diseases of the retina and choroid Flashcards by Evie Mander

what is chorioretinitis

inflammation of the choroid and retina

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who most commonly gets chorioretinitis

immunosuppressed patients

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what causes acute retinal necrosis

HSV/HZV

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name the 2 causes of endogenous chorioretinitis

bacterial or fungal

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what is endogenous chorioretinitis associated with (2)

bacterial endocarditis
indwelling catheters

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what is toxoplasma gondii associated with (2)

contaminated soil or undercooked meat

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clinical presentation of chorioretinitis

reduced visual acuity with floaters

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investigations for chorioretinitis

swab:
culture for bacterial and viral
serology for toxoplasma and toxocara

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management of sight-threatening toxoplasma gondii

clindamycin/azithromycin +/- steroids

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management of chorioretinitis

antimicrobials ± topical steroids

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what is an epiretinal membrane

scar tissue formation across the inner surface of the retina

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what is the most common cause of epiretinal membrane

age-related vitreous retraction

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name 2 other causes of epiretinal membrane

eye surgery or inflammation

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clinical presentation of epiretinal membrane (2)

metamorphopsia
decreased acuity

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what is metamorphopsia

where objects appear distorted or misshapen

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epiretinal membrane on fundoscopy (2)

retinal striae
subretinal fluid or cystic damage

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management of symptomatic epiretinal membrane

surgery

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what is retinal detachment

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

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most common cause of rhegmatogenous retinal detachment

tears or holes in the retina

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what 2 things are required for rhegmatogenous retinal detachment

acute posterior vitreous detachment
predisposing peripheral retinal degeneration

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state 4 risk factors for rhegmatogenous retinal detachment

Posterior vitreous detachment
Pathological myopia
Previous intraocular surgery
Trauma

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what is non-rhegmatogenous retinal detachment

detachment without any retinal tears

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2 main types of non-rhegmatogenous retinal detachment

tractional and exudative

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exudative retinal detachment

subretinal fluid accumulation without retinal tears

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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