Posterior eye disease Flashcards
Compare and describe the appearance of these two optic nerve heads both of which illustrate pallor.
A) This colour photograph of the left eye demonstrates a large cap/disc ratio of more than 0.9, with nasal displacement of the vessels and visible lamina cribrosa. The most likely diagnosis is glaucoma. DD chiasmal tumors, syphilis, ischaemic optic neuropathy, retinal degenerative disease. B) This colour photograph of the left eye demonstrates pale disc with attenuated vessels typical of primary optic atrophy. The causes include compressive optic neuropathy, post optic neuritis, optic nerve tumours, congenital optic atrophy, hereditary optic neuropathies, toxic/metabolic optic neuropathies.
Picture A shows the appearance of one optic disc, the contralateral eye is unaffected. Picture B shows one eye and the other optic disc has a similar appearance.
Describe and compare the appearances of the two optic discs.
What visual symptoms would A experience in comparison with B?
What systemic symptoms might A and B have?
What investigations would you undertake for A and for B?
Describe and compare the appearances of the two optic discs.
A) The disc is pale, swollen with flame shape haemorrhages; B) the disc is hyperemic, swollen with blurring of the margins and obscured blood vessels.
What visual symptoms would A experience in comparison with B?
A) Will have profound loss of vision down to counting fingers or hand movement; B) May not experience visual loss, or experience short periods of decreased vision (transient obscuration) often precipitated by head posture.
What systemic symptoms might A and B have?
A) May have headache, jaw claudication, scalp tenderness, polymyalgia rheumatica, anorexia, weight loss, fever (and be older than 70) B) May have headache, double vision, nausea and vomiting.
What investigations would you undertake for A and for B?
A) ESR, CRP, Platelets, and temporal artery biopsy suspecting Giant Cell (Temporal) Arteritis. (Unilateral optic disc swelling is not papilloedema). B) neuro-imaging (CT, MRI), as bilateral optic disc swelling due to raised ICP is papilloedema.
What is the feature in this fundal photograph?
What systemic and ocular symptoms might this patient have noticed?
What investigations might be necessary?
What is the feature in this fundal photograph?
Embolus within branch retinal artery (from carotic artery or cardiac). The retinal veins are usually darker and fatter than the arteries.
What systemic and ocular symptoms might this patient have noticed?
Systemic - transient ischaemic attacks, may be hypertensive. Ocular - transient visual loss (amaurosis fugax) or sudden painless onset of visual field defect.
What investigations might be necessary?
Systemic investigations to find source of emboli: blood pressure, complete blood test including cholesterol and lipid profile, carotid duplex ultrasound, cardiac evaluation. Ocular: the diagnosis is clear.
The vision in this patient’s right eye is reduced following a traumatic injury some time previously. Compare the appearance of the right and left optic disc and nerve fibre layers.
Where is the likely site of injury?
What other simple test could you undertake to demonstrate the site of the lesion?
- The vision in this patient’s right eye is reduced following a traumatic injury some time previously. Compare the appearance of the right and left optic disc and nerve fibre layers.
The right optic disc is atrophic, with increased cup/disc ratio, together with prominent atrophy of the nerve fibre layer.
Where is the likely site of injury?
The injury is more likely to involve the retrobulbar portion of the optic nerve, and be direct or indirect.
What other simple test could you undertake to demonstrate the site of the lesion?
Examine the pupils for right relative afferent pupillary defect (swinging flashlight test – R pupil dilates as light is shone from L to R, then constricts again as shone from R to L). Patient will notice light is a lot dimmer (or absent) of R side (a subjective RAPD).
What is the underlying disease?
What are the white lesions, what are the red lesions?
what is the underlying disease?
Diabetes (with non-proliferative diabetic retinopathy).
What is the white lesion called?
Cotton wool spots (fluffy), and hard exudates (well defined).
What are the red lesions called?
Dot and Flame haemorrhages.
This picture shows one type of retinal vascular occlusion.
Describe the signs present in this picture.
What is the diagnosis?
What will be the approximate level of vision?
This picture shows one type of retinal vascular occlusion.
Describe the signs present in this picture.
Diffuse retinal haemorrhages in all quadrants of the retina, dilated, tortuous retinal veins, (not clearly shown but cotton wool spots and disc oedema may also be present).
What is the diagnosis?
Central retinal vein occlusion.
What will be the approximate level of vision?
Average to poor (variable from 6/12 to counting fingers).
This picture shows another type of retinal vascular occlusion.
Describe the signs present in this picture.
What is the diagnosis?
What will be the approximate level of vision?
This picture shows another type of retinal vascular occlusion. Describe the signs present in this picture.
Pale retina (ischaemic / oedema), narrowed retinal arterioles with segmentation of the blood column, cherry red spot at the macula (thinnest part of retina).
What is the diagnosis?
Central retinal artery occlusion.
What will be the approximate level of vision?
Very poor (counting fingers to light perception).
This is the appearance of the retina in a myopic person who had symptoms of photopsia (flashes) and floaters, then progressive visual loss (like a curtain obscuring vision) over the last 3 days.
What is the diagnosis?
What would this person’s approximate vision be?
What is the prognosis?
This is the appearance of the retina in a myopic person who had symptoms of photopsia (flashes) and floaters, then progressive visual loss (like a curtain obscuring vision) over he last 3 days.
What is the diagnosis?
Left retinal detachment.
What would this person’s approximate vision be?
The macula is detached (centre of image) therefore vision likely to be poor – around the 6/36 or worse level.
What is the prognosis?
With surgery, the vision potentially could be as good as 6/12.
