
•  Observable maculopathy
Refer to ophthalmology-
•  Referable maculopathy
Treat-
•  Clinically significant maculopathy
26
Q

Maculopathy treatment:

A
  1. Lifestyle-stop smoking, weight control, exercise
  2. Glycaemic control
  3. Blood pressure control
  4. Dyslipidaemia control
  5. Support renal function-ACE inhibitors
  6. Laser, anti-VEGF injections and surgery
27
Q

VEGF?

A

Vascular endothelial growth factor

28
Q

Different classifications of clinically significant macular oedema?

A

1- Retinal oedema within 500um of the centre of the macula
2- Hard exudates within 500um of the centre of the macula, if associates with retinal thickeninngs
3- Retinal oedema one disc area (1500um) or larger, any part of which is within one disc diameter of the centre of the macula

29
Q

Hard exudate hints at…

A

oedema

MD4001 Week 5 (11 decks)

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