diseases of the retina and choroid Flashcards
what is chorioretinitis
inflammation of the choroid and retina
who most commonly gets chorioretinitis
immunosuppressed patients
what causes acute retinal necrosis
HSV/HZV
name the 2 causes of endogenous chorioretinitis
bacterial or fungal
what is endogenous chorioretinitis associated with (2)
bacterial endocarditis
indwelling catheters
what is toxoplasma gondii associated with (2)
contaminated soil or undercooked meat
clinical presentation of chorioretinitis
reduced visual acuity with floaters
investigations for chorioretinitis
swab:
culture for bacterial and viral
serology for toxoplasma and toxocara
management of sight-threatening toxoplasma gondii
clindamycin/azithromycin +/- steroids
management of chorioretinitis
antimicrobials ± topical steroids
what is an epiretinal membrane
scar tissue formation across the inner surface of the retina
what is the most common cause of epiretinal membrane
age-related vitreous retraction
name 2 other causes of epiretinal membrane
eye surgery or inflammation
clinical presentation of epiretinal membrane (2)
metamorphopsia
decreased acuity
what is metamorphopsia
where objects appear distorted or misshapen
epiretinal membrane on fundoscopy (2)
retinal striae
subretinal fluid or cystic damage
management of symptomatic epiretinal membrane
surgery
what is retinal detachment
detachment of the inner layer of the retina from the retinal pigment epithelium
most common cause of rhegmatogenous retinal detachment
tears or holes in the retina
what 2 things are required for rhegmatogenous retinal detachment
acute posterior vitreous detachment
predisposing peripheral retinal degeneration
state 4 risk factors for rhegmatogenous retinal detachment
- Posterior vitreous detachment
- Pathological myopia
- Previous intraocular surgery
- Trauma
what is non-rhegmatogenous retinal detachment
detachment without any retinal tears
2 main types of non-rhegmatogenous retinal detachment
tractional and exudative
exudative retinal detachment
subretinal fluid accumulation without retinal tears
most common cause of tractional retinal detachment
proliferative diabetic retinopathy
name some causes of exudative retinal detachment
choroidal tumours
inflammation
toxaemia of pregnancy
neovascularisation
what would detachment of the macula cause
central vision loss
clinical presentation of retinal detachment
painless progressive visual field loss
may describe a curtain/shaddow
fundoscopy of exudative RD
convex, smooth elevation
may be very mobile and deep with shifting fluid
leopard spots seen after flattening
fundoscopy of rhegmatogenous detachment
deep mobile elevation extending to ora serrata
slightly opaque with dark blood vessels
retinal tear may be visible
name 4 things associated with retinal tears/holes
age-related degeneration
myopia
eye injuries
eye surgery
what is a retinal break
full thickness defect in sensory retina
what causes a retinal hole
chronic retinal atrophy
what causes a retinal tear
dynamic vitreoretinal traction
clinical presentation of retinal hole or tear
usually asymptomatic
may see floaters
investigation for a suspected retinal tear or hole
fundoscopy
2 mainstays of treating retinal holes or tears
laser therapy or cryotherapy
name a complication of a retinal hole/tear
retinal detachment
what is posterior vitreous detachment
Detachment of the posterior vitreous cortex from the internal limiting membrane of the retina
most common cause of posterior vitreous detachment
age-related generation of the vitreous body
clinical presentation of posterior vitreous detachment
usually asymptomatic
photopsia with eye movements
floaters
investigation for posterior vitreous detachment
fundscopy
management of posterior vitreous detachment
no treatment needed, just reassurance
complication associated with posterior vitreous detachment
can predispose to developing retinal tears or detachment
who usually presents with central serous chorioretinopathy
otherwise health men aged 30-50 yrs
clinical presentation of central serous chorioretinopathy (2)
hyperopia
metamorphopsia
what is hyperopia
long-sightedness
central serous chorioretinopathy on fundoscopy
roundish detachment of central retina
central serous chorioretinopathy on fluoresceine angiography
small, focal hyperfluorescent RPE leak
management of central serous chorioretinopathy
high rate of spontaneous resolution but medical and surgical options
what is VMT
vitreomacular traction
clinical presentation of VMT (2)
metamorphopsia
decreased vision
investigation for VMT
optical coherence tomography
what causes a macular hole
usually idiopathic
clinical presentation of a macular hole (3)
- Metamorphopsia
- Central visual field losses
- Severe reduction of visual acuity
fundoscopy of a macular hole
sub-foveal spot or ring
partial or full thickness break is observed in more advanced cases
what is CME
cystoid macular oedema
what is cystoid macular oedema
retinal thickening of the macula due to accumulation of fluid in the outer plexiform layer
name some causes of CME
postoperative
uveitis
retinal venous occlusions
choroidal neovascularisation
epiretinal membrane / VMT
retinitis pigmentosa
clinical presentation of CME
blurred central vision
management of CME
majority resolve spontaneously
what is the most common cause of blindness in people >65
macular degeneration
name 4 risk factors for macular degeneration
increasing age
smoking
family history
poor nutrition
what causes dry ARMD
deposition of drusden in the retinal pigment epithelium causing progressive atrophy
what causes wet ARMD
neovascularisation in the choroid, mediated by VEGF
clinical presentation of wet ARMD (2)
rapid central visual loss
distortion
clinical presentation of dry ARMD
gradual decline in vision
scotoma
what is scotoma
a blind spot
fundoscopy of wet ARMD
haemorrhage/exudate
fundoscopy of dry ARMD (2)
drusden
atrophic patches of retina
management of wet ARMD
anti-VEGF intravitreal injections
management of dry ARMD
no cure - supportive low vision aids e.g. magnifiers
axial length in pathologic myopia
> 26mm
pathophysiology of pathologic myopia
environmental and genetic influences cause increased axial growth of the eyeball
symptom of pathologic myopia
blurred vision
clinical sign of pathological myopia
scleral thickening
fundoscopy of pathologic myopia
lacquer cracks
subretinal haemorrhage
fuch’s spot - degeneration of the macula
posterior staphyloma
degeneration (cystoid, paving stone, lattice)
what is posterior staphyloma
outpouching of scleral tissue typically involving the optic disc or macula
why would we use fluorescein angiography
looking for development of choroidal neovascularisation
management of pathologic myopia
annual check-ups
anti-VEGF if CNV develops
