Images Flashcards
Hollenhorst plaque
- Cholesterol
- associated with atherosclerosis and risk for stroke
- usually seen at arterial bifurcations
Toxocariasis
* parasitic nematode Toxocara canis
RPE defect
** window defect, appears as yellow-white. Well demarcated circular lesion present in mid-peripheral retina
** benign
Posterior embryotoxon
*anteriorly displaced Schwalbe line
* no treatment at this time
* RTC: annual for CEE
S/S red, itchy eyes with swollen eyelids, chemosis
Idiopathic
Angioedema
* mast cell degranulation, leading to increased vascular permeability which causes fluid and proteins to leak into subcutaneous spaces
Myelinated nerve fiber layer
* white feathery margins typically extending from the optic disc
Myelinated nerve fiber layer
* white feathery margins typically extending from the optic disc
Bergmeister
*remnants of embryological posterior hyaloid artery that failed to atrophy
(Hyaloid artery supplies blood to developing eye during fetal development)
Patient wears silicone hydrogel CLs
Mucin balls
* occur with silicone hydrogel lenses that are too flat
* mechanical rubbing of CL stimulates goblet cells to produce extra mucin which form balls that embed into corneal epithelium
*ignore black lesion
Terrien marginal degeneration
* bilateral superior corneal thinning
* blur from high ATR astigmatism
* men in their 30’s
* longstanding may see pseudopterygium
* tx: correction, if unsuccessful tectonic or penetrating ketatoplasty
Corneal farinata
* small white specs in the interpalpebral zone of posterior stroma
* bilateral
* no tx required
Congenital zonular cataract
Make sure you know the layers!
Fibrous disciform scar in exudative AMD
* formed by formation of choroidal neovascular membrane
Transillumination defects seen in patient with tyrosinase-negative albinism
Subconjunctival hemorrhage
* painless, sectoral hemorrhage of conjunctival vessel into subconjunctival space
* clear demarcation line at the limbus of cornea
Butterfly macular dystrophy
* pattern dystrophy
* yellow/gray deposits within macular region in a triadiate pattern
* treatment not necessary and prognosis good
* autosomal dominant, 2nd to 5th decades of life
Conjunctival melanocytoma
* slow growing black lesion of conjunctiva
* rare
* mass not freely movable over sclera and tends to be homogenous in color and lack cystic spaces
Advanced glaucoma visual field loss
* very small island of central vision left
* patient is considered legally blind due to there being less than 20 degrees of vision in horizontal meridian of the better seeing eye
Lens vacuoles
* view with retro illumination
* pooling of water in lens due to aggregation of crystalline proteins which are less water-soluble now
* due to aging, cataract formation, diabetes
Left homonymous hemianopsia
* lesion in right visual pathway distal to optic chiasm
* respects vertical midline
Left homonymous hemianopsia
* lesion in right visual pathway distal to optic chiasm
* respects vertical midline
Pt has keratoconus
Fleischer ring
* epithelial iron deposit at the surrounding base of the cone in keratoconus
* best seen under slit lamp with blue light
Non-ischemic central retinal vein occlusion
* caused by formation of thrombus near or at the lamina cribrosa leading to compression of central retinal vein by CRA which impedes blood flow return
* blood accumulates causing endothelial cell damage leading to formation of a thrombus leading to retinal hemorrhages
Preretinal hemorrhage (boat shaped)
* blood trapped between vitreous cortex and ILM
* associated with PDR
* caused by blood loss from neovascularization of disc or elsewhere resulting in entrapment of blood between posterior aspect of hyaloid and retinal surface
Epithelial ingrowth
* proliferation of epithelial cells at the flap interface after LASIK
* flap may need to be relifted and cells removed if interfering with vision
Pseudoexfoliation syndrome
* white flaky material deposits along pupillary margin
* unilateral
* transillumination defects limited to iris sphincter
* material can accumulate in TM causing increase in IOP —> glaucoma
Full thickness macular hole
Supernumerary puncta
* more than 1 punctum
Large mutton fat keratic precipitates
* granulomatous anterior uveitis
Toxoplasmosis
*Inactive infection
* Protozoa: Toxoplasma gondii
* contaminated raw meat or cat feces ingestion
Is this an active infection?
No, it is inactive toxoplasmosis
* old retinal lesions appear as circular areas of chorioretinal atrophy surrounded by pigmentation
* generally stable
* no tx is necessary
Visuoscopy; what type of eccentric fixation does this patient posses?
3 prism diopters nasal and 1 prism diopter superior eccentric fixation
*each mark is 1 PD, count from center of target and the direction is opposite
EBMD (epithelial basement membrane dystrophy)
* aka map-dot-fingerprint dystrophy or cogan microcystic dystrophy
* fibrillation protein deposits between bowman’s and epithelial basement membrane
What congenital retinal vascular anomalies is apparent?
Cilioretinal artery
* anomalous direct or indirect branch of posterior ciliary arteries
* emerge from temporal aspect of optic disc
* positive because allows for secondary route of blood flow in cases of CRAO
Corneal topography I
Keratoconus
*asymmetrical figure “8”
* high K values >48 = steep
Herpes simplex virus keratitis
* dendrites terminal end bulbs that stain with rose bengal
* main portion of dendrites stain with sodium fluorescein
S/S; acute, painless, unilateral vision loss
CRVO
* caused when centra retinal artery compresses central retinal vein causing blood flow to be impeded and forms a thrombus which leads to an occlusion
Pt was welding without proper eye protection
Image 1?
Image 2?
What condition does this patient have?
- Krukenberg spindle
- Transillumination defects
Patient has PDS (pigment dispersion syndrome)
Neovascular AMD
- left untreated can lead to leakage of blood and protein under macula, scarring from abnormal blood vessels eventually cause irreversible damage to retinal photoreceptors leading to rapid vision loss
Amelanotic choroidal melanoma
* eye cancer where melanocytes in choroid proliferate but lose ability to produce pigment
* amelanotic means without pigment
Retinal detachment
* lesion is inferior nasal, patient will report phototopsias superior temporally
Retinal detachment
Lattice degeneration
* ~1% will progress and lead to retinal detachment
14 month old Asian male
“Eyes have become cloudy”
Primary congenital glaucoma
* eye appears cloudy due to corneal edema secondary to high IOP
* most common form of infantile glaucoma
39 WM, saxophonist
Unilateral, Acute, painless loss of lower portion of vision
Valsalva retinopathy
* one or more well- rounded or dumbbell shaped hemorrhages beneath the posterior hyaloid of vitreous or the internal limiting membrane
56 WF
T2DM with A1c: 9.1% with FBG: 171 mg/dL
Severe non-proliferative diabetic retinopathy
* CWS
*hemes in all 4 quadrants
But no neovascularization, venous beading or IRMA present
Optic pit
* rare, congenital
* unilateral
* pit temporally
* asymptomatic
Advanced primary open angle glaucoma
* ONH damage. Retinal NFL defects
* bilateral, asymmetrical
Fuch’s
*beaten metal appearance
50 AF
Subjective Rx
OD: -17.00 -1.25 x 090
OS: -15.00 -1.25 x 090
Degenerative myopia
* vertically elongated optic nerves
* Chorioretinal atrophy with temporal myopic conus
* confirm dx with A-scan
*normal Axial length is 22-25mm
*abnormal >26 mm
Optic nerve melanocytoma (benign)
* variant of melanocytic nevus
* deep pigmented lesion on optic disc
* congenital, non-hereditary
Plaquenil maculopathy
Choroideremia
* X-linked recessive (females are carriers and do not display reduction in VA)
* degeneration of RPE and choriocapillaris
Optic nerve drusen
* optic nerve elevation and irregular disc margins
*diagnostic imaging: B-scan (turn down gain to visualize high acoustic drusen)
OCT imaging
* no tx
White without pressure
* seen in patients with axial elongation
* most frequently seen inferior and temporally
* mostly seen in AA pts
CHRPE
* lacunae: areas of depigmentation within or around borders
* flat with well-defined borders
Mutton fat keratic precipitates in pt with sarcoidosis
*idiopathic inflammation
*middle aged AA females
* need ACE and chest x-ray (90% lung involvement, granulomas )
Y suture cataract
Retinitis pigmentosa
* Bone spiculues
*autosomal recessive
Presumed ocular histoplasmosis
* peripapillary atrophy
* atrophic histoplasmosis spots
Retinal hole with surrounding cuff of edema
* caused by retraction of retina by vitreous, pulls a small piece of retinal tissue
*operculum seen hovering in vitreous looks like a disc shaped floater, smaller than retina defect
Aniridia
* autosomal dominant
*majority of iris is lacking
Fundus flavimaculatus with geographic atrophy
Choroidal rupture
*tear in choroid, brunch’s and RPE
* associated with blunt ocular trauma
Cortical cataracts
Symblepharon
* partial or complete adhesion between palpebral conj and bulbar conj
* lower lid
MGD
*frothy tear film
*aka posterior blepharitis
* caused by dysfunction of the sebaceous glands
Traumatic cataract
* from blunt or penetrating ocular trauma, intraocular foreign body Or following cataract surgery
* rosette cataract
Posterior synechiae
*adhesions between posterior surface of iris and anterior capsule of crystalline lens
* result of intra ocular inflammation
56 WF
Cc: FBS, sandy, gritty feeling
Gradual onset
Watery discharge
Similar episodes occurring over last few years
Superior limbic keratoconjunctivitis
