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OD3 - Clinical Optometry Practice > DIS - Basic Pathology: Vascular II - Week 9 > Flashcards

DIS - Basic Pathology: Vascular II - Week 9 Flashcards

1
Q

Where does CRVO tend to occur and at what age?

A

Usually behind the lamina cribrosa, typically >65yoa

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2
Q

List the three types of CRAO blockages that can occur.

A

Cholesterol
Fibrin platelets
Calcium

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3
Q

Where do cholesterol emboli tend to occur? Do they generally cause occlusion?

A

At bifurcations

Rarely cause occlusion

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4
Q

What is the loss of vision like with CRAO? Is pain involved? Is it acute or chronic?

A

Acute, severe, painless

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5
Q

What may CRAO precede (2)?

A

TIA / amaurosis fugax

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6
Q

Is RAPD present with CRAO?

A

Yes

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7
Q

What magnitude of vision lodd can occur with CRAO?

A

NLP

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8
Q

What is the ERG like with CRAO?

A

Normal a wave

Diminished/absent b wave

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9
Q

List 6 fundus findings you would expect with CRAO.

A 
Superficial retinal whitening
Cherry red macula spot
Attenuated retinal arterioles
Retinal embolus visible
Segmentation of arterial blood column
Possible sector of normal retinal colour if ciliomacular artery is present
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10
Q

What happens to retinal filling in angiography with CRAO?

A

Delay

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11
Q

List two differential diagnoses for CRAO.

A

Tay sachs disease

Ophthalmic artery occlusion

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12
Q

How should CRAO be referred (2)? How urgent is it?

A

Ophthalmologist - urgent if <48h

GP - evaluation of risk factors

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13
Q

List 5 possible interventions for CRAO. Explain each.

A

Ocular massage - gonio lens 10s on, 5s off
Isosorbide - dilates peripheral vessels
Diamox - reduces IOP
Paracentesis - rapid IOP lowering
IV streptokinase - dissolves fibrin clots

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14
Q

What is the prognosis of CRAO like? What about if it is caused by calcific emboli or GCA?

A

Poor, especially with calcific thrombi or GCA

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15
Q

List four things that happen over the weeks with CRAO.

A

Retinal whitening fades
Attenuated arteries remain
Optic atrophy
Risk of NVG

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16
Q

What is the mebolus size like in BRAO compared to CRAO? Where does the blockage usually occur? At what age typically?

A

Smaller
Usually at arterial bifurcation
-further up the arterial tree
-typically >65yoa

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17
Q

Is RAPD present or absent with BRAO?

A

May or may not be

-will be if retinal loss is large enough

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18
Q

What is the prognosis of BRAO like (2)?

A

Poor unless the embolus dislodges

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19
Q

List four signs of BRAO.

A

Retinal clouding
Embolus (look at other branches)
Attenuated arteries
Segmentation

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20
Q

List three differential diagnoses for retinal whitening due to inflammation (BRAO).

A

Lymphoma
Toxoplasmosis chorioretinitis
CMV retinitis

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21
Q

List a differential diagnosis for non-inflammatory retinal whitening (BRAO).

A

Medullated nerve fibres

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22
Q

How should BRAO be managed?

A

As per CRAO

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23
Q

What is meant by combined CRAO/CRVO? How common is it? What is vision loss like and what onset?

A

Blockage of both the CRA and CRV
Very rare presentation
Very poor vision with acute onset

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24
Q

How does the retina appear with combined CRAO/CRVO (4)?

A

Retinal whitening
Extensive retinal haemorrhage
Macular oedema
Dilated vessels

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25
Q

What is the management like for combined CRAO/CRVO and what is there a risk of?

A

As per CRAO with systemic workup as per CRAO

Risk of NVG

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26
Q

What is ocular ischaemic syndrome?

A

Marked carotid/ophthalmic artery obstruction

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27
Q

What is required for ocular ischaemic syndrome? Describe in terms of percentages (2).

A

Requires significant decrease in flow/arterial hypoperfusion

-no symptoms without 70% reduction

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28
Q

what percentage obstruction to the carotid/ophthalmic artery will cause a 50% decrease in CRA flow?

A

90%

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29
Q

List four causes/associations of ocular ischaemic syndrome.

A

Atherosclerosis
Giant cell arteritis
Diabetes
Previous stroke/CVA

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30
Q

What happens to vision with ocular ischaemic syndrome? What happens with light exposure?

A

There is a slow decline

Slow recovery in vision after light exposure

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31
Q

Is pain involved with ocular ischaemic syndrome?

A

Peri-orbital pain (angina-like)

32
Q

List 5 anterior ocular signs of ocular ischaemic syndrome.

A 
Corneal oedema
Pupil mid-dilated/slow
Cells in AC
Iris neovascularisation
Cataract
33
Q

List 5 posterior ocular signs of ocular ischaemic syndrome.

A 
Slightly dilated veins
Microaneurysms
Dot/blot haemorrhages
Retinal whitening
Spontaneous arterial pulsation
34
Q

Should ocular ischaemic syndrome be referred? Is it urgent?

A

Yes, with some urgency

35
Q

How many short posterior ciliary arteries do normal eyes have and what do they supply?

A

2-3 supplying the ONH

36
Q

What is the cause of arteritic anterior ischaemic optic neuropathy? What disease can cause it? What artery is generally occluded?

A

Inflammatory narrowing of the lumen

  • giant cell arteritis
  • short posterior ciliary artery
37
Q

List 7 things that can cause non-arteritic anterior ischaemic optic neuropathy.

A 
Hypertension
Hypercholesterolaemia
Hypotensive events
Carotid artery disease
Diabetes
Collagen vascular disease
Nocturnal hypotension
38
Q

How does arteritic anterior ischaemic optic neuropathy affect vision? How does it affect C reactive protein levels in blood and what blood test important for diagnosing this? Is pain involved?

A

Poor vision
Elevated CRP
Elevated ESR
Neck pain and jaw claudication

39
Q

What kind of visual field defec is present with arteritic anterior ischaemic optic neuropathy?

A

Altitudinal - other VF defects are available

40
Q

Does arteritic anterior ischaemic optic neuropathy cause diplopia?

A

It may or may not

41
Q

How does the ONH look with arteritic anterior ischaemic optic neuropathy?

A

Pale and oedematous

42
Q

Is RAPD present with arteritic anterior ischaemic optic neuropathy?

A

Yesd

43
Q

What does arteritic anterior ischaemic optic neuropathy resolve into?

A

Optic atrophy

44
Q

Is arteritic anterior ischaemic optic neuropathy bilateral? What is this known as?

A

Yes

-pseudo-foster-kennedy syndrome

45
Q

How quickly is vision affected with non-arteritic anterior ischaemic optic neuropathy?

A

Acute

46
Q

When does non-arteritic anterior ischaemic optic neuropathy generally result in visual loss?

A

Often on waking

47
Q

Is there any pain involved with non-arteritic anterior ischaemic optic neuropathy?

A

Nol

48
Q

What does non-arteritic anterior ischaemic optic neuropathy resolve into?

A

Optic atrophy

49
Q

How urgent is arteritic anterior ischaemic optic neuropathy? What about non-arteritic?

A

Both urgent

50
Q

Is there risk to the fellow eye with arteritic anterior ischaemic optic neuropathy?

A

Yees

51
Q

What is the treatment for arteritic anterior ischaemic optic neuropathy (2)?

A

Prompt steroids

  • IV methyl prednisolone
  • oral prednisolone
  • taper
52
Q

What prospects are there of visual recovery following non-arteritic anterior ischaemic optic neuropathy?

A

Little prospect

-depends on the extent of ischaemia

53
Q

What are retinal macroaneurysms? Do they have any association with microaneurysms? what are they similar to? are they related to intracranial berry aneurysms?

A

Aquired dilations of retinal arterioles
Similar to aortic aneurysms
Unrelated to intracranial berry aneurysms

54
Q

Which 2 retinal arteries is there a predilection for retinal macroaneurysms (sectorally)?

A

Superior or inferior temporal arterioles

55
Q

Which demographic is there a predilection for retinal macroaneurysms?

A

Elerdy female

56
Q

What are retinal macroaneurysms strongly associated with?

A

Hypertension

57
Q

What three things cause the visual symptoms of retinal macroaneurysms?

A

Exudation
Sub-retinal
Vitreous/sub-hyaloid haemorrhage

58
Q

Should retinal macroaneurysms be referred? List four management options.

A 
Refer
Observation
Laser around lesion
Manage vitreous haemorrhage
Manage underlying systemic disease
59
Q

Is spontaenous resolution of retinal macroaneurysms common or rare?

A

Common

60
Q

List four differential diagnoses for retinal macroaneurysms.

A

Disciform degeneration
Other causes of vitreous/pre-retinal haemorrhage
BRVO
Coats disease

61
Q

What is a retinal nerve fibre layer infarct? What causes it? Are they transient? How long do they take to resolve?

A

Cotton wool spot
Acute blockage of terminal retinal arteriole
Transient - resolves in 6 to 8 weeks

62
Q

List 5 common causes of cotton wool spots.

A 
Embolus
Hypertension
Inflammation
Diabetes
Coagulopathies
63
Q

What are the notable symptoms of cotton wool spots?

A

Has few symptoms

64
Q

Is RAPD present with cotton wool spots?

A

No RAP from cotton wool spots alone

65
Q

Can cotton wool spots cause permanent NFL loss?

A

Yes

66
Q

How do cotton wool spots affect vision?

A

No measurable loss of vision

67
Q

List three differential diagnoses for cotton wool spots.

A

Medullated nerve fibres
Inflammatory white dot syndromes
Intra-retinal lipid

68
Q

What kind of ischaemia does neovascular glaucoma cause? What does this result in?

A

Severe diffuse retinal ischaemia
Results in rubeosis
-iris neovascularisation

69
Q

Desribe how retinal ischaemia can result in glaucoma.

A

The retina is ischaemic and releases VEGF, which diffuses anteriorly
In the anterior chamber, VEGF causes the growth of new vessels on the iris and in the angle, blocking it
Results in glaucoma

70
Q

List three diseases that can cause neovascular glaucoma. List an additional 5 lesser causes.

A 
Ischaemic CRVO
Diabetic retinopathy
Carotid occlusive disease
-ocular ischaemic syndrome
Also:
CRAO
BRVO
Intraocular tumours
Longstanding retinal detachment
Chronic inflammation
71
Q

List the three stages of neovascular glaucoma.

A

Rubeosis
Open angle glaucoma phase
Angle closure glaucoma phase

72
Q

What happens during the rubeosis stage of neovascular glaucoma (2)?

A

Dilated capillary tufts form at the pupil

Grow radially into the angle

73
Q

What happens during the open angle glaucoma stage of neovascular glaucoma (2)?

A

Vessels arborise in the angle

Fibrovascular membrane forms, blocking outflow

74
Q

What happens during the angle closure glaucoma stage of neovascular glaucoma (1)?

A

Fibrovascular membrane contracts, angle zips up

75
Q

List 7 signs and symptoms of neovascular glaucoma.

A 
Pain
Congestion
Corneal oedema
Elevated IOP 
Distorted pupil
Synaechial closure
Aqueous flare
76
Q

List four treatment options for neovascular glaucoma.

A 
Prevention
-treat ischaemia, monitor at risk cases
Prompt recognition of rubeosis - refer
Retinal ablation
Tube shunt

OD3 - Clinical Optometry Practice (114 decks)

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