Retinal Vascular Disease Flashcards
What’s malignant hypertension
High BP
Arteriolar fibrinoid necrosis
What’s hypertensive retinopathy
Due to damage by raised BP- Damage to blood vessels
Focal arteriolar narrowing, Arteriosclerotic changes and nerve fibre heammohrage
For accelerated hypertension u see macular star, cotton wool spots and disc odeama
Central retinal vein occlusion- could be due to 1.mechanical constriction at lamina cibrosa or due to 2.Hemodynamic factors which obstruct blood flow
- Retinal veins are dilated
- va worse than 6/36
- visual loss may occur when asleep
- haemorrhages- superficial and deep which could lead to ischeamia
- afferent pupillary defect
- lots of cotton wool spots
- odeama
How would u manage CRVO
Investigate RF Maximise recovery and va Prevent re occlusion Treat any underlying cause Is it Ischeamic or not Laser pan retinal photo coagulation for any neovas Prevent glaucoma Protect other eye
What are the risk factors for CRVO
Hypertension Diabetes mellitus Smoking POA glaucoma Hyperviscosity Hyperlipdeamia
Investigation for CRVO
Blood test and sugar levels checked
Urine analysis
Under age of 50- look for clotting abnormalities- likely to get thrombis.
central retinal vein occlusion clinical features
ISCHEAMIC- Sudden loss of vision Less than 6/36 Multiple dark heammohrages Lots o cotton wool spots Likely to develop rubeosis irisdis
NON ISCHEAMIC-
Younger age
Vision between 6/36-6/60
Less dark heammohrages and cotton wool spots
Less likely rubeosis iridis
About a third of these cases turn schematic. Dud dud dud
What complications arrise with CRVO. Look at this fancy question
You can get rubeosis iridis-ISCHEAMIC damage that stimulates vegFs to grow iris to anterior chamber
Central macular odema- unresponsive to laser so need intraretinal injections
Neovascular glaucoma- high IOP
Neovascularisation
BRVO
Appearance depends On which vessel-specific quad or Ono macular
Haemmorages cotton wool spots and exudates
Occlusion occurs at arterior vein crossing
Visual prognosis depends if macular involved
How would u manage BRVO
Investigate the systemic cause
Some may get better spontaneously
Laser photo coagulation for new vessels
And focal laser for macular odeama
Tell them to avoid oral contraceptives Take aspirin Treat hypertension Lower IOP Anticoagulant?
How would u manage cmo
Intra vitreal injection
Reduces it
For a couple of months
Side effects being cataract and raised IOP
What are the risk factors for BRVO
Hypertension
Cardio vascular disease
Lipid abnormality
Artery occlusion types and risk factors
Central retinal artery occlusion
Branch retinal artery occlusion
Cilo retinal arteries
Rf hypertension Smoking Diabetes Hyperlipideama Carotid bruits Emboli Vascular disease
How would u manage retinal artery occlusion
Rebreath co2 from bag
Lower the IOP
Digital massage of globe
In hosp u do anterior chamber paracentesis
Look for underlying cause. Check heart and carotid arteries. Treat these causes
Giant cell arteritis. Aka temporal arteritis
ISCHEAMIC ON
Both optic disc swollen and pale as occlusion of posterior ciliary artery
Elderly Px
Occlusion of arteries in head and neck
Sx- weight loss, stiffness in neck, tenderness of scalp. Doctor needs to see. Confirmed by esr blood test. May need biopsy to test. Need STEROIDS as both eyes can be involved v quickly
Macro aneurysms
Little aneurysms
Out pouching of vessels
Surrounding u can get exudates or vitreous haemmohrage
Associated with hypertension or carotid artery disease
Laser??
Vascular tunours
RARE Choroidal angioma Retinal angioma Cerebullar tumours Coats disease
Radiation retinopathy
Due to radiation
Those people who have radiation for neck and throat tumour
U see haemmohrage and exudates
Retinopathy prematurity
Less than 30weeks less than 1300g
Proliferative retinopathy
High levels of O2
Classification Stage 1- demarcation line Stage 2- ridge Stage 3- fibrovascular proliferation and scar tissue Stage 4- RD Stage 5- total tractional RD
Treat with laser
1/3 go away themselves
Connective tissue disorders
Sheathing of vessel wall Cotton wool spots New vessels Vitreous heammohrages Vitreous cells
Collagen disorders
Systemic lupus iridothosis
Polyarteritis nodosa
Inflammatory disorders affecting retinal blood vessels
What are the blood disorders
Anaemia
Lukeamia
Heamoglobinopathies
Hyper viscosity syndrome
features of sickle cell
Painful joints Bone marrow infarcts Abdominal pain Necrosis head of femur Pulmonary infarcts CNs infarcts RE dysfunction Salmonella infection Retinopathy - affect peripheral retina- can cause sea fans which can burst and cause a heommohrage Can get iris atrophy or synechie Flare and cells in anterior chamber Retinopathy in post segment
How would u treat sickle cell
Observe
Laser scatter photo coagulation
Vitrectomy if bleed
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