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DDX > RETINA > Flashcards

RETINA Flashcards

1
Q

DDX of CSR

A

Non inflammatory:

  • HTN
  • optic pit
  • CNV
  • polypoidal
  • tumour- hemangioma/melanoma
  • CSR

Inflammatory:

  • VKH
  • SO
  • uveal effusion - posterior scleritsi

Infectious:

-TB/syphilis

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2
Q

Pigmentary disturbance

A
  1. Systemic disease
    1. Refsum
    2. ushers
    3. bardet biedel
    4. alstrom
    5. cockayne
    6. myotonic dystrophy
    7. kearns sayre
  2. Vascular occlusion
    1. OA, CRAO, BRAO occlusion
  3. Inflammatory
    1. diffuse uveitis
    2. DUSN
    3. WDS- AZOOR
  4. Infectious
    1. syphilis
    2. Toxo
    3. Rubella
  5. Trauma
    1. IOFB
    2. siderosis
    3. chronic RD
  6. Other
    1. paraneoplastic
    2. XLRS
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3
Q

Increased risk PVD

A
  1. increased AL
  2. age
  3. aphakia
  4. myopia
  5. uveitis
  6. trauma
  7. VH
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4
Q

worst prognosis in re attachment of RD

A
  1. uveitis
  2. PVR
  3. giant tear
  4. choroidal detachment
  5. posterior breaks
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5
Q

Peripheral NV

A
  1. vascular diseases
    1. PDR
    2. BRVO
    3. BRAO
    4. CCF
    5. sickle cell
    6. ROP
    7. FEVR
    8. ROP
    9. IRVAN
  2. inflammatory
    1. sarcoid
    2. retinal vasculitis - SLE
    3. pars planitis
    4. BSR
    5. toxo
    6. MS
  3. other
    1. IP
    2. chronic RD
    3. RP
    4. retinoschsis
    5. melanoma
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6
Q

Thickened choriod

A
  1. Non inflammatory
    1. CSR
    2. choroidal hemangioma
    3. melanoma
    4. primary CNS lymphoma
  2. Inflammatory
    1. VKH
    2. SO
    3. BDUMP
    4. uveal effusion syndrome
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7
Q

Retinoschisis

A
  1. degenerative
    1. typical or reticular
  2. congenital
    1. X linked
  3. secondary forms
    1. optic pit
    2. myopia
    3. vit traction
    4. retinal venous occlusion
    5. goldman favre
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8
Q

bulls eye maculopathy

A
  1. stargardts
  2. cone and cone rod dystrophies
  3. hydroxychloroquine/chloroquine
  4. ARMD
  5. chronic macular hole
  6. central areolar choroidal dystrophy
  7. olivopontocerebellar atrophy
  8. batten disease
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9
Q

Cherry Red spot

A
  1. Gangliosidosis
  2. Tay Sachs
  3. Sandhoff disease
  4. Niemann Pick
  5. Sialidosis
  6. metachromatic leukodystrophy
  7. CRAO
  8. trauma
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10
Q

Pigmentary retinopathy and hearing loss

A
  1. Usher
  2. Alport
  3. Alstrom
  4. Cockayne
  5. Refsum
  6. Rubella
  7. Hurler
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11
Q

hydroxychloroquine toxicity

A

Risk of toxicity- <1% 5 years, <2% at 10 years and 20% at 20 years

Risk factors: DIRT: High dose, duration of use, concomitant renal disease, or use of tamoxifen

Dose: maximum daily HCQ use of 5.0 mg/kg real weight, CQ 2.3 mg/kg real weight

Screening schedule: A baseline fundus examination, annual screening after 5 years for patients on acceptable doses and without major risk factors.

Screening Tests: 10-2 or 30-2 (asians) and SD OCT, other multifocal ERG and FAF

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12
Q

Crystalline retinopathy

A
  1. Systemic diseases
    1. hereditary primary oxalosis
    2. oxalosis from renal failure or hemodialysis
  2. Drug induced causes
    1. tamoxifen
    2. talc
    3. nitrofurantoin
    4. canthaxanthine
    5. methoxyflurane
    6. ethylene glycol
    7. koala nut
    8. triamcinolone injection
  3. Ocular causes
    1. bietti
    2. calcific drusen
    3. gyrate
    4. retinal telangiectasia
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13
Q

DDX of CNV

A

Degenerative

  • AMD
  • Myopic degeneration
  • angioid streaks
  • osteogenesis imperfecta
  • JXT
  • retinochoroidal coloboma
  • tilted disc

Heredodegenerative

  • vitelliform
  • optic nerve drusen
  • choroideremia
  • RP with exudate

Tumour

  • nevus
  • hemangioma
  • metastatic tumour
  • hamartoma of the RPE
  • choroidal osteoma
  • melanoma

inflammatory

  • OHS
  • WDS - MFC, PIC, serpiginous, BSR
  • toxo
  • rubella
  • sarcoid
  • syphilis
  • uveitis
  • SO
  • CSR
  • VKH

Trauma

  • choriodal rupture
  • IOFB
  • surgical truam
  • intense photocoagulation
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14
Q

DDX CWS

A

H - HTN (systemic)

A - AIDS / HIV (CMV retinitis)

R - Radiation retinopathy

D - Diabetic Retinopathy (#1)

C - Cardiac embolic disease, carotid artery obstructive disease

A - anemia (hyperviscosity syndrome) - leukemia / lymphoma

V - Vasulitis (lupus, collagen vascular disease)

E - Eales disease

S - Sickle cell retinopathy, Syphilis, Sarcoid

Others: Purtscher’s

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15
Q

CME that does not leak

A

XLR

Nicotinic acid

Goldmann-Favre

Xalatan / Epinephrine

Racemose angioma

Retinal cavernous hemangioma

RP

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16
Q

Myopia findings

A

Optic disc tilt

Peripapillary chorioretinal atrophy

Lacquer cracks

Isolated, round, deep subretinal hg that clear spontaneously

Forster-Fuchs spots

Posterior staphyloma

Elongation and atrophy of the ciliary body

Gyrate areas of atrophy of the RPE and choroid

Cystoid, paving-stone, and lattice degeneration

Thinning or hole formation in the peripheral retina

Thinning and rearrangement of the collagen layers of the sclera

CNV

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17
Q

DDX of vasculitis by causes

A

Non-infectious / Autoimmune

Sarcoidosis, Bechet’s Whipple’s, MS, Crohn’s

CT disease

Wegener’s, PAN, Sjogren’s, Dermatomyositis, Polymyositis

Infectious

Bacterial (syphilis, TB), viral (ARN,HSV, HZV, CMV), Parasitic (toxoplasmosis,

toxocara)

Ocular

Birdshot, pars planitis, frosted branch angiitis, Eale’s disease, AMHV

Neoplastic

lymphoma, leukemia, mets, paraneoplastic, CAR

18
Q

DDX CME

A
  1. post op - irvine gass, corneal surgery, retinal surgery, laser iridotomy, cryo for retinal tear, PRP, laser, aphakia, pseudophakia
  2. inherited/dystrophies - RP, JXRL, goldmann favre
  3. medications - xalatan, epinephrine, nicotinic acid
  4. tumours - melanoma, nevi, hemangioma
  5. tractional - ERM, VMT
  6. inflammatory - pars planitis, behcet, sarcoid, toxoplasmosis, BSR, CMV, scleritis,
  7. vascular - DR, CRVO, BRVO, OIS, CNVM, coats, JXT, radiation
19
Q

choroidal folds

A
  • Thin RPE
  • T – Tumours- choroidal melanomas, mets, osteoma
  • H- hypotony – overfiltration, cyclodiag
  • I- inflammation –posterior scleritis, TED, orbital inflammation
  • I- idiopathic (hyperopes)
  • N – neovascular mem (CNV)
  • R – retrobulbar mass
  • P – disc swelling
  • E – extraocular hardware
20
Q

Neovascular AMD DDX

A
  1. macroaneurysms
  2. vitelliform
  3. polypoidal
  4. CSCR
  5. inflammation (VKH, SLE, scleritis)
  6. Trauma, tumours
  7. Sorsby
21
Q

Types of emboli

A

cholesterol (refractile yellow Hollenhorst from carotids)

platelet-fibrin (large vessel arteriosclerosis)

calcified (chalky white from valves)

complement-induced leukoembolization (Purtscher’s)

long bone # (fat / air)

childbirth (amniotic fluid)

IVDU (talc / pieces of cannula)

bacterial endocarditis (septic)

cardiac atrial myxoma (tumour cells)

coagulation

MVP

arrhythmias

depot drug preps (corticosteroids / anaesthetic)

22
Q

Disc edema, heme, vein congestion

A

incomplete CRVO

diabetic papillopathy

hypertensive optic neuropathy

AION

radiation retinopathy

acute macular neuroretinitis

23
Q

Retinal vasculitis by vascular type affected

A

arteritis

  • SLE
  • PAN
  • syphilis
  • HSV/VZV
  • IRVAN
  • churg struss
  • GCA

phlebitis

  • sarcoidosis
  • MS
  • behcets
  • BSR
  • HIV
  • eales
  • IU
  • TB

arteritis/phlebitis

  • toxo
  • relapsing polychondritis
  • wegners
  • crohn
  • frosted branch angiitis
  • neoplastic causes

Vascular occlusion: TB**, syphilis, eales, SLE***, MS, bechets****, relapsing polychondritis, susac, ARN, sarcoid

Retinal necrosis: Toxo, ARN, CMV

24
Q

Electronegative ERG

A

CSNB (Oguchi’s)

CRVO / acute CRAO

JXLR

Siderosis

Coats

Myotonic dystrophy

Duschenne muscular dystrophy

Batten’s disease

Quinine toxicity / methanol

MAR / CAR (melanoma-associated retinopathy / cancer-associated

retinopathy)

retinoschisis

25
Q

yellow foveal lesion

A

Bests’

Adult vitelliform

pattern dystrophy

basal laminar drusen

serous PED

resolving subretinal H

early macular hole

solar maculopathy

26
Q

straightened vessels around macula

A

ROP

FEVR

toxocara

incontinentia pigmenti

RPE hamartoma

epiretinal membrane

27
Q

macular dragging

A

ROP

FEVR

Incontinentia pigmenti

Toxocara

JXLR

28
Q

conjunctival vascular anomalies

A

Fabry’s

ataxia telangiectasia

CC fistula

hyperviscosity syndrome (multiple myeloma, polycythemia rubra vera)

sentinel vessels for underlying tumor

sickle cell

Sturge Weber

29
Q

Spontaneous VH

A
  • PDR #1
  • retinal break without detachment
  • PVD
  • RRD
  • BRVO/CRVO
  • Trauma
  • JXLR
  • peripheral NV (pars planitis, fevr, coats)
  • polypoidal
  • AMD
  • tersons
  • HTN/macroaneurysms
30
Q

Leopard spots of IVFA

A

uveal effusion syndrome

infiltrative lesion (lymphoma, leukemia)

longstanding exudative RD

choroidal metastasis with overlying pigment clumping

organ transplantation (serous RD’s with geographic zones of leopard

pattern of RPE clumping)

BDUMP

31
Q

Roth spots

A
  • bacterial endocarditis
  • leukemia
  • anemia
  • thrombocytopenia
  • sepsis
  • HTN
  • DR
  • anoxia
  • CO posioning
  • MM
  • shaken baby
  • sickle cell
  • lupus
32
Q

exudative RD

A

Vascular

  • CNV
  • HTN
  • Coats
  • FEVR
  • Eales
  • VHL
  • CRVO
  • Retinitis/vasculitis

Inflammation

  • VKH
  • Posterior scleritis
  • SO
  • POHS
  • Idiopathic uveal effusion syndrome

Choroidal tumours

  • Melanoma
  • Hemangioma
  • Mets
  • MM
  • retinal capillary hemangioblastoma

Congenital abnormalities

  • morning glory disc
  • coloboma
  • optic pit

Other:

  • CSR
  • nanophthalmos
  • infectious retinochoroiditis (toxoplasmosis, syphilis, CMV)
33
Q

night blindness

A

LCA

CSNB

RP

gyrate atrophy

choroideremia

Goldmann-Favre (rare)

vit A deficiency

Norrie’s

Stickler’s

Night myopia

advanced glaucoma

status PRP

34
Q

parafoveal telangiectasia

A

Coats (kid onset)

Idiopathic parafoveal

DR

BRVO / CRVO

ERM

Radiation

Sickle cell

Macroaneurysm (single)

carotid artery obstruction

tuberous sclerosis

35
Q

Frosted branch angiitis

A

idiopathic

Systemic:

  • leukemia / lymphoma
  • SLE
  • crohns

Infecious

  • TB
  • CMV
  • toxo
36
Q

Retained IOFB

A

Inert: stone, sand, glass, porcelain, plastic cilia

Reactive: aluminum, zinc, copper, iron….zinc and aluminum tend to cause minimal inflammation, may become encapsulated

COPPER: if pure- prompt removal needed, causes acute chalcosis with severe inflammation may lead to loss of eye, late removal may not cure…. if alloyed with another metal to final copper content of < 85% chronic chalcosis can occur

  • affinity for basement membranes
  • see: KF ring, green aqueos particles, green discoloration of iris, lens capsule, brownish red vit opacities, metallic flecks on retinal vessels and ILM

IRON:

  • affinity for neuroepithelial tissues such as iris sphincter, dilator muscles, nonpigmented cilariy epitheliun, lens epi, retina, RPE
  • oxidation and dissemination of ferric ions promotes FENTON reaction, iron catalyzes the generation of oxidant such as hydroxyl radicals–> cell membrane damage and enzyme inactivation
  • see: ust colored K stromal staining, heterochromia, mydriasis, brown deposits on lens, ret pig degeneration, optic disc atrophy
37
Q

Pigmented lesion in fundus

A
  1. Melanoma
  2. nevus
  3. AMD disciform scar
  4. suprachoroidal hemorrhage
  5. RPE hyperplasia
  6. CHRPE
  7. melanocytoma
  8. choroidal osteoma
  9. metastatic carcinoma
  10. choroidal hemangioma
38
Q

Signs suggesting malignancy of iris lesion

A
  1. ectropion iridis
  2. prominent vascularity
  3. sectoral cataract
  4. 2ndary glaucoma
  5. seeding of peripheral angle structures
  6. extrascleral extension
  7. lesion size
  8. progressive growth
39
Q

COMS study

A

Small - 1-2.4mm height 4-8mm diameter

Observed

1% mort @ 5 years

clinical growth factors: greater thickness and basal diameter, orange pigmentation, absence of rpe change/drusen, presence of tumour pinpoint hyperF on IVFA

Medium - 2.5 - 10mm height 6-16mm diameter

I-125 brachy therapy vs. enucleation

20% mort at 5 years, no difference between groups

mets at 5 years 10% both groups

Enuc group: 2/660 were misdx

Brachy group: 10% local tumour recurrence, 13% enuc risk at 5 years, va decreased to 20/200 in 40% at 3 years, quadruple visual angle in 50% pts at 3 years

Large - >10mm height >16mm diameter

Radiation + Enuc. vs. Enuc alone.

5 year mort rate 50%

no differences in survival between groups

adjunctive radiotherapy no improvement to survival

established appropriateness of primary enucleation in managing large choroidal melanoma

40
Q

Dystrophy couselling

A
  1. proper refraction
  2. Amsler grid to detect CNVM or CME
  3. referral to low vision
  4. communicate with teacher about childs visual abilities and limitations
  5. Annual follow up to rule out any treatable vision threatening diseases (cataract, glaucoma)
41
Q

DDX of RD

A
  • exudative RD
  • RRD
  • tractional RD
  • acquired/age related degenerative retinoschisis
  • X linked retinoschisis
  • choroidal detachment

RECALL: visual outcomes for mac off detachments do not change if surgery is performed within 7 days

42
Q

DDX of chorioretinal lesion

A

Infection

  • syphilis
  • DUSN
  • Toxo
  • POHS
  • TB
  • ARN

Inflammation

  • SO
  • VKH
  • lymphoma
  • sarcoid
  • WDS

DDX (6 decks)

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