other other macular disorders Flashcards
what is the peripheral retina
anterior to the equator, extending to the oraserrata (3dd away)
the peripheral retina encompasses what percentage of the fundus
40%
what changes occur with blood vessels in the peripheral retina
smaller
fewer
become basically parallel to ora
the ora is more scalloped on which side
nasally
what are oral bays
they are extensions of pars plana at the ora serrata
what are oral teeth (dentate processes)
extensions of retina between oral bays
oral bays and teeth together are called what
dentate processes
migraine headaches cause flashes that last for how long? unilateral or bilateral?
flashes usually last 10-60 minutes
usually unilateral
start central, move peripheral
if flashes occur from vitreal or retinal causes, how long do they last
only a few seconds, usually provoked by head movement. usually acute and sudden onset.
what kind of questions do you want to ask someone with floaters
how long have the floaters been present which eye how many whats the shape what their story: trauma, disease, inflammation, etc.
what are some differentials for floaters
- pbd
- vitreal heme
- retinal operculum
- entoptic = gazing in sky, small white particles are white blood cells
- posterior uveitis
what could cause pseudo flashes
medical history,
media opacities
glare
what is another word for peripheral RPE degeneration
reticular degeneration
what is peripheral RPE degeneration and what is the prevalence
granular pigment deposits between the ora and the equator and 20% of population over 40
what causes peripheral RPE degeneration
caused by the break down of the RPE with deposition of pigment granules in sensory retina. ultimately loss of PRs and sclerosis of the choriocapilaris
how do you manage / treat peripheral RPE degeneration
monitor routine dilation every 1-2 years
what causes paving stone / cobble stone degeneration
occlusion of compartments of choriocapilaris which causes RPE degeneration and retinal thinning
pavingstone degeneration is common in what populations
age related (greater than 40) usually benign
paving stone degeneration is common in what quadrants
nasal and temporal quadrants
where is pavingstone degeneration located
located between ora and equator
describe the apparance of lesions in pavingstone
flat
distinct margins that may have pigmented edges that are several dd in size
what is the management of pavingstone degeneration
monitor and routine dialation every 1-2 years
how common is peripheral cystoid degeneration
occurs in virtually all patients over the age of 8
what causes peripheral cystoid degeneration
involves cystoid like changes in OPL that can extend to involve the entire sensory retina
if the cyst colalesce they can form large cystoid spaces, causing true splitting or retinoschisis of the sensory retina
where is peripheral cystoid degeneration found and what does it look like
usually at ora and can extend to the equator
thickened area of retina, extending about 1/2 dd
how do you manage peripheral cystoid degeneration
just monitor and routine dialation every 1-2 years
t/f cystoid degeneration is a risk for developing retinal detachments
false
t/f white WITH pressure is a malignant condition
false
what causes white WITH pressure
a distinct milky white appearance when scleral depression is performed. without depression the retina appears normal
its commonly observed in approx 30% of eyes examined with scleral depression, and is NOT associated with peripheral retinal breaks
white without pressure is usualyl seen in what kind of eyes
10x more often in darker fundi
higher incidence in myops.
associated with aging
what is the cause of white without pressure
unusual vitreal-retinal relationship that causes disorganization of NFL of sensory retina down to RPE
where does white without pressure occur
occurs between the ora and the equator
t/f white without pressure can lead to retinal detachments
true
its associated with abnormal vitreal-retinal adhesion
what is schaffer’s sign
its presence of cells that are golden brown pigmented granules and anterior vitreous of phakic that suggests retinal breaks. sometimes called tobacco dust.
atrophic retinal holes are usually secondary to what
progressive retinal thinning due to underlying vascular insufficiency
atrophic retinal holes are usually about how big
pinpoint to 2 dd round red lesions
atrophic hole surrounded by pigment or RPE hyperplasia indicate what
indicates lesion has been prsent for approx 3 months
about how often do you get sensory retinal detachment from atrophic retinal holes
10% incidence
how to manage / treat atrophic retinal holes
if there is pigment around it, monitor it annually.
if there is a cuff of adema, refer to OMD
patient education.
risks of retinal detachment
operculated retinal holes appear where and appear how
usually occur from equator to ora
round, red, holes with a free floating plug of retinal tissue attached to the vitreous
what causes horseshoe tears
usually due to abnormal vitreal-retinal adhesions and PVD
horse shoe tears put you at risk for what two things
- retinal detachment
2. vitreal hemes
how do you manage horse shoe tears
refer all horse shoe tears to a retinal specialist because they cause 30% of retinal detachments
lattice degeneration is what, found where, how many people have it
oval or elliptical area of retinal thinning near the equator found in approx 8% of the population
what causes lattice degeneration
a vitreal retinal degeneration affecting inner retinal layers and vitreal retinal surface
lattice degeneration is more commonly found in what quadrants and what size/appearance
usually found superior or inferior quadrants.
usually parallel to ora serrata
usually 2dd to a full quadrant in size
1/2 dd to 1.5 dd in width
looks like fine white lines that look attenuated or sheathed vessels with some RPE hyperplasia changes
vitreous liquefies over lattice
what is snail tracking degeneration
basically the same as lattice degeneration but looks like a whiteish trail instead.
what are vitreal retinal tufts
accumulation of proliferated glial cells on retinal surface causing retinal degeneration and subsequent vitreous attachment
vitreal retinal tufts are found where and what do they look like
found between equator and ora, usually nasal
look like grayish white pieces of tissue
what is a complication of vitreal retinal tufts
retinal detachment or tears may occur with vitreous liquefaction
where is retinal dialysis found if associated with trauma vs spontaneously
trauma = mostly in superior nasal quadrant
spontaneous in younger patients = inferior temporal quadrant and bilateral
what is the definition of retinal dialysis
its a retinal tear that occurs near the ora serrata that looksl ike a slow progressing retinal detachment
what is the treatment for retinal dialysis
refer all dialysis; needs prompt treatment
what are some causes for rhegamatogenous retinal detachments
20% caused by lattice
20% caused by blunt trauma
high myopia
what is a non-rhegamatogenous retinal detachment
a definition has no loose end to a retinal break and often a sign of a space occupying lesion, like a tumor
what are the two types of acquired retinoschisis
flat = typical bullous = reticular
what is retinoschisis
splitting of sensory retina, outer plexiform and inner nuclear layer
with acquired retinoschisis, where is it usually found; uni or bilateral
usually bilateral, and found typically in inferior temporal quadrant
what is flat RS
believed to represent advanced cystoid degeneration, usually not associated with retinal holes.
what is bulluos RS, what does it look like, what is the cavity filled with
looks like thin transparent ballooning forward of retinal tissue
cavity is filled with hyaluronic acid
posterior edge may be serrated, but typically has no pigmented line
progression is rare.
what is one possible complication of bullous RS
11% of patients with RS will develop retinal detachments
besides retinal detachments, what are some other complications of RS
can get multiple inner retinal holes or outer retinal holes that are larger than inner retinal holes, and typically only one.
