Optic Nerve/Retina 2 Flashcards
What are the 2 basic changes to retinal vasculature w/ Diabetic Retinopathy?
- Abnormal permeability of vessels
- Vascular occlusion, leading to ischemia and subsequent neovascularization
What is the tx for Hypertensive Retinopathy?
- Systemic blood pressure control
- Ophtho referral (for newly diagnosed HTN, longstanding/severe HTN, vision loss)
- Arteriolar Narrowing (copper wiring)
- Arteriolar Sclerosis (silver wiring)
- A:V crossing changes (AV nicking)
Mild Hypertensive Retinopathy
- Under which circumstance would you evaluate etiology of Central Retinal Vein Occlusion?
- What is the prognosis?
- If the pt is young, evaluate for severe HTN and hypercoagulable states
- Prognosis is variable
The 3 classifications of Hypertensive Retinopathy
- Mild
- Moderate
- Severe
- Cotton-wool spots (areas of atrophy)
- Retinal/Flame hemorrhages
- Retinal edema/exudates (macular star)
Moderate Hypertensive Retinopathy
- Sxs noticed first thing in AM upon waking
- Acute painless unilateral vision loss (not complete vision loss)
- No eye redness
Sxs of which eye condition?
Central Retinal Vein Occlusion
In which 3 circumstances should a pt w/ diabetes be examined by an ophthalmologist for Diabetic Retinopathy?
- Type 1 DM for over 5 years
- At first diagnosis of Type 2 DM
- If ocular sxs develop or if suspicious findings of retinopathy
- Urgent referral to ophtho
- Observation (most cases)
- ASA (ONLY if pt w/ underlying coagulopathy)
Tx for which eye condition?
Central Retinal Vein Occlusion
Diabetic Retinopathy is present in what % of diabetic patients?
40%
*BUT, not all have visual disturbances
Asymptomatic w/ no vision complaints
Hypertensive Retinopathy
- Typically asymptomatic until later stages
- Blurred vision due to acute increases in serum glucose, causing lens swelling and refractive shift (even in absence of condition)
- Sugar pushes on lens
Diabetic Retinopathy
37 yr old male, optic disc edema, cotton wool spots, flame hemorrhages, dot-blot hemorrhages, AV nicking, hard exudates. Asymptomatic, vision 20/20. BP is 198/142.
What is the diagnosis?
Hypertensive Retinopathy
1 cause of blindness in Western world of patients under 50 yrs old
Diabetic Retinopathy
3 ways Diabetic Retinopathy is classified
- Non-proliferative DR
- Proliferative DR
- Diabetic Macular Edema
Which DR has the worst prognosis?
Proliferative DR
Prognosis for Central Retinal Artery Occlusion
Poor prognosis
What is the goal after finding out pt has Central Retinal Artery Occlusion?
- Determine etiology
- Prevent further emboli
- NLP (no light perception)
- Afferent pupillary defect
- Pale retina w/ “cherry red spot” at fovea
Signs of which eye condition?
Central Retinal Artery Occlusion
Ophthalmology referral for:
- Laser photocoagulation
- Anti-angiogenic injection
- Vitrectomy (take out some vitreous humor)
Tx for Diabetic Retinopathy
Occlusion by emboli, results in decreased blood flow and hypoxia to retina
Central Retinal Artery Occlusion
- Sudden painless, TOTAL monocular vision loss
- No eye redness
Sxs of which eye condition?
Central Retinal Artery Occlusion
To tx Diabetic Retinopathy, the patient needs to control their blood sugars.
- What should their daily glucose remain under?
- What should their HbA1C remain under?
- 120
- 7
May have repeated transient episodes before complete loss of vision.
Central Retinal Artery Occlusion
How often should diabetic patients have ophthalmoscopic exam through dilated pupils?
Yearly
Retinal vascular changes due to systemic hypertension
Hypertensive Retinopathy
- Under which circumstance would you treat Central Retinal Vein Occlusion?
- With what meds?
- If there is macular edema
- Give Intravitreal steroids
Disc edema (papilledema)
Severe Hypertensive Retinopathy (includes sxs of mild/moderate)
- Neovascularization
- Vitreous hemorrhage
- Traction retinal detachment
Proliferative DR (includes features of non-prolif DR)
- Can occur at any stage of condition
- Fundoscopic findings:
- Retinal thickening
- Microaneurysms
- Hard exudates
Macular Edema (DR)
- Emergent referral to ophtho
- Tx often not effective unless started within a few hours of onset
Central Retinal Artery Occlusion
Occlusion due to thrombi
Central Retinal Vein Occlusion
- Microaneurysms (earliest sign)
- Dot-blot hemorrhages
- Cotton-wool spots (ischemia)
Non-Proliferative DR
3 possible etiologies of Central Retinal Artery Occlusion
- Carotid plaques
- Cardiac emboli
- Temporal arteritis (if pt older than 55 yrs) - get carotid US
- +/- APD (afferent pupilary defect)
- Variable visual acuity
- Multiple hemorrhages
- Venous dilation/tortuosity
- “blood and thunder” fundus
Signs of which eye condition?
Central Retinal Vein Occlusion
