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Clin Med - Ophthalmology > Disorders of the Retina > Flashcards

Disorders of the Retina Flashcards

1
Q

The retina is a direct extension of ________

A

The nervous system.

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2
Q

the retina does what so the brain can “visualize”

A

Transforms the image focused by the anterior ocular structures into impulses.

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3
Q

Why do the vessels in the retina provide such a unique view?

A
  • they are so small, they are representative of what is happening in other vessels in the body.
  • very telling for the health of a patient
  • only place where an examiner can look directly at blood vessels
  • vascular diseases appear in these small vessels first
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4
Q

What is in the center of the macula?

A

Fovea centralis

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5
Q

True or False Veins typically appear larger and darker when viewed in the eye.

A

True!

Arteries are more pale and thinner appearing.

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6
Q

What are the 3 basic forms of diabetic retinopathy?

A
  • Proliferative diabetic retinopathy
  • diabetic macular edema
  • Ishchemia of the macula
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7
Q

Can all 3 forms of diabetic retinopathy lead to blindness?

A

Yes, they all lead to blindness

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8
Q

Proliferative Diabetic Retinopathy results from _________?

A

Retinal Ischemia

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9
Q

What do ischemic retinal tissues release in Proliferative Diabetic Retinopathy?

A

Angiogenic Factors

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10
Q

What happens when Angiogenic fibers are released?

A

neovascularization

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11
Q

What is the big deal w these neovascularized vessels growing in the vitreous gel?

A

Normal movement and traction can shear these fragile new vessels–> leads to hemorrhaging and cloudy vision

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12
Q

What happens when contraction is placed on this fibrous clot?

A

Puts traction on the retina and can cause retinal detachment from choroid.

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13
Q

What are the symptoms of Proliferative Diabetic Retinopathy?

A
  • may be asymptomatic
  • vision may decrease slowly or suddenly
  • excessive floaters occur w a hemorrhage= “showers”
  • Blind spots can occur (scotomata)
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14
Q

What are the signs of Proliferative Diabetic Retinopathy?

A
  • Neovasculalization* of fine lacy blood vesells seen on the optic nerve, retina, or surface of the iris.
  • cotton wools spots on retina ( whitish lesions with fluffy hazy appearing borders)
  • pre-retinal hemorrhages (boat shaped hemorrhages)
  • vitreous hemorrhages–> cause loss of normal red reflex
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15
Q

So if you see boat shaped hemorrhages floating around in cotton wooly spots whats the first thought in your mind?

A

Proliferative Diabetic Retinopathy!!!

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16
Q

What labs tests should be performed for Proliferative Diabetic Retinopathy?

A

-lab tests to dx diabetes

fasting blood sugar, HBA1c

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17
Q

What is the Tx for Proliferative Diabetic Retinopathy?

A
  1. Control diabetes. Tight glycemic control decreases the profession of diabetic retinopathy, nephropathy, and neuropathy.
  2. Retinal Laser photocoagulation
  3. newly dx’d DM type II need optho consult
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18
Q

Diabetic Macular Edema can lead to what?

A

micro-aneurysms, which leak intravascular fluid into the retina.

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19
Q

What happens when this fluid is leaked from the micro-aneurysms?

A

May accumulate in the fovea–> leads to decreases central vision

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20
Q

What are the symptoms of Diabetic Macular Edema?

A
  • may be asymptomatic

- vision may be diminished unilaterally or bilaterally (remember… from the leakage)

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21
Q

what signs will you see when a pt presents with Diabetic Macular Edema?

A
  • slight opacification of the macula (from the edema fluid)
  • micro-aneurysms (tiny blisters/pimples)
  • Hard exudates (yellow lesions w/ discrete borders)
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22
Q

What is the tx fro Diabetic Macular Edema?

A

Refer to ophthalmologist

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23
Q

What do normal retinal vasculature blood vessel walls look like?

A

So thin they are invisible. really only see the blood, not the walls that hold it.

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24
Q

What does chronic hypertension do to the vessel walls?

A

Thickened vessel walls and an associated narrowing of the vessel lumen

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25
Q

What is the Hallmark sign of Hypertensive Retinopathy?

A

Diffuse arteriolar narrowing

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26
Q

What is the normal Artery to Vein Ratio?

What is the A:V ratio w Hypertensive Retinopathy?

A
  • normal= 2:3

- Hypertensive Retinopathy=1:3 or even 1:4…. arteries VERY narrow.

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27
Q

Back in the day before brighter halogen light sources were around what color would the vessel wall appear?

A

Yellowish–> “copper wiring” (quote unquote)

-Silver wiring

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28
Q

What are the symptoms of Hypertensive Retinopathy?

A
  • vision may be normal, or slightly blurred, or suddenly decreased (vision can be anything really…)
  • scotomata (blind spot)
  • double vision
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29
Q

An an examiner what signs will you see with Hypertensive Retinopathy?

A
  • Arteriolar narrowing
  • AV nicking
  • Sclerotic Vessels
  • cotton wool spots
30
Q

What is AV nicking anyways?

A

Arterial pressure is too great, so when it crosses over a vein it obliterates the vein directly below it. Further down the vein does return to its normal caliber.

31
Q

TX for Hypertensive Retinopathy?

A

Bad news….

  • No specific ophthalmic tx.
  • Treat underlying HTN
  • may have to refer to ophthalmologist
32
Q

What is the cause of Retinal Artery Occlusion?

A

embolus

33
Q

What may Retinal Artery Occlusion be preceded by?

A

amaurosis fugax=”a curtain descending” or cloudy vision

-transient monocular blindness related to emboli

34
Q

Amaurosis fugax can also be a warning sign of what?

A

Impending cerebral stroke

35
Q

What signs will be found on the physical exam of a patient w/ Retinal Artery Occlusion?

A
  • profound vision loss (transient).
  • patient may only perceive hand motion or light
  • whitening of retina on ophthalmoscopic exam
  • Cherry red spot in macula
36
Q

If you see a cherry red spot on the macula and believe it to be Retinal Artery Occlusion, would you refer this patient?

A

Yes this is an ophthalmological emergency!

37
Q

What is retinal vein occlusion associated with?

A

Hypertension and blood dyscrasias

note: dyscrasias–> disease/disorder associated w blood

38
Q

retinal vein occlusion is a result of a________?

A

Thrombosis is the RV

39
Q

What are the physical exam findings of retinal vein occlusion?

A
  • retinal hemorrhages

- dilated tortuous veins

40
Q

T/F retinal vein occlusion is an Ophthalmological emergency.

A

True!

make that call if you see those cherry red spots on the macula and believe it to beretinal vein occlusion!

41
Q

What is Retinitis pigmentosa?

A

Inherited dz=retina degenerates

42
Q

What pt population is Macular Degeneration typically seen in?

A

Elderly patients (>60)

43
Q

What other name is Macular Degeneration sometimes called?

A

Exudative macular degeneration

44
Q

What do patients with Macular Degeneration typically complain of?

A
  • Metamorphosia, things that should have straight lines appear wavy*
  • visual loss that can occur over days or longer
45
Q

On the physical exam for a pt with Macular Degeneration you will see

A

-retinal hemorrhage- typically in the macular region

46
Q

If you suspect a pt has Macular Degeneration should you refer?

A

Yes immediate referral to ophthalmology

47
Q

What is Ischemic Optic Neuropathy most often associated with?

A
  • giant cell arteritis/temporal arteritis

- also hypertension and diabetes (pts>40)

48
Q

What is the common age for Ischemic Optic Neuropathy ?

A

> 60

49
Q

Describe the visual loss for Ischemic Optic Neuropathy

A
  • sudden

- monocular on affected side

50
Q

What do pts typically complain of w Ischemic Optic Neuropathy

A
  • jaw pain
  • scalp tenderness
  • neck pain
  • weight loss
51
Q

What will your physical exam reveal of a pt w Ischemic Optic Neuropathy?

A
  • optic nerve=swollen

- afferent pupil (marcus-Gunn pupil=+ swinging flashlight sign)

52
Q

Ischemic Optic Neuropathy ________ ophthalmology referral

A

Immediate

53
Q

Optic Neuritis is associated with______?

A

Multiple Sclerosis

54
Q

What are the demographic features of MS? And thus Optic neuritis?

A
  • ages 15-45
  • Women>men
  • Colder latitudes>tropical latitudes
55
Q

Visual loss for Optic neuritis occurs over __________ days

A

several

56
Q

for Optic neuritis occasionally there will associated complaints of

A
  • painful eye movement

- periorbital pain but ≠ocular pain

57
Q

What are the physical exam findings for Optic neuritis?

A
  • may= afferent pupil defect
  • 2/3 pts= normal optic disc on funduscopic e
  • 1/3= optic disc edema (blurring of optic disc margin)
58
Q

What referral should you make for Optic neuritis?

A
  • refer to neuro of MS suspected

- ophthalmology

59
Q

Tx for Optic neuritis?

A

IV corticosteroids

60
Q

Atrophic Macular Degeneration is commonly seen in patients >______yo

A

60, and may be associated w family hx

61
Q

Exam findings for Atrophic Macular Degeneration?

A
  • loss of central vision
  • may see Drusen(hyaline nodules) on funduscopic exam
  • later in dz= retinal atrphy/retinal scar
62
Q

What causes retinal detachment?

A
  1. fluid separates the retina from retinal epithelium
  2. retina separates from vitreous
  3. Tractional Detachment- scar tissue in vitreous gel contracts–>pulls retina towards vitreous (commonly from virtual hemorrhage from proliferative diabetic retinopathy)
63
Q

What are the symptoms of retinal detachment?

A
  • flashes (photopsia)
  • floaters
  • visual filed loss (wherever retina is detached)
  • metamorphosia (wavy/distorted lines)
  • decreased vision
64
Q

What are the signs of Retinal detachment?

A

-marcus gunn pupil
unilateral visual field loss (when one eye is closed, double vision remains when the bad eye is opened)
-Retinal ruggae (ripples in pond)

65
Q

Work up for Retinal Detachment?

A
  • difficult to dx on physical exam
  • hx is the real guide
  • look at red reflex on both eyes several ft away (note differences)
66
Q

Tx for retinal Detachment?

A
  • immediate ophthalmological consultation

- surgical intervention

67
Q

What happens if retinal detachment is not corrected immediately?

A

will result in permanent visual loss in the affected eye

68
Q

choroditis (etiology/pathology)

A
  • inflam of choroid layer
  • acute onset
  • infx
69
Q

choroiditis (presentation)

A
  • blurry, impaired vision in 1 eye
  • photophobia
  • red eye
  • decreased VA
  • injection of eye
70
Q

choroiditis (tx)

A
  • tx underlying cause

- steroids in non-infectious

71
Q

T/F: Newly diagnosed DM type II need optho consult.

A
  • true, for proliferative diabetic retinopathy

Clin Med - Ophthalmology (13 decks)

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