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Posterior Seg > Retinal Hemorrhages and Exudates > Flashcards

Retinal Hemorrhages and Exudates Flashcards

1
Q

The superficial capillary network is mostly impacted by ___ disease

A

Artery

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2
Q

The deep capillary network is mostly impacted by __ disease

A

vein

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3
Q

Where is a pre-retinal hemorrhage located

Associated with the ___ capillary network of the ___ zone

A

Between the internal limiting membrane and nerve fiber layer.

Associated with the superficial capillary network or the radial/circumpapillary zone (posterior pole)

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4
Q

How does gravity affect a pre-retinal hemorrhage?

A

Affects it’s appearance- demonstrating a well demarcated superior horizontal line.

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5
Q

Predicted visual outcome of pre-retinal hemorrhage

A

Decreased VA, VF defect or scotoma.

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6
Q

Etiology of pre-retinal hemorrhages

A

PVD
Valsalva (most common- forceful attempt to exhale)
DM

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7
Q

Appearance of pre-retinal hemorrhage

A

Well demarcated superior horizontal line
Elevated bubble
Can have flayed edges with a dark center when acute (this is blood spreading in between the ILM and NFL)

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8
Q

Color of pre-retinal hemorrhage from recent to older

A

Red - yellow - white. Then reabsorbed by the retina.
Change in color because blood is becoming deoxygenated.
This process can take months.

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9
Q

Outcomes of pre-retinal hemorrhage

A

Want to determine cause

Will resolve on own in couple of months. Just monitor.

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10
Q

Where are flame shaped hemorrhages located? What capillary bed are they associated with?

A

NFL, associated with the superficial /innercapillary network/radial network of the cicumpapillary zone.
Artery based disease.

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11
Q

Appearance of a flame shaped hemorrhage

A

Flayed or flame appearance. Associated with counter of NFL.

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12
Q

Do flame shape hemorrhages leak into deeper tissue or the vitreous?

A

NO. The hemorrhage is located within the NFL. Can spread within that layer.

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13
Q

Flame shape hemorrhages represent an area of localized retinal _____

A

Hypoxia. and artery based disease.

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14
Q

Predicted visual outcomes of flame shape hemorrhages

A

Watch for neo due to ischemia
Usually no effect on VA- since there are no capillaries located in the fovea.

Possible scotoma if large enough. But usually asymptomatic.

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15
Q

How fast should a flame shape hemorrhage resolve? How do we treat?

A

Usually due to an artery based disease- determine etiology and treat systemically. Should resolve in weeks to months if systemic treatment is successful.

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16
Q

What is the most common etiology of flame shape hemorrhages

A

Hypertension- artery based

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17
Q

Roth spot

A

Flame shape hemorrhage surrounding a white middle (roth spot)

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18
Q

The white center in roth spots are due to which 4 things

A
  1. WBC from inflammatory disease.
  2. CWS surrounded by the hemorrhage.
  3. Leukemic cells/WBC surrounded by hemorrhage
  4. Fibrin surrounded by hemorrhage.
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19
Q

Intraretinal hemorrhages are located in which layers? What capillary network is it associated with?

A

In the INL, OPL, and may extend to the ONL.

Associated with the deep capillary network.

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20
Q

What do intra retinal hemorrhages appear as?

A

Spot or blot of blood.

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21
Q

What is different about intra retinal hemorrhages compared to flame shape and pre retinal?

A

Intra retinal can be in multiple layers- INL, OPL, and ONL.

Flame shape and pre-retinal can only be in one layer.
Flame shape in NFL
Pre retinal in between ILM and NFL

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22
Q

Shape of intra retinal hemorrhages? Does this affect surrounding tissues?

A

The hemorrhages follow vertical lines of retinal tissues- INL, OPL and ONL.

Can push other structures aside.

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23
Q

intra retinal hemorrhages are signs of??

A

Venous based diseases- venous stasis. Need to do OCT! Difficult to see with 78 or 90

Retinal edema. back up of blood due to poor capillary flow.

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24
Q

If you see an isolated intra retinal hemorrhage, suspect

A

Micro aneurysm. Especially in posterior pole. Associated with diabetic retinopathy, a venous based disease.

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25
Q

If you see a sector of intra-retinal hemorrhages, suspect?

A

Branch retinal vein occlusion

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26
Q

If you see all four quadrants of intra retinal hemorrhages, suspect?

A

Central retinal vein occlusion

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27
Q

If you see bilateral intra-retinal hemorrhages, suspect?

A

Prob systematic, venous based disease. Suspect significant ischemia.

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28
Q

If you see unilateral intra-retinal hemorrhages, suspect?

A

Something is wrong w one eye- prob not systemic.

BRVO, CRVO? Ischemia. Carotid blockage?

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29
Q

Intra retinal hemorrhages predicted visual outcomes?

A

Usually no effect on VA, unless there is surrounding edema that involves the macula.

Scotoma is unlikely.

**must determine etiology or underlying cause to create effective treatment plan.

30
Q

Sub retinal hemorrhages. Where are they located? (2 places)

A

Both locations in the outer retinal.

Between RPE and photoreceptors OR between RPE and Bruch’s.

31
Q

Sub retinal hemorrhages usually results from

A

Bleeding of a choroidal neovascular membrane (CNV)

32
Q

What do sub retinal hemorrhages look like?

A

Lobulated boarders
Color appearance changes when acute vs chronic

Sub retinal (between PR and RPE) is red
Sub RPE (between RPE and Bruch's) is grey-green
33
Q

Sub retinal hemorrhage visual outcomes?

A

Scar tissue will eventually develop which will be devastating to the visual outcome.

**Determining the etiology is critical to establishing an effective treatment plan. Outcomes are typically poor.

34
Q

CNV- what is it and what type of hemorrhage does it usually cause?

A

Choroidal neovascular membrane.

Main cause of sub retinal hemorrhages

35
Q

Vitreous hemorrhage location

A

Hemorrhage located between the detached vitreous hyaloid membrane and internal limiting membrane, or within the vitreous.

Retro-vitreous or Intra-vitreous

36
Q

How does a vitreous hemorrhage occur?

A

Occurs from a break in the internal limiting membrane- usually associated with retinal beaks or neovascularization.

ILM is hard to break- maybe due to inflammation.

37
Q

A vitreous hemorrhage is likely due to?

A

DM
Retinal break/tear/detachment with associated damage to vasculature
PVD

38
Q

Vitreous hemorrhage appearance acute vs chronic

A

The retina may not be visible in the acute phase- tomato soup appearance.

Chronic appearance- Yellow hue, feathery white clumps of debris.

39
Q

Vitreous hemorrhage predicted visual outcomes

A

Significant vision loss in acute phase.
Scotoma
Floaters

40
Q

Vitreous hemorrhage management

A

Surgical procedures and intervention might be necessary to manage

41
Q

What test to do if you can’t see the retina?

A

B scan

42
Q

CWS are located where?

A

Within the NFL (Same as flame shaped hemorrhages)

Associated with the superficial capillary network or radial network of the posterior pole.

43
Q

CWS are due to what kind of based disease?

A

Artery based

Due to ischemia of the NFL –> edema in NFL

44
Q

CWS appearance

A

Blurred retinal vessels in acute stages with fuzzy boarders. Similar to a flame shaped hemorrhage.
Swollen NFL, looks elevated

45
Q

CWS are immediate precursors of

A

Neovascularization

Because they represent an area of localized hypoxia and artery based disease.

46
Q

Predicted visual outcomes of CWS

A

Usually no effect on VA- as long as it doesn’t involve the macula.

Possible scotoma if NFL degeneration.

47
Q

CWS could be due to which systemic diseases?

A

HTN, diabetes

48
Q

Where is retinal exudate located? What capillary network?

A

OPL, but can extend from the ONL to the INL.
Similar to dot blot hemorrhages (intra retinal hemorrhage) in that it spans many layers of the retina.
^^Both are space occupying. Pushes other retinal tissue aside.

Deep capillary network involved. Venous based disease such as DM.

49
Q

What does retinal exudate appear as at the macula in henle’s layer?

A

Macular star.

50
Q

What does retinal exudate appear as when acute?

What does it look like after some time?

A

When acute- melted wax. White candle that dribbled wax onto paper. Raised and shimmery.

After time, appears pale or dirty yellow in color.

51
Q

retinal exudate always presents with ____

A

Edema.

52
Q

What comes first? Exudate or edema?

A

Edema first. Exudate comes later.

See exudate? know that edema has been there a while.

53
Q

Patterns of retinal exudate

A

Migrates away from edema/location of insult. Can develop different patterns- localized, ring/circinate, or arc.

54
Q

What is retinal exudate composed of?

A

Lipoprotein and macrophages leaking out of deep capillary network.

55
Q

Location of retinal exudate

A

Can occur in posterior pole, equator, or retinal periphery.

56
Q

Predicted visual outcomes from retinal exudate

A

Decreased VA
Metamorphopsia
**Always determine etiology

57
Q

Does retinal exudate every resolve? What about the associated edema?

A

Edema may resolve.
Exudate may not.

Similar to salt water- water evaporates. Salt remains.

58
Q

Retinal exudate is commonly due to which systemic condition or 2 ocular conditions?

A

DM- venous based. Deep capillary network.

CRVO, BRVO
Macro or micro aneurysms

59
Q

Retinal and macular edema

  • Layers involved
  • Location of local/acute edema. Which capillary beds and layers.
  • Location of diffuse/chronic edema. Which capillary beds and layers.
A

INL and OPL

Local/acute edema- Outer capillary network. Deep. Between INL and OPL. Contained. (May contain exudate in OPL)

Diffuse/chronic edema- Associated with both inner and outer capillary networks. can span ILM to RPE (involving the PR)

60
Q

Cotton wool spots should NEVER be located __

A

In the FAZ. Because no capillaries in the FAZ

61
Q

Hemorrhages should not be located in the FAZ, but

A

They can be due to disease radiation from other parts of the retina like pre-retinal hemorrhages, exudate, or edema.

62
Q

Blood or exudate in the FAZ is an indication of edema or leakage ___

A

Elsewhere. It traveled.

63
Q

Local edema (contained in 1 layer of retina, between INL and OPL)

Can be difficult to observe alone, but usually associated with ___

A

Dot blot hem (intra retinal) and exudate

64
Q

Why is diffuse edema poorly defined and hard to observe?

A

Because it can span many levels- ILM to RPE. May appear as retinal thickening. Can see this with 78 or 90D

65
Q

RBC- high or low levels indicate

A

High- Hyperviscosity.

Low- Anemic

66
Q

WBC- high or low levels indicate

A

Low- immune compromised

high- Active infection

67
Q

Platelets- high or low levels indicate?

A

low- Helps us determine if pt is at risk for bleeding (hemorrhage)

high- hypercoagability. Clots.

68
Q

Hematocrit percentages for male and female

A

Male: 39-49

Female- 33-43

69
Q

These 3 measurements can help us determine types of anemia

MCV
MCHC
MCH

A

Mean cell volume- average volume of RBCs.
76-100fL

Mean cell hemoglobin concentration- average concentration of Hb per 100mL of packed RBCs.
33-37 g/dL

Mean cell hemoglobin- average weight of Hb per individual RBC.
27-33pg

70
Q

Lymphocyte levels are high. May indicate?

A

Viral infection

71
Q

monocyte levels are high may indicate?

A

Phagocytosis and immune regulation.

Posterior Seg (4 decks)

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