Abnormal retinal pigmentation Flashcards
pigmentation in fundus can be divided into
choroidal
retinal- congenital/acquired
e.g. of choroidal pigmentation
tigroid- can see vessels underneath
albino
choroidal neavus
common 2% of population harmless flat pigmented lesion, with diffuse edges grey subretinal
malignant transformation of choroidal neavi
to malignant neavi likely to have melanoma if: greater than 2mm thickness subretianl fluid flashers, floaters, visual loss orange pigment- lipofuscin margin near disc unltrasonogrophic hollwoness absence of halo- halos are a sign of congenital abnormalities
what does a supicous lesion look like
large
close to the disc
orange in colour
maligment melanoma of choroid
becomes large
elevated
exudative/sub-retinal fluid??
tumour grows from choroid- under retina-
it can spread externally outside the eye, or even through eyes BV. blindness due to affecting central artery
what do u do with a nevus
asses risk factors take a photo- review in 12months if u can't photograph it refer to HES at 12months- rephotograph and compare size any change to lesion? refer to HES
melanocytoma
tumour pigmented lesion on OD surface usually malignant progresses slowly- but can progress and spread on body
congenital pigment pigmentation
v common
split into 5:
bear track congenital hypertrophy retinal pigment epithlium coloboma toxoplasma peripapillary pigmentation
ber track
aka grouped pigmentation
dont change
usually in RPE
not neavi- don’t turn malignant
congenital hypertrophy reinal pigment epithelium. CHIRPY
flat lesions largeeeEE dark-black hsve depigmented circle under oval with a halo surrounding normally harmless sometimes a marker for gardeners syndrome- polyps in the colon- which can turn malignant and turn int bowel cancer if FAP and more than 3 CHrpe- 100% chance of bowel cancer
congenital pigmentatin
present on birth cytomegalovirus infection toxoplasma herpes rubella syphilis- can cause retinitis- then u see pigmentation
acquired retinal pigmentation
rp- pigment usually in periphery- bone spicule- could also have pale disc and attenuated vessels trauma to posterior segment- blunt/penetrating lesion RD- tidemark- disruption to RPE old inflammatory disease latrogenic choroidal neovascular membrane macular dystrophy drug related
wot do u differentially diagnose rp with
Lyme disease, tuberculosis, syphilis, congenital rubella, toxoplasmosis and bartonellosis.
if u suspect rp ask
fh night probs poor dark adaptation examination- fundus,, subcapsular lesn opacity? optic atrophy, narrowed arterioles/. CMO refer these px
trauma
can cause choroidal rupture
scarring
concentric rings to OD- where choroidal RPE split
fundal contusion injury
Chorioretinitis sclopetaria
after severe blunt injury
tilted OD
unusual astigmatism peripapillary atrophy congenital misalignment of entry into optic disc generally harmless
choroditis
white fluffy- active
heal then cause scars
laser photocoagulation scars
healing with proliferation of scars
choroidal neovascular membrane
grey/greeen
an cause distortion of vision
heommahrage
drug induced
chloroquine- artheritis/lupus- permanent reduction in vision
thioridazine- antidepressants
if u see pigmentation
where- retinal? choroid? edge of scar
is it normal variation
or congential?-aquired?
