Posterior Chamber and Retinal Disorders Flashcards
Describe what happens with a retinal detachment
Primary event is a retinal tear. Fluid vitreous passes though the tear and lodges behind the sensory retina.Combined traction and pull of gravity results in progressive detachment.
What are predisposing factors of retinal detachment?
Age – 50-75. Myosis. Cataract extraction. Trauma
Family history. Advanced diabetes
What are signs and symptoms of a retinal detachment?
Blurred vision in one eye, becoming progressively worse. Floaters, sometimes described as a large horsefly (photopsias). Flashing lights- caused by the tugging on the retinal surface by the separating vitreous (significant indicator).
What are treatments of retinal detachment?
Cryotherapy (freezing). Scleral buckle. Intravitral gas. Vitrectomy
Describe what happens with a central retinal artery occlusion.
Emboli enter and occlude the retinal artery
What are predisposing factors to a central retinal artery occlusion?
Age – mean is 60-80. Carotid artery disease. Atrial fibrillation. Hypertension. Diabetes. Temporal Arteritis
What are signs and symptoms of a central retinal artery occlusion?
Sudden profound monocular visual loss, Can be preceded by amarousis fugax, Painless, Can detect hand movements but can’t count fingers
What does a fundascopic exam show with central retinal artery occlusion?
Ischemic retinal whitening. Cherry red spot on macula or fovea. Arteriole narrowing. “boxcar” segmentation of the retinal veins.Marked afferent pupillary defect
What is a marked afferent pupillary defect?
When a light is shone in the abnormal eye of a patient with an APD, the pupil of the affected eye paradoxically dilates rather than constricts
What is treatment of central retinal artery occlusion?
Ocular massage. Anterior chamber paracentesis.
Revasularization techniques-Thrombolysis
What are systemic etiologies that are predisposing factors to a central retinal vein occlusion?
Increasing age. HTN. Coagulation disorders. Diabetes
What are ocular etiologies that are predisposing factors to a central retinal vein occlusion?
Raised intraocular pressure (> 25 mmHg) vein inflammation (vasculitis)
What are signs and symptoms of central retinal vein occlusion?
Visual impairment is commonly first noticed upon waking. Usually a sudden monocular loss of vision
PAINLESS
What does a fundoscopic exam reveal for a central retinal vein occlusion?
Minimal AfferentPupillaryDefect (APD). venous tortuosity / dilatation. Retinal hemorrhages. variable cotton-wool spots. mild to moderate disc edema. macular edema
What do patients who have a central retinal vein occlusion need to also be screened for?
diabetes, systemic HTN, hyperlipidemia and glaucoma.
What are patients who have a central retinal vein occlusion at high risk of developing?
neovascular glaucoma / proliferative retinopathy ~ 3 months later
What is amaurosis fugax?
Monocular loss of vision described as “a curtain passing VERTICALLY across the field of vision leading to complete loss of vision and then a similar curtain effect as the vision returns” lasting a few minutes with complete recovery
What is the usual cause of amaurosis fugax?
retinal emboli from ipsilateral carotid disease
What further testing should be done for amaurosis fugax?
evaluation of carotids by doppler ultrasound or CT/MRI angiography, have EKG to ensure A. Fib is not cause of emboli
What is treatment for amaurosis fugax?
low dose ASA,Ocular massage is <24 hours, Lower IOP
What are differential diagnoses of amaurosis fugax?
Impending central retinal artery/vein occlusion. Impending OPHTHALMIC artery occlusion. Carotid stenosis. Temporal arteritis. Ocular migraine
What labs should be done for amaurosis fugax?
CBC. Fasting blood sugar. ESR and CRP. Lipid profile
When should you suspect optic neuritis?
young patient with vision loss and no immediately obvious exam findings
What are signs and symptoms of optic neuritis?
Unilateral decreased vision over 1-3 days. Occasional pain with eye movement. Age 18-45 female
What are possible etiologies of optic neuritis?
MS, idiopathic, viral infections, TB, sarcoidosis
What does a fundoscopic exam of optic neuritis reveal?
Optic nerve usually has a normal appearance acutely. Can have swollen disc. Relative afferent pupillary defect (RAPD). Decreased color vision. May get worse with exercise or temperature increase (Uhtoff’s sign).
What are the differential diagnoses of optic neuritis?
Ischemic optic neuropathy, papilledema, severe HTN, intraorbital or intracranial mass, toxic (ETOH, heavy metals, malnutrition)
What is work up and treatment of optic neuritis?
Complete ophthalmic exam, Complete neurologic exam / MRI & possible IV steroids, ESR / CRP/ TA bx. check BP. No oral steroids
What are the possible etiologies of papilledema?
Intracranial tumors. Hydrocephalus. Pseudotumor (young, obese females). Subdural hematoma (trauma). Brain abscess / Meningitis
What are signs and symptoms of papilledema?
Slow vision loss from increased ICP / optic nerve swelling. Can have acute attacks of vision loss when lying flat. Bilateral. Blurred disc margins. Peripapillary disc hemorrhages. Double vision
What is treatment for papilledema?
treat underlying cause
What are signs and symptoms of temporal arteritis?
Patients >55 years old. Sudden, painless, non-progressive visual loss. Headache. Scalp tenderness. Jaw claudication*. Fever. Weight loss.
Polymyalgia rheumatica association
What does a fundoscopic exam reveal for temporal arteritis?
+ RAPD. Pale, swollen optic disc
What labs should be done for temporal arteritis GCA)?
ESR (sed rate) and CRP (C-reactive protein).
ESR>47 and CRP>2.45 is 97% specific
What makes the definitive diagnosis for temporal arteritis (GCA)?
Temporal artery biopsy
What does histology show with temporal arteritis (GCA)?
granulomatous infiltrate of internal elastic lamina of artery. occlusion of vessel lumen. giant cells present
What is treatment for temporal arteritis (GCA)?
Treat with steroids even before biopsy is done. if no / mild visual symptoms:60-90mg Prednisone po qd.
if severe symptoms or visual loss:1gm Solumedrol IV q 6 hrs x 3-5 days, then SLOW taper off oral steroids over 2 weeks
What happens with age related macular degeneration?
“wearing out” of retina / photoreceptors. Degradation products form “drusen” in retina. two types: dry and wet
What are risk factors for age related macular degeneration?
Age. Smoking (2x higher). Family history. Caucasian. sun exposure.?diet. ?HTN. ?atherosclerosis. ?cataract surgery
Describe dry ARMD
Gradual vision loss and Drusen. Pt complaints:
gradual loss of vision in one or both eyes
Describe wet ARMD
Sudden vision loss. Subretinal neovascularization
Accumulation of fluid and blood. Patient complaints:
Acute distortion in vision, especially distortion of straight lines, or loss of central vision. Symptoms usually appear in one eye, although the disease is generally in both eyes.
What is treatment of ARMD?
antioxidants may prevent cellular damage in the retina by limiting the damaging effects of free radicals: vitamin C 500mg, vitamin E 400IU, beta carotene 15mg, Zn 80mg, Copper 2mg
