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BOARDS2: Retina/vitreous > Flashes And Floaters > Flashcards

Flashes And Floaters Flashcards

1
Q

Things that cause flashes of light

A

PVD
RD
Ocular migraine
Occipital lobe infarction

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2
Q

What is a PVD

A

Most common differential for flashes of light. Result from the detachment of the posterior hyaloid of the vitreous from the retina. HA and collagen complex in the victory’s is disrupted with age, resulting in the clumping of collagen into bundles. Liberated collagen fibers can contract within this complex, resulting in detachment of the posterior hyaloid from the retinal ILM; the detachment can be localized, partial, or total

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3
Q

Why is the cause of the flashes of light in a PVD

A

Traction on the retina at the site of the vitreoretinal adhesion

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4
Q

Stats on PVDs

A

More common in females, and the prevalence approximates age after 50 years.

  • PVDs occur an average of 20 years earlier in myopes compared to emmetropia
  • additional risk factors include DM, intraocular surgery, intraocular inflammation, vitreous hemorrhage, and trauma
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5
Q

Signs of PVDs

A

Weiss ring and anteiror displacement of the posterior hyaloid membrane. May present with pigmented cells in the anterior vitreous (from the RPE, called Shaffer’s sign) and a vitreous hemorrhage

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6
Q

What is the most common cause of retinal tears

A

PVDs and degenerative vitreous liquefaction causing vitreous traction

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7
Q

Rhegmatogenous RDs

A

Result from retinal breaks (full thickness retinal defects)

  • atrophic holes
  • retinal tears
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8
Q

Atrophic retinal holes

A

small, round, full-thickness defects caused by chronic atrophy of the sensory retina (NOT vitreoretinal traction); they are associated with low risk for a subsequent detachment. Most often in the temporal retina (superior>inferior), and are often associated with lattice degeneration

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9
Q

Retinal tears

A

Caused by vitreous traction.

  • flap tears: result of uneven vitreous traction; the vitreous traction often persists after the retinal tear occurs , leading to an increased risk of subsequent retinal detachment
  • operculated tears: symmetric and the result of even vitreous traction; the traction no longer persists after the tear, reducing the risk of a subsequent retinal detachment. An operculum will be seen floating above the retinal tear
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10
Q

Where are retinal breaks most likely ro occur

A

ST quadrant (60% of cases) in patients with an RD

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11
Q

How likely is it that an eye with an RD will have more than 1 tear

A

50%

Usually located within 90 degrees of one another

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12
Q

Nonrhegmatogenous RDs

A

NOT caused by retinal breaks, they include serous (exudative) and tractional RDs

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13
Q

Exudative RD

A

Result from an accumulation of fluid underneath the sensory retina due to damage to the RPE. Examples of conditions that can cause this are ARMD, DR, inflammation, vascular conditions, neoplastic

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14
Q

Tractional RDs

A

Most commonly caused by PDR, ROP, and sickle cell. The fibrous tissue associated with preretinal neo creates traction on the retina, leading to a detachment

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15
Q

Who gets RRDs the most

A

Males over age 45

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16
Q

Risk for RRD

A 
Lattice degeneration 
Previous ocular surgeries
PVD
Trauma
Family Hx of RRD pre previous occurrence of RRD
Myopia
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17
Q

Lattice degeneration as a risk of RRD

A

20-33% of eyes that develop RRD will have associated lattice; however only 1% of eyes that have lattice will develop RRD

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18
Q

Symptoms of RRD

A

Can be asymptomatic, most present with symptoms of acute onset of flashes of light, floaters a shadow or curtain blocking vision, and/or decreased vision

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19
Q

Signs of RRD

A

Retinal elevation (convex retina with folds) with an assocaited retinal break (atrophic hole or tractional tear), retinal movement with the eye movement, clear subretinal fluid that does not move with eye movement, pigmented cells in the anterior vitreous, hypotony, a mild iritis, and possibly an APD

Chronic RRDs are associated with a pigment demarcation line (takes 3m or longer to develop), intraretinal cysts (after 1 year), fixed folds, and/or subretinal precipitates

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20
Q

Quadrant of symptoms in RDs

A

The quadrant that patients report the flashes of light are of no significant importance when determining where the RD is, but if there is a shadow or VF defect, it does correlate.

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21
Q

Symptoms of ERDs

A

Usually asymptomatic unless the RD involves the macula; patients report symptoms that are similar to RRDs, but are more variable (vision loss can range from minimal to severe)

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22
Q

Symptoms of TRDs

A

Often asymptomatic, unless macula is involved. Symptoms include decreased vision,flashes and floaters (rarely), and/or progressive VF defect (may remain stationary for months to years)

23
Q

Classical migraines

A

Preceded by a visual aura that develops over 5-20 minutes and lasts less than 60 minutes. The visual aura is most commonly bilateral and does not cross the midline. Patients often report photopsia, bright spots, zig-zags, jigsaw puzzle defects, tunnel vision, spreading scotomas, altitudinal defects, and other visual disturbances. These patietns will not have any vitreous or retinal abnormalities

24
Q

Focal occipital lobe infarction

A

Results in photopsia. Likely to occur in an older patient as a result of stroke

25
Q

Photopsia and retinitis

A

Flashes of light can also be a symptom of retinitis. Many patietns with RP report small, shimmering, blinking lights similar to the symptoms of a migraine visual aura. CMV retinitis May cause small peripheral retinal breaks that result in RD

26
Q

___ of patients with an acute symptomatic PVD will present with a retinal break. This number increases to _____ if there is an associated vitreous hemorrhage present

A

10-15%

70%

27
Q

Vitreous hemorrhage

A

Can cause sudden painless low vision and/or black spots that may present with corresponding flashes of light. Mild VHs may still allow for visualization of the fundus, severe cases obscure the entire fundus, warranting a B scan to look for RDs behind the vitreous hemorrhage. Chronic VH appear yellow or gray yellow

28
Q

Which is more common, migraines with visual auras or without visual auras

A

Without visual auras
- most migraines are not associated with visual auras and are termed common migraines (80%). Migraines with visual auras are termed classic migraines. Note that pts who have migraines with visual auras and normal behavioral risk factors related to stroke are at a higher risk for an ischemic stroke

29
Q

Lattice degeneration

A

Area of peripheral retinal thinning that us typically circumferential (often cigar shaped) nad concentric with the ora. The central area of the lesion is atrophy, and the outer margins have firm adhesions to the vitreous

  • is found in 6-10% of patients and is more common in myopic eyes. It is bilateral in 33-50% of cases and more commonly located temporally and superior
  • 12% of patients will have the classic pattern of crisis-crossed white sclerosed blood vessels
30
Q

____ of patietns with RRDs have lattice degeneration

A

20-33%

31
Q

Only ____ of lattice degeneration are associated with atrophic holes and only ____ will develop RRDS

A

25%

1%

32
Q

Treatment for asymptomatic lattice degeneration

A

Does not require treatment. Prophylactive treatment is generally not indicated unless the fellow eye has had a lattice related RD

33
Q

When is prophylactic treatment considered in lattice degeneration

A

For patients with high myopia, aphakia, or a strong family Hx of RDs

34
Q

Treatment of symptomatic lattice

A

Should receive prophylactic treatment with cryopexy or laser photocoagulation

35
Q

Vitreoretinal tufts

A

Small, focal areas of vitreous traction located in the peripheral retina. They occur in 5% of the population and are secondary most common peripheral retinal lesion assocaited with an RD (lattice is number 1); less than 1% of pts with vitreoretinal tufts develop RDs. No prophylactic treatment needed

36
Q

What refractive shift is expected after RD surgery with a scleral buckle

A

Myopic

37
Q

Treatment of symptomatic retinal tears

A

With persistent traction (horseshoe tears, giant tears) have a high risk of subsequent RD and are generally treated promptly after dx

38
Q

Treatment for asymptomatic flap tears

A

Have a lower risk of RD, but are typically treated prophylactically

39
Q

Treatment for symptomatic operculated tears

A

Also have a lower risk of detachment; treatment depends on the retinal specialist.

40
Q

What types of retinal tears rarely require prophylactic treatment

A

Atrophic holes, asymptomatic operculated tears, and asymptomatic lattice.

41
Q

What location of retinal break is more dangerous

A

Superior because of gravity

42
Q

retinal breaks with subretinal fluid

A

Need managed aggressively

43
Q

How are retinal breaks treated

A

With laser photocoagulation or cryotherapy; these techniques create a strong adhesion between the retina and RPE so vitreous fluid entering the retinal break cannot spread and create a RD

44
Q

Visual potential in RDs

A

Directly related to the duration of the retinal detachment and the severity of macular involvement

45
Q

Treatment of chronic asymptomatic RD

A

Not required

46
Q

Treatment of mac off RD

A

Usually result in permanent reduction in vision even with timely and appropriate treatment; these RDs should bd treated urgently within 48-96 hours

47
Q

Treatment of mac on RDs

A

Immediately (within 24 hours)

48
Q

Types of surgical treatment for RDs

A

Pneumatic retinopexy
Scleral buckle
Vitrectomy

49
Q

Pneumatic retinopexy

A

An intravitreal gas bubble is injected to temporarily tamponade the retinal tissue against the RPE., this prevents additional vitreous fluid from entering the tear and allows the RPE to pump excess subretinal fluid into the choroid. Laser photocoagulation or cryotherapy is then used to permanently seal the retinal break. Pneumatic retinopexy is primarily used for superior retinal breaks; it has a high success rate and seals the retinal break without utilization of a scleral buckle

50
Q

Scleral buckle

A

Flexible silicone strip is permanently sutured on or within the sclera in order to indent the sclera and relieve vitreoretinal traction associated with the retinal break, cryotherapy or laser photocoagulation can then be used to create permanent adhesion between the retina and RPE. Side effects include induced myopia, pain, hemorrhages, infection, and diplopia

51
Q

Vitrectomy for RRD

A

Removal of the vitreous allows release of vitreoretinal traction. Intravitreal gas (retinopexy) or silicone oil is then utilized to tamponade the retina before applying laser photocoagulation or cryotherapy for permanent adhesion. Vitrectomy can be performed with or without scleral buckle. Common indicates for a vitrectomy with retinal breaks include the following

  • Inabiltiy to visualize the retinal break as a result of a cloudy vitreous
  • inability to close retinal breaks through tankard techniques, typically as a result of a very large break, posterior breaks that include a macular hole, and severe vitreoretinal traction
52
Q

Post opt complications of RD surgery

A 
Elevated IOP
Cataracts 
Hemorrhage 
Infection
Post op positioning complications (pt should be face down)
53
Q

Treatment of exudative RS

A

Treatment of the underlying condition

BOARDS2: Retina/vitreous (8 decks)

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