Trans 012 Disturbances In Vision Flashcards
Where does Retinal detachment occur?
Detachment occurs in the subretinal space (between RPE layer and rods & cones
Types of Retinal detachment
Non rhegmatogenous: fraction and exudative
Rhegmatogenous.
What type of Retinal detachment
There is a leak in the blood vessels
• Breakdown of integrity of the vascular system of choroid and
/or retina
o Eclampsia&pre-eclampsia
o Tumorsofchoroidandretina
o Intraocular inflammation: choroidal effusion
▪ Vogt Koyang Harada Disease o Collagen Disease
Exudative detachment
May humila sa retina kaya umangat
• Ischemic retinal disease causing fibroproliferative membrane
formation
o Diabetic Retinopathy
o Central Retinal Vein Occlusion (CRVO), Branch Retinal
Vein Occlusion (BRVO)
• Intraocular inflammation causing membrane formation
• Rhegmatogenous retinal detachment with proliferative
vietreoretinopathy (traction membranes)
TRACTION DETACHMENT
What retinal detachment has this symptom Symptoms:
o Blurry wavy vision, visual fields cuts, floaters and flashes
preceding blurry vision, NO PAIN, absence of symptoms is possible
• Pathophysiology
o Presenceofretinalbreak
o Theremaybevitreoustractiontotheretinalbreak
o Accumulation of fluid between RPE and photoreceptors
Take note: Pag nasa taas ang butas, retinal detachment is faster rhegmatogenous Retinal detachment
StageI:mildtomoderatearteriolarnarrowingorsclerosis
o Stage II: Moderate to marked arteriolar narrowing, with
focal or generalized narrowing, exaggerated light reflex,
and AV crossing changes
o Stage III: the above PLUS cottonwool spots, hard
exudates, retinal hemorrhages, extensive microvascular
changes, retinal edema
o StageIV:theabovePLUSdiscedema
What staging?
Keith Wagener Barker Staging of Hypertensive Retinopathy
W’hat stage in
Barker staging has
AV crossing changes
Stage 2
W’hat stage in
Barker staging has Cotton wool spots
Stage 3
W’hat stage in
Barker staging has disk edema
Stage 4
Av nicking versus venous elevation versus venue deviation
If an artery which is a thick muscular coat crosses a vein plus the effect of hypertension the changes in the wall will be harder. It will cause narrowing of the tips of the vein “pencil point” AV nicking
The vein cross to the hard artery, the vein will be elevated. Venous elevation
If the artery cross the vein it might delineate the path of the vein. Venous deviation
Deflection of retinal vein as it crosses the
arteriole.
Salus’ sign
Tapering of the retinal vein on either side
of the AV crossing.
Gunn’s sign
BankingoftheretinalveindistaltotheAV
crossing.
Bonnet’s sign
Causes
o Hypertension, arteriosclerosis, diabetes mellitus,
inflammation, collagen disease, hyperviscosity
syndromes
• Symptoms/signs
o Sudden painless blurring of vision, afferent pupillary defects
what disease?
Central Retinal vein occlusion
Treatment of the central Retinal vein occlusion if there is swelling of the macula
if there is swelling of the macula we inject
Anti-VEGF(vascular endothelial growth factor) medication
Causes:
o Emboli, thrombi, hemorrhage under an atherosclerotic
plaque, inflammation, spasm, dissecting carotid artery aneurysm, hypotension, hypertensive arterial necrosis, prolonged pressure on the globe
• One of the only 2 TRUE ophthalmologic emergencies! The other one is chemical burns of the cornea
• Treatment:
o Loweringeyepressurestat,toimproveocularbloodflow How to be resolve within 5 minutes
Can also have a branch occlusion
CENTRAL RETINAL ARTERY OCCLUSION
Risk factors of having diabetic retinopathy
Risk Factors o DurationofDiabetes o Glycemic control o Age o Type of diabetes o Family Hx of DM o Blood pressure o Serum lipids o Nutritional Factors/Obesity o Clotting Factors o Renal Disease
Types of diabetic retinopathy
Non proliterative and proliterative
Mild, Moderate, Severe, Very Severe microaneurysms, retinal hemorrhages and hard and soft exudates, venous beading, IRMAs
Symptoms:
o Variablevisualdeficits/floaters
o Normal20/20visionpossible
Non proliterative
Early, High Risk
o Retinal and disc neovascularization (NVE & NVD),
vitreous and pre-retinal hemorrhages, fibrovascular membranes
Proliferative Dr
If there is macular
Edema, will there be loss of vision?
Yes
induces regression of new vessels and reduces the
incidence of severe visual loss from proliferative diabetic
retinopathy by 50%. Several thousand regularly spaced laser burns are
applied throughout the retina outside the vascular arcades to reduce the angiogenic stimulus from ischemic areas
Pan-retinal photo-coagulation (prp)
Treatment for macular edema
• Intravitrel anti-VEGF injections
Reason for proliferation in diabetic retinopathy
Lack of oxygen
