CHOROID ANOMALIES Flashcards
define choroidal nevus?
Benign focal accumulation of melanocytes within the choroid that is present at birth & are typically non-progressive.
what can a choroidal nevi convert to?
choroidal melanoma
choroial nevi symptoms?
asymptomatic
choroidal nevi signs? how to differentiate from CHRPE?
- gray-green or brownish, circular mass with well-demarcated borders – surface drusen may be present.
- will dissapear with red-free filter - “nev-us will leav-us”
tx/managment for choroidal nevus?
- monitor with fundus photography - first f/u should be in 3 months.
- second f/u can be every 1 year.
what is the most common primary intraocular malignancy in adults?
choroidal melanoma
define choroidal melanoma?
it is a an abnromal pigmented tumor of the choroid.
what is the nortality rate for choroidal melanoma if it metastasizes?
15-45% w/in 10 yrs
what is the most common sites a choroidal melanoma metastasizes? (in order from most to least common).
liver > lung > bone > skin > CNS
choroidal melanoma symptoms?
- asymptomatic if in the peripheral
choroidal melanoma signs?
- large gray-brown-yellow dome shape elevations.
- may have yellow/orange lipofuscin – denotes metabolic activity.
- borders are indistinct
risk factors for choroidal melanoma development?
Risk factors for malignant transformation: “To Find Small Ocular Melanoma Using Helpful Hints Daily”
T: thickness >2mm, size >5mm
F: Fluid-subretinal, serous RD
S: symptoms-flashes and floaters
O: orange pigment (lipofuscin) present over the lesion
M: margin of tumor <3mm from optic disc
U: ultrasonic hollowness
H: halo absent
D: Drusen-absent
w/u for choroidal melanoma?
- B-scan ultrasonography detects potential elevation and the thickness of the tumor
tx/managment for choroidal melanoma?
- refer to concologist - for blood testing, chest and abdominal x-ray (r/o metastasis).
- enucleation - if choroidal melanoma.
what is choroidal metastasis?
spread of cancer from another place in the body to the eye.
which is the most common intraocular malignancy in adults?
choroidal metastasis
what are the most common sites of the primary tumor with somone with choroidal metastasis?
- woman = breast
- men = lung
what is choroideremia?
- X-linked recessive disorder that ultimately results in choroidal degeneration and subsequent loss of retinal function.
what type of inheritence is choroideremia? what gender is affected more?
X-linked recessive - meaning only males are affected while females are carriers.
onset of choroideremia? is it progressive?
- 20-30 yrs of age –> progresses to legal blindness by 50-60 yrs of age.
symptoms of choroideremia?
- nyctalopia – total night blindness in 10 within 10 yrs.
- photophobia
- peripheral vision loss
- maintain central vision until later stage.
signs of choroideremia?
- Bilateral diffused peripheral atrophy of the RPE & choriocapillaris – “moth-eaten” appearance.
- visible underlying sclera
- RPE pigment clumping
tx for choroideremia?
- no tx
- low vision consult.
what is cobblestone degeneration aka pavingstone degeneration?
characterized by discrete yellow–white patches of focal chorioretinal atrophy that mayhave pigmented margins
where is the most common location for pavingstone to occur in the retina?
inferior or inferior temporal retina
what is pavingstone degeneration associated with?
high myopia
what is birdshot retinochoroidopathy?
it is idiopathic, bilateral, chronic, recurrent inflammation of the choroid and retina.
who gets birdshot retinochoroidopathy?
- Healthy 20-50 y/o whites of northern European descent.
what genetic association does birdshot have?
associated with HLA-A29 - suggests it is an autoimmune disease
symptoms of birdshot?
- Decreased night vision
- Decreased color vision
- Floaters
signs of birdshot?
- Bilateral, multiple, creamy round/oval, yellow/white splotches located in the posterior pole & extending to the periphery.
- Low-grade vitritis
- Secondary CME or CNVM in some - contributes to decrease VA
tx for birdshot?
only tx id significant inflammation, reduced vision, CME/CNVM:
* steroids - inflammation
* cyclosporine - for vitritis & CME
what is serpiginous choroidopathy?
- It is idiopathic, chronic, progressive and recurrent inflammation of the RPE and choroid.
what is genetic association does serpiginous choroidopathy have?
HLA-B7
who gets serpiginous choroidopathy
50-60 yr old men
symptoms of serpiginous choroidopathy
- Decreased VA
- Scotomas
- Metamorphopsia
signs of serpiginous choroidopathy?
- Early – unilateral, ill-defined gray/yellow subretinal infiltrates that start at ONH and extend to the macula in “serpant-like” manner.
- Late – retinal atrophy
- possible CNVM in 25% of cases
tx for serpiginous choroidopathy?
- Resolves over 6-8 weeks but tends to recur.
- steroids - for inflammation
- PRP or anti-VEGF injections - CNVM
- low vision consult - poor vision prognosis
what is candidiasis? what species is involved?
- Fungal infection due to Candida sp.
candidiasis has the highest susceptibility during __?
o Endophthalmitis
o HIV
o Immunosuppression
o IV drug users
o Systemic mycotic infection
o Ocular trauma
symptoms of candidiasis?
- blurry vision
- pain
- floaters
signs of candidiasis?
- yellow-white choroidal lesions
- vitritis
- possible RD
tx for candidiasis?
- oral or IV antifungals
- if vitreous is involved - tx with intravitreal antifungal injections
- pts need to be monitor daily or hospitalized if they are noncompliant
- consult with infectious dz specialist.
