C2 - F revision deck

Question 1

What are the types of posterior coloboma

Answer 1

retina, choroid, macular, onh

Question 2

what is chorioretinal coloboma?

Answer 2

it is the congenital absence of part of the rpe and choroid.

caused by the defective closure of the embryonic fissure(nor develop gradually between 6-7 week of fetal life )

Question 3

what is the ssx of chorioretinal coloboma

Answer 3

yellow white appearance, often hyperpigmented margin.common in inferonasal and may be associated with coloboma of the iris and onh

Question 4

what is the common complication of chorioretinal coloboma

Answer 4

retinal detachment - rhegmatogenous rd

Question 5

chorioretinal coloboma mx

Answer 5

no cure
tx for rd: depend on the severity of the condition
- small: photocoagulation/ cryopexy
- large: surgery is need ; scleral buckle, pneumatic retinopexy, vitrectomy

Question 6

what is macular coloboma

Answer 6

this is a rare, non-syndromic development defect of the eye characterized by well-circumscribed oval or roudnded.

• usually unilateral, atrophic lesion of varying size presenting rudimentary or absent retina, choroid and sclera located at the macular.

Question 7

ssx of macular coloboma

Answer 7

decreased vision, tropia(occasionally)

Question 8

association of macular coloboma

Answer 8

usually isolated, but may be associated with down syndrome, skeletal or renal disorder

Question 9

mx of macular coloboma

Answer 9

using low vision devices
genetic counselling

Question 10

what is onh coloboma

Answer 10

partial or complete failure of closure of the optic fissue resulting in coloboma

prevalance has been reported to be 0.14 in the general population. half of the case is bilateral

Question 11

ssx of onh coloboma

Answer 11

visual field defects
rapd
enlarged, sharply circumscribed glistening white and deeply excavated onh which usually occurs inferiorly
- may mimic glaucomatous cupping in mild cases
- can develop serous macular detachment

Question 12

mx for onh coloboma

Answer 12

low vision devices

Question 13

what is persistent hyaloid artery

Answer 13

it is the remnant of the hyaloid vascular system. occasionally run from disc to the lens.

anterior = mittendorf dot @posterior surface of the lens
posterior = bergmeister’s papilla over onh

*more commonly in premature babies and 3% full term

Question 14

possible consequences of pha

Answer 14

amblyopia, strabismus, nystagmus, posterior polar cataract and vitreous haemorrhage(less frequent)

Question 15

mx of pha

Answer 15

assess risk of amblyopia and monitor for cataract, vitreous haemorrahage

Question 16

what is leukocoria

Answer 16

white pupil

Question 17

ssx of leukocoria

Answer 17

poor va
strabismus
nystagmus (if bilateral)

Question 18

role of optometrist in leukocoria

Answer 18

• history taking ande xamination
• referral for dfe/ laser treatment/ surgery
• refractive correction/ patching after removal of opacity “stimulus deprivation amblyopia”

Question 19

conditions presenting leukocoria

Answer 19

retinoblastoma
retinopathy of prematurity
congenital cataract
retinal detachment
persistent hyperplastic primary vitreous
onh/chorioretinal coloboma
coats disease

Question 20

what is rop

Answer 20

rop affects premature infants weighting about 1250 or less that are born before 31 week of gestation

in early phase, vessel growth is retarded by hyperoxia, subsequent retinal hypoxia promotes anomalous vascularization

nasal retinal is normally fully vascularized after 8 month of gestation, temporal periphery at or about 1 month before delivery

Question 21

risk factor of developing rop

Answer 21

exact cause is unclear

early exposure to high amient oxygen concentration is a key risk fact

Question 22

how many stages are there in rop

Answer 22

5

Question 23

what is stage 1 of rop and its tx plan

Answer 23

• demarcation line - thin, flat, tortuous, grey white line running roughly parallel with the ora serrata

mildly abnormal blood vessel growth.

tx:
usually no treatment and eventually develop normal vision.

the disease will resolves on its own without further progression

Question 24

what is stage 2 of rop and its tx plan

Answer 24

ridge arising in the region of the dermacation line

moderately abnormal blood vessel growth.

tx:
usually no tx and eventually develop normal vision

the disease will resolves on its own without further progression

Question 25

what is stage 3 of rop and its tx plan

Answer 25

extraretinal fribrovascular proliferation from ridge into the vitreous

tx: is needed if there is plus disease (bv enlarge and tortuous)
- intravitreal vegf
- pars plana vitrectomy
- laser treatment

Question 26

signs and symptoms of uveitis

Answer 26

blepharospasm
Mutton fat (keratic precipitate)
anterior and posterior synechiae
cells and flare
hypopyon
pain in near work
pain in consensual light reflex
photophobia
bov
lacrimation
epicapsular star
choroiditis (posterior uveitis only)
reduce iop
cataract
miotic
stroma oedema
perilimbal fush

Question 27

management of anterior uveitis

Answer 27

urgent referral; mydriatics, steroids, analgesics

Question 28

signs and symptoms of posterior uveitis

Answer 28

painless floaters, bov,
pain, photophobia, red eye(rare)
mild to moderate anterior segment inflammation
severe findings of uveitis; posterior synechiae
vitrous condensation and haze
snow ball, and snow banking
vitreous haemorrhage (young px)

Question 29

what is snow ball and snow banking.

Answer 29

Snowballs are whitish focal collections of inflammatory cells and exudate, usually most numerous in the inferior vitreous.

Snowbanking is characterized by a grey-white fibrovascular and/or exudative plaque, most frequently found inferiorly

Question 30

ssx of posterior uveitis

Answer 30

Floaters (intermediate uveitis)
Minimal pain, photophobia, blurred vision
Vitreous haze
Diffuse yellow/white fluffy lesions in the retina
Irregular RPE pigmentation with areas of prominent choroid