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Ophthalmology -FA > retina pathology > Flashcards

retina pathology Flashcards

1
Q

Ophthalmoscopy (funduscopy) - how to identify left and right eye

A

the macula is in the center of the image, and the optic disk is located towards the nose

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2
Q

posterior eye segment

A

vitreous chamber

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3
Q

The central retinal artery branches off the

A

ophthalmic artery (branch of ophthalmic artery)

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4
Q

Papilledema

A

optic disc swelling due to increased intracranial pressure (2ry to mass effect) –> usually bilateral

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5
Q

intracranial pressure - normal range

A

at rest, is normally 7–15 mmHg for a supine adult.

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6
Q

intracranial pressure causes (on vision)

A

enlarged blind spot

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7
Q

blind spot - definition

A

small portion of the visual field of each eye that corresponds to the position of the optic disk. There are no photoreceptors, and, therefore, there is no image detection in this area

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8
Q

Papilledema - fundoscopic exam

A

elevated optic disc with blurred margins

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9
Q

Retinitis - pathophysiology / associated with

A

retinal edema and necrosis leading to scar

- immunosuppression

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10
Q

causes of Retinitis

A

often viral (CMV, HSV, HZV) but can be bacterial or parasitic

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11
Q

Central retinal artery occlusion - clinical presentation and management

A

acute, PAINLESS monocular vision

management: evaluate for embolic source (carotid artery, atherosclerosis, cardiac vegetations, patent foramen ovale

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12
Q

Central retinal artery occlusion - fundoscopic exam

A

retina cloudy with attenuated vessels and cherry red spot at fovea

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13
Q

Retinitis pigmentosa is an

A

inherited retinal degeneration

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14
Q

Retinitis pigmentosa - clinical presentation

A
  1. painless, progressive vision loss beginning with night blindess
  2. tunnel blindness
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15
Q

Retinitis pigmentosa - onset of vision loss

A

progressive vision loss beginning with night blindess

tunnel blindness

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16
Q

Retinitis pigmentosa - beginning with night blindess (why)

A

robs are affected first

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17
Q

Retinitis pigmentosa - fundoscopic exam

A

bone spicule - shaped around macula

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18
Q

Retinal vein occlusion - pathophysiology

A

blockage of central or branch retinal vein due to compression from nearby arterial atherosclerosis

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19
Q

Retinal vein occlusion - fundoscopic exam

A

Retinal hemorrhage and venous engorgement, edema in affected area

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20
Q

retinal detachment - pathophysiology

A

separation of neurosensory layer of retina from outermost pigmented epithelium –> degeneration of photoreceptors –> vision loss

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21
Q

neurosensory layer of retina

A

photoreceptor layers with robs and cones

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22
Q

pigmented epithelium layer of retina - function

A
  1. shields excess light

2. supports retina

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23
Q

separation of neurosensory layer of retina from outermost pigmented epithelium –> …

A

degeneration of photoreceptor –> vision loss

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24
Q

retinal detachment - may be secondary to

A
  1. retinal breaks
  2. diabetic traction
  3. inflammatory effusions
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25
Q

retinal detachment 2ry to diabetic traction (mechanims)

A

scar tissue from neovascularization shrinks, causing the retina to wrinkle and pull from its normal position

26
Q

retinal breaks are more common in

A
  1. patients with myopia

2. history of head trauma

27
Q

retinal breaks - management

A

surgical emergency

28
Q

retinal breaks are often preceded by

A
  1. posterior vitreous detachment (FLASHES AND FLOATERS)

2. eventual monocular loss of vision like a curtain drawn and down

29
Q

Eye floaters are

A

small moving spots that appear in your field of vision.

30
Q

diabetic retinopathy

A

retinal damage due to chronic hyperglycemia

31
Q

diabetic retinopathy is retinal damage due to

A

chronic hyperglycemia

32
Q

diabetic retinopathy - types

A
  1. nonproliferative

2. proliferative

33
Q

nonproliferative diabetic retinopathy (mechanism)

A

damaged capillaries leak blood –> lipids and fluids seep into retina –> hemorrhage and macular edema

34
Q

nonproliferative diabetic retinopathy - treatment

A
  1. blood sugar control

2. macular laser

35
Q

proliferative diabetic retinopathy (mechanism)

A

chronic hypoxia results in new blood vessels formation with resultant traction on retina

36
Q

treatment of proliferative diabetic retinopathy

A
  1. anti - VEGF (bevacizumab)
  2. peripheral retinal photocoagulation
  3. surgery
37
Q

peripheral retinal photocoagulation - mechanims

A

uses light to coagulate tissue (energy from a strong light source is absorbed by tissue and is converted into thermal energy)

38
Q

generally - diabetic retinopathy findings

A
  1. hemmorrhage
  2. exudates
  3. microanurysms
  4. vessel proliferation
39
Q

Bruch’s membrane is the

A

innermost layer of the choroid

40
Q

Age-related macular degeneration

A

degeneration of macula

41
Q

Age-related macular degeneration causes (symptoms)

A

distortion (metamorphopsia) and eventual loss of central vision

42
Q

metamorphopsia

A

defective vision, with distortion of the shape of objects seen

43
Q

Age-related macular degeneration - types and frequency

A
  1. Dry (nonexudative) - >80%

2. Wet (exudative) - 10-15%

44
Q

Dry (nonexudative) Age-related macular degeneration (mechanims)

A

deposition of yellowish extracellular material in and between Bruch membrane and retinal pigment epithelium (drusen) with GRADUAL decreasing in vision

45
Q

Drusen are (and composed by)

A
  • deposition of yellowish extracellular material in and beneath Bruch membrane and retinal pigment epithelium - composed by lipids, immune and inflammatory related proteins, amyloid associated proteins etc
46
Q

prevent progression of Dry (nonexudative) Age-related macular degeneration with

A
  1. multivitamin supplements

2. antioxidant supplements

47
Q

Wet (exudative) Age-related macular degeneration (mechanims)

A

RAPID loss of vision due to bleeding 2ry to choroidal neovasvularization

48
Q

treat Wet (exudative) Age-related macular degeneration (mechanims) with

A
  1. anti-VEGF (RANIBIZUMAB)

2. Laser

49
Q

wet vs dry Age-related macular degeneration (according frequency and time of visual loss)

A
  1. Dry (nonexudative) - >80% - gradual

2. Wet (exudative) - 10-15% - rapid

50
Q

Central retinal artery occlusion - type of pain

A

painless

51
Q

Central retinal artery occlusion - management

A

evaluate for embolic source (carotid artery, atherosclerosis, cardiac vegetations, patent foramen ovale

52
Q

Retinal detachment - fundoscopy

A

crinkling of retinal tissue and changes in vessels direction

53
Q

retinal artery occlusion - treatment

A
  1. 100% O2
  2. ocular massage
  3. acetazolamide
  4. anterior chamber paracentiesis (decreased IOP)
  5. thrombolytics
  6. evaluate embolic source
54
Q

retinal vein occlusion - treatment

A

ranibizumab (VEGF-A inh)

55
Q

Reattachemen of retina is attempted …

A

with a number of mechanical methods such as:

  1. surgery 2. laser 3. cryotherapy
  2. injection of an expansile gas that pushes the retina back up against the globe of the eye
56
Q

The MCC of blindness in older person in the US

A

macular degeneration

57
Q

diabetic retinopathy - how to prevent / most accurate test

A
  • annual screening (before serious visual loss)

- flurescein angiography

58
Q

diabetic retinopathy - surgery

A

vitrectomy (remove the vitreous gel from the middle of the eye): to remove vitreal hemorrhage obstructing

59
Q

neovascular or wet Macular degeneration - results of the treatment

A
  1. over 90% of patients will expereience a halt (stop) of progression
  2. 1/3 will have improvement in vision
60
Q

neovascular or wet Macular degeneration - treatment

A

best initial: VEGF inh (ranibizumab, bevasizumab, aflibercept. Injected directly into the vitreous chamber every 4-8 wks.

Ophthalmology -FA (9 decks)

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