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My Own Deck > Retina And Vitreous > Flashcards

Retina And Vitreous Flashcards

1
Q

What is the vitreous made up of?

A
  1. Water (98%)
  2. Collegen
  3. Hyaluronan
  4. Combo of other materials
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2
Q

Whats another name for the vitreous core?

A

Vitreous cortex and hyaloid membrane

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3
Q

4 facts about the vitreous

A

Its the bulk of the globe
Provides structural support
Shock obsorber
Visoelastic

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4
Q

What are the vitreous attachment and their order of strongest attachment?

A
  1. Vit base (strongest)
  2. Post Lens
  3. Optic Disc
  4. Macula
  5. Vessels
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5
Q

What is the function of the hyaloid artery?

A

Connects blood supply of optic nerve and anterior eye

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6
Q

What is pointed at here?

A

The hyaloid canal or cloquets canal

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7
Q

What 2 aspects are being pointed at here?

A

Top arrow: Mittendorf dot

Bottom arrow: hyaloid artery

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8
Q

Whats another name for a persistent hyaloid artery?

A

A bergmeister papilla

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9
Q

What are the potential signs symptoms that can arise with a mittendorf dot?

A

Signs: Circular opacity attached to posterior lens. Similar to PSC

Sxs: No sxs, may have reduced VA if close to visual axis

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10
Q

What happens to the vitreous with age?

A

Liquefaction process- becomes less gel more fluid

Shrinkage process- liberation of small collegen fibrils from vit

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11
Q

What is the shrinkage and liquefaction called?

A 
Liquefaction= Synchesis 
Shrinkage= Syneresis
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12
Q

When are fibril floater most visible?

A

Bright and plain background

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13
Q

What are signs of a healthy vitreous degeneration

A

Gradual onset
Longstanding
Bilateral

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14
Q

What part of the vitreous detaches from the retina?

A

Posterior hyaloid membrane

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15
Q

What aspect remains intact in PVD?

A

Anterior hyaloid membrane and ora serrata

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16
Q

What is vitreous ret dehiscence and causes it?

A

Seperation of vitreous from reti a allowing vit to collapse centripetal
Cause: weakening of vitreous ret interface with age

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17
Q

What will catalyse the detachment?

A

Perforation which allows fluid to leak b/w ILM and post vit which will enlarge the spaces

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18
Q

Where does PVD start?

A

Macula region

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19
Q

What is a partial detachment?

A

Attachments between retina and vitreous remain intact elsewhere

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20
Q

When is PVD complete?

A

When its detached from the ONH

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21
Q

What is shown here and how does it occur

A

A weiss ring- occurs when vit detaches from the ONH

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22
Q

What is an anomalous PVD?

A

Vit degeneration without detachment

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23
Q

What is residual adherence?

A

Adherence between vit and retina become under strain due to the ocular mobility

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24
Q

What can anomalous detachment lead to?

A

Vitreo ret traction which then leads to tears

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25
Q

What are the risk factors to PVD?

A
  1. Age (80-90 yrs= 86%
  2. Myopia- 4-5x earlier
  3. Gender- Females 2-3x
  4. Ocular Trauma- Cataract extraction (76%)
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26
Q

How long after would a PVD occur post cataract surgery?

A

1 week to 1-2 yrs

Mean time- 7 months

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27
Q

What are the sxs of PVD?

A
  1. Painless
  2. Flashes
  3. Floaters
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28
Q

What are the signs?

A
  1. Floaters
  2. Weiss ring
  3. Crumpled vit (partial- crumpled milky white, comlete- empty space
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29
Q

Where are the flashes more commonly perceived by the patient?

A

Temporal VF

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30
Q

Aside from eye movements, what else cause traction as part of anomalous PVD?

A

Vit haemmorage

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31
Q

What are the signs of vit haemm?

A
  1. Fresh well defined edges

2. Obscured blood vessels

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32
Q

What are the sxs of vit haemmorage?

A
  1. Sudden
  2. Small dark floaters
  3. Red floaters/mist
  4. Blurred vision/ cloudy vision
  5. Reduced VA
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33
Q

What other vit haemm causes are there?

A

Proliferative DM retinopathy

Ocualr trauma

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34
Q

What is the incidence of tears and retinal detachment in non diabetic pxs?

A

Tears- 70%

Retinal detachment- 40%

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35
Q

When is PVD managed by optoms without a need for referral?

A

Benign- no complications meaning no tx required

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36
Q

When is an emergency referral required for PVD?

A
  1. If increase or change in sxs alone

2. PVD Complicated by vit haemm

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37
Q

If the optom is unable to see the px, what is done in these cases?

A

Px goes to A+E

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38
Q

Following a PVD what most commonly develops and and long after?

A

Retinal breaks/tears- develops within 6 weeks

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39
Q

What sxs are suggestive of a retinal break/tear?

A
  1. Increase in numeber of floater size

2. ‘Curtain/shadow/cobweb’ develops on part of the VF

40
Q

What assessment is needed to rule out any tears breaks or detachment?

A

Dilated fundus exam

41
Q

Which is the most common form of retinal detachment out of the 3 major forms?

A

Rhegmatogenous RD

42
Q

What is the cause of Rhegmatogenous RD?

A

Formation of breaks in the retinal tissue. This leads to influx of fluid under the retina

43
Q

Which layers separate in a Rheg RD?

A

Neurosensory retina from the Retinal pigment epithelium layer

44
Q

How does the Rheg RD occur?

A

Smooth continual retinal tissue must be perforated by break. The tension b/w the detaching post vit and ILM can cause the retina to tear

45
Q

What is the estimated acute and sxs PVDs that will lead to Rheg RD?

A

7-13%

46
Q

What keeps the RPE and NSR together?

A

Weak mechanical forces- microvilli

47
Q

Where does the fluid accumulate in Rheg RD?

A

Subretina

48
Q

What the risk Factors of Rheg RD?

A
  1. Fellow eye
  2. +ve Fam Hx
  3. PVD- (Acute, sxs, gradual, increased tension, vit haemm, incomplete PVDs)
  4. Age
  5. Myopia
  6. Ocular trauma
  7. Ocular surgery (Cat)
49
Q

Which occupations are more at risks of RRD?

A

Boxers

50
Q

How are 60 year old compared to <30 year olds likely o develop RRD?

A

20x more likely

51
Q

What is the incidence of RRD?

A

6.8/100,000 people/ year in 25-44 yrs 69.5/100,00 people/ year in 75-84 yrs

52
Q

How likely are myopes to develop RRD?

A

Low myopia= 3x
High myopia= 10x

Increase of Axial length by 1mm= risk increases by factor of 1.3x

53
Q

What is likely risk of RRD post cat surgery?

A

0.68-0.9%…. usually develop within 1st 12/12

54
Q

What are the sxs of RRD?

A
  1. Flashes and Floaters

2. Acute onset

55
Q

What are the signs of RRD?

A
  1. VA- Unaffected if macula on
  2. Pupils -ve RAPD usually (extensive= +ve RAPD)
  3. IOP- compare with effected eye
  4. VF- Peripheral VF defects
  5. Tobacco and shafers sign (Ant vit)
  6. Retinal breaks and tears
56
Q

What VF assessment would be suitable for a peripheral defects?

A

Confrontation method

57
Q

If a positive shafers sign is present, what are the chances of a retinal detachment?

A

95%

58
Q

What comprises of the neuro sensory layer?

A

ILM including the PRL. Tears are only through the neurosensory layer only

59
Q

What is being shown here?

A

Shafers/Tobacco dust- small dark brown RPE cells

60
Q

Where are breaks are commonly found?

A

Superior temporal 60%

61
Q

What is a common type of tear?

A

A horse shoe or u shape. (The black arrow

62
Q

How would you manage a px with tobacco dust?

A

TB dust but no tear- an emergency opinion

63
Q

What signs require emergency referral to ophthalmologist?

A
  1. Vitreous haemm
  2. +ve shafers sign/tobacco dust
  3. Retinal break, tear or hole
  4. Retinal detachment
64
Q

What is the gold standard to check for detachment in the most periphery?

A

Goldmann 3- mirror lens

(A sclera indentation may be required with this)

65
Q

What are the different types peripheral Ret degeneration?

A
  1. Lattice
  2. Snail track
  3. White c pressure
  4. Other peripheral ret deg
    a. Paving stone
    b. Microcystoid
    c. Honeycomb
66
Q

Which is the most common and important peripheral degeneration?

A

Lattice deg

67
Q

Where is lattice more commonly found?

A

Myopes
pxs with RRD
Areas with thin/Absent ILM

68
Q

Why are breaks typical found in the superior temporal periphery?

A

Vitreous and retina are particularly strong over lattice areas. This increases tension which increases risk of retinal break

69
Q

What is the distinguished feature of lattice deg?

A

Sclerosed blood vessels- hardened vessels that appear white. Cause is uncertain
Also feature hyperpigmentation

70
Q

What to do if patient shows ASYMPTOMATIC lattice degeneration?

A

No referral needed. Give information about RD sxs and advise emergency eye exam if sxs present.

71
Q

What are the college of optometrists guidelines for pxs with lattice deg?

A

Refer as emergency- lattice deg and sxs of PVD/RD even if signs are normal

72
Q

What is the 2nd most important peripheral degeneration?

A

Snail track

73
Q

Where is a snail track located?

A

Around the equator and young myopes

74
Q

What are the signs of snail track?

A

Band of white frost like dots

75
Q

What is being shown here?

A

White s pressure- areas are usually demarced

76
Q

What is being shown here?

A

Paving stone deg

77
Q

Which other retinal degeneration have no increased risk of RD?

A

Paving stone
Microcystoid
Honeycomb

78
Q

Which degeneration allows you to see choroid blood vessels?

A

Paving stone

79
Q

What is the typical location of paving stone degeneration

A

Inferior retina

80
Q

What vitreous degeneration are there?

A
  1. Asterois hyalosis

2. Retinoschisis

81
Q

What are the signs of asteroid hyalosis?

A

Pale yellow white lesions (calcium lipid deposits)
Unilateral ~75%
Move/float c eyemovements- can cause visual sxs
‘Snow globe’
Elderly ~3%

82
Q

What are the signs of retinoschisis?

A 
Smooth dome shaped elevation Hypermetropes
Bilateral 
Asymptomatic 
F+F absent 
No tension 
NSL elevated 
Common in inferior retina 
May have small white dots
83
Q

What causes retinoschisis?

A

Aggregation of microcyst in layers causing a split in OPL. This serveres connection between PRL and RGC

84
Q

What is the prevelamce of retinochisis?

A

5-7% adults

85
Q

What is the 2nd most common RD?

A

Tractional

86
Q

What is tractional RD associated with?

A
  1. Proliferative diabetic retinopathy
  2. Retinal venous obstruction
  3. Prematurity retinopathy
  4. Sickle cell retinopathy
    ( ALL link to retinal ischaemia which contributes to vitreoretinal membranes)
87
Q

What is not associated with tractional RD?

A
  1. Tears

2. Tabbaco sign

88
Q

How is Exudative RD formed?

A

Fluid accumulation b/w BM and RPE also known as PED

89
Q

What causes exudative RD?

A

Breakdown of the outer BRB which regulates flow of blood constituents b/w choroid and outer retinal layers

90
Q

How is the outer BRB broken down and what conditions are responsible?

A

Inflammatory or retinovascular conditions:

a. Post uveitis
b. Post scleritis
c. Intra ocular or retro Bulbar tumours
d. Infections I.e. tuberculosis and syphilis

91
Q

What is the ophthalmological management for retinal detachments?

A

REFER! Same day phone call

92
Q

When calling the hospital, what information should we give to HES staff?

A

Case history info-
Is vision effected
When change in vision was noticed
Time scale between loss and F+F

93
Q

What are the aim for surgical treatment?

A

Reattach NSR to RPE by - sealing breach, draining subret fluid and providing force c NSR and RPE

94
Q

How long would a macula ‘ON’ px would be seen for a surgery?

A

24-48 hours

95
Q

What surgical interventions are there?

A

Scleral Buckle

Pars Plana Virectomy

96
Q

In scleral buckle how are breaks sealed?

A

Laser and cryotherapy

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