Station 3.29: RETINAL PATHOLOGY

Question 1

What are the signs and causes of Age‐related macular degeneration (AMD)

Examine this elderly patient’s fundi. She complains of recent loss of vision

Answer 1

Signs, Risk Factors, Treatment and Prognosis

Question 2

What are the signs and causes of Retinitis pigmentosa

This man has been complaining of difficulty seeing at night. Please examine his eyes

Answer 2

Signs, Causes, prognosis and casues of Tunnel Vision

Question 3

What are the signs and causes of Retinal artery occlusion

Examine this man’s fundi.

Answer 3

Clinical signs
* Pale, milky fundus with thread‐like arterioles
* ± Cherry red macula (choroidal blood supply)
* Cause: AF (irregular pulse) or carotid stenosis (bruit)
* Effect: optic atrophy and blind (white stick)

Note that branch retinal artery occlusion will have a field defect opposite to the quadrant of affected retina

Discussion
Causes
* Embolic: carotid plaque rupture or cardiac mural thrombus Treatment: aspirin, anti‐coagulation and endarterectomy
* Giant cell arteritis: tender scalp and pulseless temporal arteries Treatment: high‐dose steroid urgently, check ESR and arrange temporal artery biopsy to confirm diagnosis

Question 4

What are the signs and causes of Retinal vein occlusion?

Examine this patient’s fundi.

Answer 4

Clinical signs
* Flame haemorrhages +++ radiating out from a swollen disc
* Engorged tortuous veins
* Cotton wool spots
* Cause: look for diabetic or hypertensive changes (visible in branch retinal vein occlusion).
* Effect: Rubeosis iridis causes secondary glaucoma (in central retinal vein occlusion), visual loss or field defect.

Discussion
Causes
* Hypertension
* Hyperglycaemia: diabetes mellitus
* Hyperviscocity: Waldenström’s macroglobulinaemia or myeloma
* High intraocular pressure: glaucoma