Posterior eye/retinal pathology Flashcards
What is the vitreous body?
Gel inside eye ball that maintains structure of the eyeball and keeps retina pressed onto choroid.
Made of collagen and water and in age becomes less able to maintain its shape.
What is posterior vitreal detatchment?
Where the vitreous body comes away from the retina, common in older patients.
Clinical presentation of posterior virtual detachment?
Completely painless and asymptomatic.
Can present with spots of vision loss/floaters and flashing lights.
Management of posterior vitreous detachment?
No treatment required vision will improve as brain adjusts.
What conditions are patients with posterior vitreous detachment predisposed to?
Retinal tears
Retinal detachment
Both present in a similar way
What is retinal detachment?
The retina of the eye separates from the underlying choroid. This is usually due to an underlying retinal tear.
Why is retinal detachment sight threatening?
The retina relies on the blood vessels from the choroid for its blood supply and detachment can therefore lead to retinal ischaemia.
Risk factors for retinal detachment?
posterior virtual detachment
Diabetic retinopathy
Trauma to the eye
Retinal malignancy
Older age
Family history
Clinical presentation of retinal deatchment?
Acute onset peripheral vision loss
Blurred or distorted vision
Flashes/floaters in vision
Management of retinal detachment?
Slit lamp examination
Immediate referral to ophthalmology
Surgical intervention to create adhesions - e.g. Laser therapy or cryotherapy.
OR
Vitrectomy (vitreous body removed and replaced with oil or gas), scleral buckling or pneumatic retinopexy
Clinical presentation of retinal vein occlusion?
Blood clot or thrombus forms in the retinal veins at the back of the eye and blocks the drainage of blood away from the retina.
Course of the retinal vein and overall role?
Runs through the optic nerve and is responsible for draining blood from the retina.
Clinical presentation of central retinal vein occlusion?
Sudden loss of vision.
VEGF release leading to neovascularisation
Appearance of central retinal vein occlusion on fundoscopy?
Flame and blot haemorrhages
Optic disc oedema
Macula oedema
Neovascularisation
Risk factors for central retinal vein occlusion?
Hypertension Diabetes Smoking Glaucoma Sytemic inflammatory conditions SLE
Investigations for central retinal vein occlusion?
Fundoscopy and slit lamp examination
Full medical history Full blood count ESR (inflammatory disorders) BP for HTN Serum glucose/Hba1c - diabetes?
Management of central retinal vein occlusion?
Immediate referral
Laser photocoagulation
Intravitreal steroids (e.g. dexamethasone intravitreal implant)
anti-VEGF therapies e.g. Ranibizumab
Clinical presentation of central retinal artery occlusion?
RAPD
Pale retina with CHERRY RED SPOT.
Course of central retinal artery to the orbit?
Internal carotid artery branches into the ophthalmic artery which branches off to form the central retinal artery.
Most common cause of central retinal artery occlusion?
Atherosclerosis
What are the causes of central retinal artery occlusion?
Atherosclerosis
Temporal arteritis - vasculitis affecting the ophthalmic or central retinal artery reduces the blood flow.
Risk factors for retinal artery occlusion?
Older age Family history Smoking Hypertension Alcohol Diabetes Poor diet Inactivity Obesity
Typical patient of central retinal artery occlusion?
White female over the age of 50.
Already affected by RA/polymyalgia rheumatica/giant cell arteritis
How are patients managed with central retinal artery occlusion?
Immediate referral
ESR blood test and temporal artery biopsy
If GCA - manage with high dose steroids.
If patients present acutely after vision changes - ocular massage, anterior chamber fluid aspiration and inhaling carbogen and sublingual isosorbide dinatrate can be tried.
