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Ophthalmology 2020 > Diabetic Retinopathy and Vascular Problems > Flashcards

Diabetic Retinopathy and Vascular Problems Flashcards

1
Q

what causes diabetic retinopathy?

A

chronic hyperglycaemia damages retinal blood vessels and basement membrane
loss of pericytes leads to leakage of blood and ischaemia

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2
Q

presentation of diabetic retinopathy on fundoscopy

A 
dot and blot haemorrhage (microaneurysms)
IRMA (dilated and torturous capillaries)
hard exudates (lipids)
cotton wool spots (fat axons)
new vessels grow
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3
Q

what colour is the retina?

A

transparent

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4
Q

why does the retina appear pink?

A

reflection of the choroid

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5
Q

what is rubeosis iridis?

A

new vessel growth

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6
Q

what causes vision loss in diabetic retinopathy?

A

oedema on fovea
vitreous haemorrhage
scarring/tractional retinal detachment

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7
Q

diagnosis of diabetic retinopathy

A

fundoscopy

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8
Q

management of diabetic retinopathy

A 
prevention with good HbA1c
laser= pan-retinal photocoagulation
anti-VEGF
vitrectomy
rehabilitation for blind/ partially sighted
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9
Q

anti-VEGF examples

A

ranibizumab

bevacizumab

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10
Q

what is hypertensive retinopathy?

A

damage to blood vessels due to hypertension

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11
Q

when does hypertensive retinopathy develop faster?

A

malignant hypertension

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12
Q

presentation of hypertensive retinopathy

A

copper/ thickened wiring of blood vessels due to thickening and sclerosis
arterioles compress veins as they harder leading to cotton wool spots ischaemia
retinal haemorrhages
disc swelling due to leakage and ischaemia

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13
Q

diagnosis of hypertensive retinopathy

A

very high BP
fundoscopy
Keith-Wagener classification

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14
Q

management of hypertensive retinopathy

A

control BP

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15
Q

what artery supplies the inner 2/3rd of the retina?

A

central artery of the retina

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16
Q

what artery supplies the peripheral 1/3rd of the retina?

A

choroid

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17
Q

presentation of central retinal artery occlusion (CRAO)

A

sudden painless loss of vision
cherry red macula
RAPD
pale oedematous retina

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18
Q

why does the macula stay cherry red in CRAO?

A

supplied by posterior ciliary arteries

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19
Q

which condition is a type of stroke?

A

CRAO

20
Q

causes of CRAO

A

CAD
GCA
embolus from the heart

21
Q

risk factors for CRAO

A 
age
FH
smoking
alcohol
hypertension
22
Q

management of CRAO

A

dislodge thrombus= massage, remove fluid, inhaling carbogen

23
Q

what is brach retinal artery occlusion (BRAO)?

A

less damage due to blockage of tributary of the central artery of the retina

24
Q

what is amaurosis fugax?

A

transient CRAO where it is momentarily blocked

25
Q

presentation of amaurosis fugax

A

painless visual loss
curtain coming down <5 minutes
full reocvery

26
Q

management of amaurosis fugax

A

refer to stroke clinic

27
Q

what is Virchow’s triad?

A

Virchow’s triad:

  • endothelial damage (DM)
  • abnormal blood flow (BP)
  • hypercoaguable state
28
Q

what causes central retinal vein occlusion (CRVO)?

A

artery becomes stiff and can press on top of the pliable vein causing it to be blocked
Virchow’s triad- venous thrombosis

29
Q

what does blockage in a vein cause?

A

back pressure causing ischaemia and forms haemorrhages and oedema

30
Q

presentation of CRVO

A

sudden painless loss of vision

31
Q

diagnosis of CRVO

A

fundoscopy
FBC
BP
serum glucose

32
Q

appearance of CRVO on fundoscopy

A 
haemorrhage
dilated torturous vessels
swelling
unable to make out edges of disc
cotton wool spots
dark retina
33
Q

risk factors for CRVO

A 
hypertension
lipidaemia
DM
smoking
SLE
glaucoma
34
Q

management of CRVO

A

laser photocoagulation
intravitreal steroids
anti-VEGF

35
Q

what is branch retinal vein occlusion (BRVO)?

A

occlusion of tributary

36
Q

presentation of BRVO

A

can be asymptomatic

painless disturbance in vision/ loss of part of field

37
Q

what is ischaemic optic neuropathy?

A

occlusion of the optic nerve circulation (posterior ciliary arteries)

38
Q

presentation of ION

A

sudden painless visual loss

red flag= young patient with unilateral vision loss/ colour vision loss (MS)

39
Q

diagnosis of ION

A

examination= swollen optic nerve, edges fluffy with loss of well-define border

40
Q

what is GCA/ temporal arteritis?

A

example of an ION

posterior ciliary artery walls become inflamed and thickened until occluded

41
Q

what condition is GCA associated with?

A

polymyalgia rheumatica

42
Q

presentation of GCA

A

headache
jaw claudication
scalp tenderness
enlarged temporal arteries (torturous appearance)
patients describe not being able to brush hair, lie on affected side, etc.
malaise
>50

43
Q

management of GCA

A

sight-threatening

manage with steroids immediately

44
Q

what is a vitreous haemorrhage?

A

bleeding occurring from abnormal vessels

45
Q

presentation of vitreous haemorrhage

A 
sudden visual loss
floaters (fly's/spider's webs in vision)
may just see red or black depending on density
loss of red reflex
eye red
laser marks from previous

Ophthalmology 2020 (25 decks)

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