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MBChB YR2: Opthalmology > Disease Profiles: Retina and Choroid > Flashcards

Disease Profiles: Retina and Choroid Flashcards

1
Q

What is a stage I macular hole?

A

Foveolar detachment

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2
Q

Which patient group is most likely to be affected by chorioretinitis?

A

Immunodeficient patients e.g. HIV/AIDS

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3
Q

What is indicated by the arrows?

A

Posterior vitreous detachment

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4
Q

Which patient group is most likely to develop central serous chorioretinopathy?

A

Men 30-50 years

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5
Q

Describe the pathophysiology of a exudative non-rhegmatogenous retinal detachment

A

Subretinal fluid accumulation without retinal tears

Can be caused by e.g. choroidal tumours, intraocular inflammation etc.

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6
Q

What is a retinal hole?

A

Hole in the retina caused by chronic retinal atrophy

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7
Q

How would you investigate chorioretinitis?

A

Swab - culture (bacterial/viral), serology for toxoplasma and toxocara

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8
Q

Describe the management of posterior vitreous detachment

A

No treatment necessary - symptoms improve as brain as brain adjusts

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9
Q

Describe the clinical presentation of an epiretinal membrane

A

Metamorphopsia

Decreased acuity

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10
Q

What causes a macular hole?

A

Idiopathic

Secondary e.g. due to vitreous detachment, trauma

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11
Q

Describe the management of retinal tears

A

Management of retinal tears aims to create adhesions between the retina and the choroid to prevent detachment

This can be done using laser therapy or cryotherapy

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12
Q

What is toxocaranis (roundworm)?

A

Form of chorioretinitis involving ingestion of toxocara eggs (parasite hosted by cats and dogs) - leads to systemic and ocular infection

Reactive inflammatory processes lead to the organism’s encapsulation and the formation of eosinophilic granulomas, which can cause irreversible visual loss if the egg has migrated to the eye

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13
Q

Describe the fundoscopy findings associated with central serous chorioretinopathy

A

Roundish detachment of central retina

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14
Q

Define pathological myopia

A

Type of myopia that begins during childhood and progressively worsens, resulting in severe myopia by adulthood with an axial length >/= 26mm or refractive error >/= -6.00D)

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15
Q

Define non-rhegmatogenous retinal detachment

A

Detachment without any retinal tears - can be tractional or exudative

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16
Q

Describe the findings associated with pathologic myopia on fundoscopy

A

Lacquer cracks

Subretinal haemorrhage

Fuschs’ spot

Posterior staphyloma

RPE/choroid atrophy

Degeneration - cystoid, paving stone, lattice

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17
Q

Describe the management of chorioretinitis

A

May involve observation or antimicrobials ± topical steroid treatment - depends on causative pathogen and other criteria

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18
Q

Describe the clinical presentation of central serous chorioretinopathy

A

Hyperopia

Metamorphopsia

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19
Q

What causes chorioretinitis?

A

Usually a response to viral, bacterial, fungal or protozoal infection

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20
Q

What is an epiretinal membrane?

A

Scar tissue formation across the inner surface of the retina which can cause visual problems

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21
Q

What is a stage II macular hole?

A

Full-thickness defect <400µm

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22
Q

What causes pathologic myopia?

A

Environmental and genetic influences cause increased axial growth of the eyeball so image focus is too far ahead of the retina - blurred vision

Often accompanied by degenerative changes in the retina

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23
Q

What is a stage III macular hole?

A

Full thickness defect >/=400µm with no posterior vitreous detachment

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24
Q

Name two complications of posterior vitreous detachment

A

Can predispose to patients developing retinal tears and retinal detachment

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25
Q

What causes the formation of an epiretinal membrane?

A

Scar tissue most commonly forms due to age-related vitreous retraction

Can also form following eye surgery or inflammation inside the eye

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26
Q

What causes floaters in posterior vitreous detachment?

A

Collection of deposits in the vitreous body of the retina perceived as spots or strings drifting through the visual field

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27
Q

What is a stage IV macular hole?

A

Full thickness defect >/=400µm with posterior vitreous detachment

28
Q

What is the most common finding in fluorescien angiography of a patient with central serous chorioretinopathy?

A

Small, focal hyperfluorescent RPE leak

29
Q

Describe the findings on fundoscopy associated with rhegamogenous detachment

A

Retinal tear may be visible

Detached retina takes a convex shape

Deep mobile elevation extending to ora serrata (junction between retina and ciliary body)

Slightly opaque with dark blood vessels

Loss of choroidal pattern

30
Q

Patients with retinal detachment may describe a curtain/shadow descending or ascending on field of vision. What does the shadow correspond to?

A

Area of detached retina

31
Q

What is toxoplasma gondii?

A

Protozoa which can cause chorioretinitis

Congenital or acquired

Usually results in a mild flu-like illness and rarely causes any further problems, but in immunocompetent patients it enters latent phase with cysts forming and can reactivate

32
Q

Describe the management of pathologic myopia

A

Annual checkups if stable

If CNV develops - anti-VEGF

33
Q

What is a macular hole?

A

Central small break in the macula

34
Q

Name the most common cause of retinal detachment

A

Rhegmatogenous - tears or holes in the retina leading to detachment

35
Q

What is a retinal break?

A

Full thickness defect in the sensory retina

36
Q

What is acute retinal necrosis?

A

Form of chorioretinitis caused by HSV/HZV

37
Q

Describe the clinical presentation of chorioretinitis

A

Older patients commonly present with reduced visual acuity with floaters, usually unilateral symptoms which develop over a few days

Congenital infections may present insidiously, with little history and few symptoms

38
Q

Define posterior vitreous detachment

A

Detachment of the posterior vitreous cortex from the internal limiting membrane of the retina

39
Q

Define central serous chorioretinopathy

A

Serous retinal detachment at the posterior pole of the eyeball (macula or perimacular region) due to a defect in the pigment epithelium which allows fluid to leak from the sclera into the subretinal space

40
Q

Describe the management of retinal detachment

A

Various sugical procedures which aim to reattach the retina and reduce any traction or pressure that may cause it to detach again

41
Q

How would you investigate viteomacular traction?

A

Optical coherence tomography

42
Q

How would you manage a sight-threatening Toxoplasma gondii infection?

A

Systemic treatment -clindamicin/azithromycin +/- steroids

43
Q

Define vitreomacular traction

A

Incomplete posterior vitreous detachment with the persistently adherent vitreous exerting tractional pull on the macula and resulting in morphologic alterations and consequent decline of visual function

44
Q

Define chorioretinitis

A

Inflammatory and exudative condition of the choroid and the retina (form of posterior uveitis)

45
Q

What is a retinal tear?

A

When a retinal break is associated with vitreous traction (PVD), it is termed a retinal tear

46
Q

What causes posterior vitreous detachment?

A

Age-related degeneration of the vitreous body (most common cause)

Myopia

Eye injury

47
Q

Describe the fundoscopy findings associated with an epiretinal membrane

A

Retinal striae

Subretinal fluid or cystic damage

Almost always associated with PVD

48
Q

Define rhegmatogenous retinal detachment

A

Tears or holes in the retina leading to detachment

Requires acute posterior vitreous detachment and predisposing peripheral retinal degeneration

49
Q

Discuss the risk factors for rhegmatogenous retinal detachment

A

Posterior vitreous detachment

Pathological myopia

Previous intraocular surgery

Trauma

50
Q

What examination findings might you see in retinal detachment?

A

May have RAPD

51
Q

Describe the clinical presentation of a macular hole

A

Metamorphopsia

Central visual field losses

Severe reduction of visual acuity

52
Q

Describe the clinical presentation of viteomacular traction

A

Metamorphopsia

Decreased vision

53
Q

Describe the clinical presentation of pathologic myopia

A

Slowly progressive vision loss, scleral thinning

54
Q

Define retinal detachment

A

Refers to the detachment of the inner layer of the retina from the retinal pigment epithelium

55
Q

Describe the findings on fundoscopy associated with non-rhegamogenous detachment

A

Detached retina takes a convex shape

Smooth elevation

May be very mobile deep with shifting fluid

Subretinal pigment (leopard spots) after flattening

No retinal tear visible

56
Q

Which investigation us used to evaluate patients with pathologic myopia for development of choroidal neovascularization?

A

Fluorescein angiography

57
Q

Name the two types of retinal detachment

A

Rhegmatogenous and non-rhegmatogenous

58
Q

What is posterior staphyloma?

A

Outpouching of scleral tissue typically involving the optic disc or macula, seen in pathologic myopia

59
Q

What is Fuschs’ spot?

A

Degeneration of the macula; occurs due to proliferation of RPE associated with choroidal haemorrhage, seen in pathologic myopia

60
Q

What causes photopsia in posterior vitreous detachment?

A

Caused by partially detached vitreous tissue pulling on the retina

61
Q

Describe the clinical presentation of posterior vitreous detachment

A

Usually asymptomatic

Photopsia with eye movements

Floaters

62
Q

Describe the fundoscopy findings associated with a macular hole

A

Depending on the stage, a subfoveal spot or ring can be noted

In more advanced cases, a partial or full-thickness macular break is observed

63
Q

Describe the management of an epiretinal membrane

A

Surgery indicated if patient has significant visual complaints of visual decline and /or metamorphopsia

64
Q

Describe the pathophysiology of a tractional non-rhegmatogenous retinal detachment

A
  1. Formation of vitreoretinal bands (most commonly due to proliferative diabetic retinopathy)
  2. Pressure on the band during eye movement or as a result of sudden decrease in intraocular pressure
  3. Retinal detachment
65
Q

Describe the clinical presentation of retinal detachment

A

Painless, progressive visual field loss

Patients may describe a curtain/shadow descending or ascending on field of vision

If detachment affects macula, central vision will be lost

Sudden onset of floaters/flashes can proceed visual loss - indicates posterior vitreal detachment

66
Q

Describe the clinical presentation of a retinal tear/hole

A

Asymptomatic

May have photopsia or see floaters

67
Q

What is endogenous chorioretinitis?

A

Very rare form of chorioretinitis caused by bacteria or fungi (50/50)

Associated with bacterial endocarditis or indwelling catheters including central lines

MBChB YR2: Opthalmology (20 decks)

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