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Posterior Segment > Block 15 Lectures 18 and 20 - Retinal Detachments > Flashcards

Block 15 Lectures 18 and 20 - Retinal Detachments Flashcards

1
Q

Separation of photoreceptors from the underlying RPE is known as _____?

A

Retinal detachment

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2
Q

What are the 3 types of RD?

A
  1. Rhegmatogenous
  2. Tractional
  3. Exudative
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3
Q

A retinal break that allows liquefied vitreous to seep into potential space between neurosensory retina and RPE is known as _____?

A

Rhegmatogenous retinal detachment

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4
Q

Formation of rhegmatogenous RD requires what 3 elements?

A
  1. Full-thickness retinal break
  2. Traction to hold the break open
  3. Liquefied vitreous
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5
Q

What accumulates between the photoreceptors and RPE in a rhegmatogenous RD?

A

Liquefied vitreous

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6
Q

What can be a signal of the initial location of a primary retinal break in rhegmatogenous retinal detachments?

A

The initial location of a curtain/shadow seen in vision

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7
Q

The majority of spontaneous rhegmatogenous RD notice what symptoms?

A

Flashes and floaters

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8
Q

Where are retinal breaks most often found in rhegmatogenous RD?

A

Superotemporal quadrant

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9
Q

What does Shafer’s sign refer to in rhegmatogenous RD?

A

Pigment cells in anterior vitreous (“tobacco dust”)

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10
Q

How might IOP be affected in rhegmatogenous RD?

A

Slightly lower in eye w/ RD

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11
Q

RAPD may be present if what type of RD is extensive?

A

Rhegmatogenous RD

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12
Q

What type of RD may show “Shafer’s sign”?

A

Rhegmatogenous

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13
Q

An operculated tear may be a sign of what type of RD?

A

Rhegmatogenous

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14
Q

Describe 3 features about the clinical appearance of a fresh/recent rhegmatogenous RD.

A
  1. Translucent elevated retina
  2. Wrinkled
  3. Moves with eye movements
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15
Q

Describe 3 features about clinical appearance of long-standing rhegmatogenous RD

A
  1. Detached retina becomes thinned and atrophied
  2. Intraretinal cysts
  3. Demarcation lines
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16
Q

Successful reattachment of retina in rhegmatogenous RD depends on what?

A

Permanent closure of the retinal breaks that caused the RD in a timely manner

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17
Q

What are 4 reattachment techniques?

A
  1. Laser or cryotherapy (prophylactic)
  2. Pneumatic retinopexy (gas tamponade)
  3. Scleral buckling (with or without fluid drainage)
  4. Vitrectomy (combined with scleral buckle)
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18
Q

Contraction of fibrous tissue on the retinal surface, pulling the retina away from the RPE below it is known as _____?

A

Tractional retinal detachment

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19
Q

Does tractional RD require retinal break?

Liquefied vitreous?

A

Neither

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20
Q

What is a common cause of tractional retinopathy?

A

Proliferative diabetic retinopathy

21
Q

What type of RD is usually a complication observed in a patient known to have diabetic retinopathy?

A

Tractional RD

22
Q

Why are symptoms limited in tractional RD?

A

Contraction of fibrous tissue occurs slowly

23
Q

How does the detached retina appear in a tractional RD?

A

Smooth and concave to surface of retina; relatively stationary and initially shallow

24
Q

What can often be seen at the site of vitreoretinal traction in an tractional RD?

A

Proliferative fibrous membrane - elevation of retina

25
Q

What cause of a tractional RD could lead to a combined tractional-rhegmatogenous RD?

A

Penetrating trauma

26
Q

Blood within vitreous gel may cause what kind of RD?

A

Tractional

27
Q

What are 2 treatment strategies for Tractional RD?

A
  1. Release of traction by vitrectomy

2. Membrane dissection

28
Q

What is an optometrist’s role in managing tractional RD?

A

Detect and refer for surgical intervention

29
Q

Is there an effective medical treatment for tractional RD?

A

No

30
Q

Early detection and treatment of what condition is key for an optometrist to help prevent tractional RD?
How is this condition typically treated?

A
  • Proliferative diabetic retinopathy

- Panretinal photocoagulation of neovascularization

31
Q

Separation of neurosensory retina from RPE by fluid accumulation from a breakdown of inner/outer blood-retinal barriers is known as _____?

A

Exudative RD

32
Q

Does an exudative RD require a retinal break?

A

No

33
Q

Which RD requires a retinal break?

A

Rhegmatogenous

34
Q

What are 2 ways the blood-retinal barrier could be defective in exudative RD?

A
  1. Increased vascular permeability

2. Dysfunction of pumping mechanisms of RPE

35
Q

What is a possible vascular cause of an exudative RD?

A

Coat’s disease

36
Q

What is a possible inflammatory cause of an exudative RD?

A

Posterior scleritis

37
Q

What is a possible neoplastic cause of an exudative RD?

A

Choroidal melanoma

38
Q

What is a possible idiopathic cause of an exudative RD?

A

Bullous central serous chorioretinopathy

39
Q

Which RD is commonly associated with fluctuating visual changes?
What causes these changes?

A
  • Exudative RD

- Shifting subretinal fluid

40
Q

If an exudative RD was associated with pain, what could be the underlying cause?

A

Posterior scleritis

41
Q

Why is photopsia not a common symptom of exudative RD?

A

No traction pulling on retina

42
Q

What does an exudative RD look like on the retina?

A

Smooth, dome-shaped elevation of retina with shifting subretinal fluid

43
Q

Which RD is associated with “leopard spots”?

A

Exudative RD

44
Q

What are “leopard spots” seen in Exudative RD?

A

Scattered subretinal pigment clumping caused by resorption of fluid

45
Q

What test can determine source/cause of subretinal fluid in exudative RD?

A

Angiography

46
Q

Diagnosis of exudative RD is mostly based on ____?

A

Clinical exam - fundus appearance and signs/symptoms of underlying cause

47
Q

If a choroidal melanoma is found to be underlying cause for exudative RD, how does an optometrist manage?

A

Referral to ophthalmic oncology

48
Q

If posterior scleritis is found to be underlying cause for exudative RD, how does optometrist manage?

A

Urgent referral to rheumatologist

Posterior Segment (5 decks)

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