Ophthalmology

Question 1

What is the photo?

Answer 1

Age-related macular degeneration

Degeneration of macula (central area of retina). Causes distortion (metamorphopsia) and eventual loss of central vision (scotomas)

Dry (nonexudative) - more than 80%. Deposition of yellowish extracellular material in and beneath Bruch membrane and retinal pigment epithelium (“drusen”) with gradual loss in vision. Prevent progression with multivitamin and antioxidant supplements

Wet (exudative) - rapid loss of vision due to bleeding secondary to choroidal neovascularization. Treat with anti-VEGF injections like ranibizumab or laser

Question 2

What is this?

Answer 2

Diabetic Retinopathy

Retinal damage due to chronic hyperglycemia. Two types.

1) Nonproliferative - damaged capillaries leak blood leading to lipids and fluid seeping into retina. This leads to hemorrhages and macular edema. Treatment is blood sugar control and macular laser
2) Proliferative - chronic hypoxia results in new blood vessel formation with resultant traction on retina. Treatment is peripheral retinal photocoagulation, anti-VEGF like bevacizumab

Question 3

Identify the images

Answer 3

Retinal vein occlusions

Blockage of central or branch retinal vein due to compression from nearby arterial athero. Retinal hemorrhage and venous engorgement, edema in affected areas.

Question 4

What is this?

Answer 4

Retinal detachment

Separation of neurosensory layer of retina (photoreceptor layer with rods and cones) from outermost pigmented epithelium (normally shields excess light, supports retina) leading to degeneration of photoreceptors and vision loss.

May be secondary to retinal breaks, diabetic traction, inflammatory effusions. Visualized on fundoscopy by the splaying and paucity of retinal vessels.

Breaks more common in patients with high myopia and are often preceeded by posterior vitreous detachment (flashes and floaters) and eventual monocular loss of vision like a curtain drawn down. Surgical emergency.

Question 5

What is the pathology?

Answer 5

Central retinal artery occlusion

Acute, painless monocular vision loss. Retina cloudy with attenuated vessels and a cherry red spot at fovea

Question 6

You know the drill

Answer 6

Retinitis Pigmentosa

Inherited retinal degeneration. Painless, progressive vision loss beginning with night blindness (rods affected first). Bone spicule-shaped deposits around macula.

Question 7

another eye pic

Answer 7

Retinitis

Retinal edema and necrosis leading to scar. Often viral (CMV, HSV, HZV). Associated with immunosuppression.