Retina Disorders

Question 1

Hypopyon, , redness, blurred/loss of vision, eye pain

Answer 1

Posterior Uveitis

Question 2

Causes of posterior uveitis

Answer 2

Commonly systemic disease
Autoimmune, sarcoidosis, IBD, Syphilis, TB, MS

Question 3

What is posterior uveitis?

Answer 3

Inflammation of the retina and vitreous humor

Question 4

Posterior uveitis TX

Answer 4

Urgent referral to ophthalmology
TX underlying condition
Anti-inflammatory/ABX as needed

Question 5

Unilateral blurry/impaired vision, injection, photophobia

Answer 5

Choroiditis

Question 6

What is choroidal melanoma?

Answer 6

Metastatic cancer that has spread to choroid

Question 7

What cancers most commonly metastasize to the choroid?

Answer 7

Breast cancer
Lung cancer

Question 8

Optic nerve swelling due to increased intracranial pressure

Answer 8

Papilledema

Question 9

How can papilledema lead to permanent blindness?

Answer 9

Can cause obliteration of the optic cup and hyperemia

Question 10

What are signs of papilledema that would be found during a fundoscopic exam?

Answer 10

Blurring of optic disc margins
Fullness/engorgement of optic veins

Question 11

What is the leading cause of blindness in the western world, in px < 50 y.o.?

Answer 11

Diabetic retinopathies

Question 12

What happens in diabetic retinopathies?

Answer 12

Diabetes px lose vision as a result of injury to retinal vasculature

Question 13

What is the main difference between proliferative and nonproliferative diabetic retinopathies?

Answer 13

Proliferative has angiogenesis
Nonproliferative does not have angiogenesis

Question 14

Retinal hemorrhages, yellow lipid exudates, dull-white cotton wool spots, microaneurysms, occluded/dilated vessels

Answer 14

Nonproliferative retinopathy

Question 15

Severe acute glaucoma, clouding vision, retinal detachment, scotomata, abnormal red reflex, hemorrhaging

Answer 15

Proliferative retinopathy

Question 16

What is important to know about severe nonproliferative retinopathy?

Answer 16

High chance of it progressing into proliferative retinopathy

Question 17

Proliferative diabetic retinopathy TX

Answer 17

Strict glycemic control
Retinal laser photocoagulation

Question 18

Slight opacification of macula, microaneurysms, hard exudates close to fovea, decreased central vision, retinal thickening

Answer 18

Diabetic macular edema

Question 19

Diabetic macular edema TX

Answer 19

Refer to ophthalmology

Question 20

What is the normal A:V ratio?

Answer 20

1:2

Question 21

Scotomata, sudden decreased vision,, AV nicking, A:V = 1:3

Answer 21

Hypertensive retinopathy

Question 22

Arteriole stenosis looks like a?

Answer 22

Copper wire

Question 23

Arteriole sclerosis looks like a?

Answer 23

Silver wire

Question 24

What causes hypertensive retinopathy?

Answer 24

Chronic hypertension that causes thickening of vessel walls and narrowing of vessel lumen

Question 25

What is AV nicking?

Answer 25

Retinal arteries indenting retinal veins as they cross

Question 26

Hypertensive retinopathy TX

Answer 26

Tx underlying HTN

Question 27

Transient, monocular blindness. clouding of vision, pale retina, red area over macula

Answer 27

Amaurosis fugax

Question 28

Dilated, tortuous veins, "stormy sunset" hemorrhages

Answer 28

Retinal vein occlusion

Question 29

Retinal vein occlusion is an

Answer 29

Emergent condition Ophthalmologic emergency

Question 30

Blood dyscrasia, Factor V Leiden, Protein C deficiency, Protein S deficiency, Thrombosis/embolus

Answer 30

Causes of retinal vein occlusion

Question 31

Attenuation of retinal blood vessels, waxy pallor of optic disc, retinal pigmentation in bone-spicule pattern

Answer 31

Retinitis pigmentosa

Question 32

Gradual loss of night vision or peripheral vision, photopsia (shimmering lights), scotomata

Answer 32

Retinitis pigmentosa

Question 33

What is retinitis pigmentosa?

Answer 33

Inherited disease that causes progressive degeneration of the retina

Question 34

Retinitis pigmentosa dx tools

Answer 34

Formal VF testing Thorough family hx Genetic studies

Question 35

Retinitis pigmentosa TX

Answer 35

Vitamin A supplements

Question 36

What is the leading cause of adult blindness?

Answer 36

Age related macular degeneration

Question 37

Distorted vision/metamorphosia, very gradual loss of vision

Answer 37

Age related macular degeneration

Question 38

In age related macular degeneration, _____________ vision is preserved, while ____________ vision worsens/is lost

Answer 38

Peripheral = Preserved Central is lost

Question 39

Age related macular degeneration TX

Answer 39

Immediate referral to ophthalmology

Question 40

What are Drusen deposits?

Answer 40

Small bright yellow deposits

Question 41

What is geographic atrophy?

Answer 41

Cell death in areas of larger deposits

Question 42

Drusen deposits, retinal atrophy/retinal scar, geographic atrophy

Answer 42

Atrophic macular degeneration

Question 43

Atrophic macular degeneration is also known as?

Answer 43

Dry macular degeneration

Question 44

Atrophic macular degeneration TX

Answer 44

Statin therapy SCT Daily vitamin/antioxidant Smoking cessation

Question 45

PX with HX of smoking, CVD, and/or alcohol abuse Growth of abnormal blood vessels in subretinal space, pooling of blood beneath retina

Answer 45

Exudative macular degeneration

Question 46

Exudative macular degeneration is also known as?

Answer 46

Wet macular degeneration

Question 47

Exudative macular degeneration causes what % of blindness?

Answer 47

80%

Question 48

Exudative macular degeneration TX

Answer 48

IV endothelial growth factor Photodynamic therapy Daily vitamin/antioxidant Smoking cessation

Question 49

Sudden painless monocular vision loss Jaw/neck pain, tender scalp Impaired color vision

Answer 49

Ischemic optic neuropathy

Question 50

Diagnostic finding of ischemic optic neuropathy

Answer 50

Marcus-Gunn pupil Swinging flashlight sign Swollen optic nerve head

Question 51

Risk groups for ischemic optic neuropathy

Answer 51

Elderly Giant cell arteritis HTN, diabetes

Question 52

Ischemic optic neuropathy TX

Answer 52

Immediate referral to ophthalmology Can be TX'ed in the ER

Question 53

Photopsia, floaters, metamorphosia, decreased vision, cobwebs

Answer 53

Retinal detachment

Question 54

What are the two types of retinal detachment? Which is more common?

Answer 54

Tractional (more common) Traumatic

Question 55

What is tractional retinal detachment?

Answer 55

Scar tissue in vitreous gel contracts, pulling on the retina

Question 56

Marcus Gunn pupil, unilateral VF loss, retinal ruggae

Answer 56

Diagnostic findings of retinal detachment

Question 57

Retinal detachment TX

Answer 57

Immediate consult w/ ophthalmology Surgical intervention