Abnormal retinal pigmentation

Question 1

pigmentation in fundus can be divided into

Answer 1

choroidal

retinal- congenital/acquired

Question 2

e.g. of choroidal pigmentation

Answer 2

tigroid- can see vessels underneath

albino

Question 3

choroidal neavus

Answer 3

common
2% of population
harmless
flat pigmented lesion, with diffuse edges
grey
subretinal

Question 4

malignant transformation of choroidal neavi

Answer 4

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

Question 5

what does a supicous lesion look like

Answer 5

large
close to the disc
orange in colour

Question 6

maligment melanoma of choroid

Answer 6

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

Question 7

what do u do with a nevus

Answer 7

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

Question 8

melanocytoma

Answer 8

tumour
pigmented lesion
on OD surface
usually malignant
progresses slowly- but can progress and spread on body

Question 9

congenital pigment pigmentation
v common
split into 5:

Answer 9

bear track
congenital hypertrophy retinal pigment epithlium
coloboma
toxoplasma
peripapillary pigmentation

Question 10

ber track

Answer 10

aka grouped pigmentation
dont change
usually in RPE
not neavi- don’t turn malignant

Question 11

congenital hypertrophy reinal pigment epithelium. CHIRPY

Answer 11

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

Question 12

congenital pigmentatin

Answer 12

present on birth
cytomegalovirus infection
toxoplasma
herpes
rubella
syphilis- can cause retinitis- then u see pigmentation

Question 13

acquired retinal pigmentation

Answer 13

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

Question 14

wot do u differentially diagnose rp with

Answer 14

Lyme disease, tuberculosis, syphilis, congenital rubella, toxoplasmosis and bartonellosis.

Question 15

if u suspect rp ask

Answer 15

fh
night probs
poor dark adaptation
examination- fundus,, subcapsular lesn opacity? optic atrophy, narrowed arterioles/. CMO
refer these px

Question 16

trauma

Answer 16

can cause choroidal rupture
scarring
concentric rings to OD- where choroidal RPE split

Question 17

fundal contusion injury

Answer 17

Chorioretinitis sclopetaria

after severe blunt injury

Question 18

tilted OD

Answer 18

unusual astigmatism
peripapillary atrophy
congenital
misalignment of entry into optic disc
generally harmless

Question 19

choroditis

Answer 19

white fluffy- active

heal then cause scars

Question 20

laser photocoagulation scars

Answer 20

healing with proliferation of scars

Question 21

choroidal neovascular membrane

Answer 21

grey/greeen
an cause distortion of vision
heommahrage

Question 22

drug induced

Answer 22

chloroquine- artheritis/lupus- permanent reduction in vision

thioridazine- antidepressants

Question 23

if u see pigmentation

Answer 23

where- retinal? choroid? edge of scar
is it normal variation
or congential?-aquired?