Retina

Question 1

CRAO

Answer 1

• painless vision loss to 20/400
• amaurosis fugax
• transient ischemic attacks
• permanent visual field defect

Treatment:

• digital massage
• decrease IOP

Management:

• carotid ascultation, ultrasound, palpation
• echocardiogram
• complete physical

Question 2

BRVO

a) macular disease
b) neovascularization

Answer 2

• visual prognosis 20/40 or better at 1 year

Management:

• carotid ascultation
• physical
• hyperviscosity in young patients

Treatment:
a) >3 months and VA worse than 20/40 - focal laser treatment
OR
ranibizumab 0.5mg
b) sector laser photocoagulation if >2 clock hours of iris

Follow-up every 1-2/3 months for first 6 months, then 6-12 months. Taper to annual.

Question 3

Risk factors for BRVO and CRVO

Answer 3

• hypertension
• diabetes
• cardiovascular disease
• increased BMI at 20 years
• open angle glaucoma

Question 4

CRVO Ischemic vs Non-Ischemic

Answer 4

Ischemic:

• CWS
• dot/blot + FLAME shaped hemes
• RAPD
• vision worse than 20/400
• edema
• hard exudates

Non-Ischemic:

• no RAPD
• dot/blot heme
• edema
• dilated tortuous veins
• acuity better than 20/400

Treatment:

• PRP if rubeosis
• 1 mg intravitreal triamcinolone
• 0.5mg ranibizumab

Follow-up:

• every month for first 6 months for neovasc
• every 6 months as needed

Question 5

Hypertensive Retinopathy

Answer 5

Treatment:

- monitor q2-3 months, then q 6-12 months.

Question 6

Ocular Ischemic Syndrome

Answer 6

• unilateral, red eye, equatorial hemes, neovasc of disc and elsewhere
• edema, uveitis, descemet’s folds
• transient vision loss
• usually male 50-80 years of age
• prolonged vision recovery after exposure to light
• FA shows decreased transit time and difference between two eyes

Causes:

• carotid disease: usually >90% stenosed
• opthalmic artery disease rarer

Treatment:

• > 55 years, ESR and C-reactive protein
• carotid and other blood tests
• PRP to reduce hypoxia
• cryotherapy for NVG

Question 7

Acute retinal necrosis (ARN)

Answer 7

• panuveitis
• vitiris and anterior chamber involvement
• Zoster and Simplex indicated
• deep retinal whitening, limited hemorrhage
• rapid progression from days to week
• CD4+ count is higher than 60, unlike PORN which is low

Question 8

Ramsay Hunt Syndrome

Answer 8

• herpes simplex oticus
• weakness of the face due to infection with VZV
• facial weakness recovered in 75% if treated in 72h
• severe ear pain, blisters around ear or in mouth