systemic Flashcards
classification for hypertensive retinopathy
keith wagener
stage I –> IV hypertensive retinopathy
I = arteriolar narrowing + torturous, increased light reflex // II = ateriovenous nipping // III = cotton wool exudate, flame + blot haemorrhages // IV = papilloedema
leading cause of blindness in adults 35-65
diabetes
pathophysiology diabetic retinopathy
hyperglycaemia –> endothelial dysfunction –> permeability –> exudate + aneurysms + neovascularisation
signs diabetic retinopathy
microaneurysm // blot haemorrhage // hard exudate // cotton wool spot // Intra retinal microvascular abnormalities
mild non-proliferative diabetic retinopathy
1 or more microaneurysm
moderate non-proliferative diabetic retinopathy
microaneurysm + blot haemorrhage + hard exudate + cotton wool spots, maybe venous beading
what are cotton wool spots
soft exudate - area of retinal infarction
severe on-proliferative diabetic retinopathy
blot haemorrhage + microaneurysm in all quadrants // benous beading 2/4 quadrants // IRMA in 1 quadrant
proliferative diabetic retinopathy
(bad) neovascularisation (–> vitreous haemorrhage) // fibrous tissue on retinal disc
diabetic maculopathy
hard exudate + macula changes
what type of retinopathy is more common in T1dm and T2DM
proliferative = T1DM // maculopathy = T2DM
mx non-proliferative diabetic retinopathy
observation - if severe laser photocoagulation
mx proliferative diabetic retinopathy
panretinal laser photocoag // intravitreal VEGF eg ranibizumab
mx diabetic maculopathy
if changes in acuity –> intravitreal VEGF
causes optic neuritis
MS!!! // (syphilis, diabetes)
symptoms optic neuritis
unilateral decreased acuity // red desaturation // pain worse on movement // RAPD // central scotoma (blind spot)
invx optic neuritis
MRI brain + orbits with GADOLINIUM contrast (if 3+ white matter lesions may be MS)
mx optic neuritis
high dose steroids
ocular manifestations RA
keratoconjunctivitis // episcleritis // scleritis // corneal ulcer // keratitis
what is papilloedema
bilateral optic disc swelling secondary to raised ICP
fundoscopy papilloedema
venous engorgement // blurred optic disc margin // swollen optic disc // red
causes papilloedema
SOL // extreme HT // idiopathic intracranial hypertension // hydrocephalus // hypercapnia // (vit A toxicity, hypoparathyroid, hypoCa)
causes tunnel vision
papilloedema // glaucoma // retinitis pigmentosa // choroidretinitis // optic atrophy // hysteria
causes Retinitis pigmentosa
inherited
symptoms Retinitis pigmentosa
night blindness (first sign) // tunnel vision
fundoscope Retinitis pigmentosa
black curved pigmentation on peripheral retina
assoc conditions Retinitis pigmentosa
refsum // usher // alports
where are haemorrhages often seen in hypertensive retinopathy
around macula ‘macula sunburst star’
