Vascular Diseases of the Eye - Stagner Flashcards
Describe Diabetic Retinopathy
leading cause of blindness in patients 20-64 years
prevelence increases with duration of diabetes and age of patient
Describe the retinal capillary changes in diabetic retinopathy (4)
- microaneurysms
- leakage of blood and fluid
- poor blood supply/ischemia
- growth of new abnormal blood vessels
Identifity the condition and describe the treatment:
pt is a type 2 diabetic of 10 years
opthalamoscopic examination shows: microaneurysms, nerve fiber layer infarcts (cotton wool spots) and macular edema hard exduates
**Non-Proliferative **Diabetic Retinopathy
Treatment:
- tight glycemic control
- Rx hyperlipidemia
- control hypertension
other microvascular changes are confined to the retina
- capillary non-perfusion
- IRMAs
- dot-and-blot intraretinal hemorrhages
- dialtion and bleeding of retinal veins
What is a microaneurysm?
pericyte loss - local structural weakness within the vessel wall
NO vision changes result
What are hard exudates?
Extracellular lipid which has leaked from abnormal retinal capillaries
fluid in the macula = blurry vision
Describe Macular Edema
most common cause of vision loss from diabetes
considered clinically signifiicant if close to the fovea or large area
diagnosis: exam, optical coherence tomography, fluroescein angiography
treatment: focal laser (zap microanuerysms), anti-VEGF, intra-ocular steroid
Severe Non-Proliferative Diabetic Retinopathy
4:2:1 Rule
4 Quadrants of diffuse intraretinal hemorrhages and microaneurysms
2 Quadrants venous beading
1 Quadrant IRMAs
15% chance of progessing to proliferative diabetic retinopathy within 1 year
Identify the condition and describe the pathophysiology and treatment
ophthalmoscopic exam shows neovascularization elswehere, decreased red reflex and vitreous hemorrhage;
pt reports increasing floaters, hx of type 1 DM
Proliferative Diabetic Retinopathy
retina is so ischemic that it responds by growing new blood vessels that break through the retina and bleed
- if growth off of the disc = NVD
- if growth off of the retina = NVE
this new growth can cause vitreous hemorrhage (floaters)
decreased red reflex
recurrent bleeding leads to fibrosis
treatment:
- virectomy
- panretinal photocoagulation
4 Common Diabetic Nerve Problems
- Diabetic Retinopathy
- Transient refractive errors
- Higher incidence of cataract
- Neovascular glaucoma
- neovascularization of iris and closure of the angle
Identify the condition and descirbe the treatment:
ophthalmoscopic examination shows: microaneurysms, arterial venous nicking, flamed shaped hemorrhages, and Elscnig Spots
Hypertensive Retinopathy
clinical features: microanerusysms, IRMA’s, blot hemorrhages, hard exudates, venous beading, Elschnig spots- nonperfusion of choriocapillaries
Acute: associated with preeclampsia, eclampsia, pheochromocytoma or renal hypertension
Severe: flame-shaped hemorrhages, blurring of the disc marginas, exudates
aterial venous nicking - related to vascular sclerosis - see the image on the left
Identify this condition and describe the treatment:
ophthalmoscopic examination shows cotton-wool spots in a sector of the retina
patient reports vision loss, no pain
Branch Retinal Vein Occlusion
superficial hemorrhages, retinal edema, cotton-wool sports in a sector of the retina drained by the affected vein
if macula is affected - painless vision loss
occurs most commonly at arteriovenous crossing
risk factors: hx systemic hypertension, cardiovascular disease, increased BMI at age 20, hx of glaucoma
tx: anti-VEGF, sector photocoagulation
Identify this condition and describe the treatment:
ophthalmoscopic examination shows: retinal hemorrhages in all 4 quadrants
Central Retinal Vein Occlusion
retinal hemorrhages in all 4 quadrants
dilated, toruous retinal veins
can be ischemic which leads to neovascularization
tx: anti-VEGF, panretinal photocoagulation
Identify this condition and describe the treatment:
pt reports: sudden painless vision loss in his left eye
physical exam findings: RAPD, decreased visual acutiy
ophthalmoscopic examination: cherry red spot, retinal edema
Central Retinal Artery Occlusion
****irreversible vision loss within 90 minutes
tx: ocular massage, reduce IOP via needle or drops, hyperbaric oxygen - none have great evidence
poor prognosis
central occlusion due to artherosclerotic disease, emboli, vascultitis, coagulopathy (branch - emobli)
boxcarring of retinal vessels
Identify this condition and describe the treatment:
pt reports - painless vision loss in her right eye, but vision has since returned
Carotid Stenosis Related Eye Diseases
Amaurosis fugax - painless transient monocular vision loss
descriptors: “curtain” coming down over the eye, blindness, dimming, fogging, or blurring
may see Hollenhorst plaque
**can be an emboli from the heart; patient is at high risk for a stroke
Identify this condition and describe the treatment:
pt reports transient vision loss, scalp tenderness, arthralgia, and recent weight loss
exam shows: tenderness over temproal artery, thickened temproal artery, bruits
Giant Cell Arteritis =
Temporal Arteritis
medium vessel vasculitis in older people (>65)
scalp tenderness, tender over temporal artery, jaw claudication, fever, weight loss, joint pain
transient vision loss, double vision, sudden marked vision loss from ischemic optic neuropathy
tx: high dose steroids to save the other eye
