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vitreoretinal disorders Flashcards

1
Q

retinitis pigmentosa

A
  • group of inherited disorders that affect the photoreceptor/retinal pigment epithelium layers
  • usually 20 to 30 year olds
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2
Q

symptoms of RP

A
  1. poor night vision (nyctalopia)
  2. loss of peripheral vision (constricted visual fields)
  3. +/- cataracts, cystoid macular edema
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3
Q

signs of RP

A
  1. bony spicules - generalised or segmental
  2. attenuated arteries (thinner vessels)
  3. waxy pallor optic nerve
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4
Q

RP a/w other disorders

A
  1. usher’s syndrome: RP and deafness
  2. Lawrence-moon-bardet-biedl syndrome: RP and polydactyly
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5
Q

mx of RP

A
  1. low vision aids to maximise pt’s vision
  2. gene therapy, retinal implants
  3. Vitamin A supplements
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6
Q

RFs for RAO

A
  1. HTN, DM, HLD
  2. blood disorders (younger onset) - haemophilia, protein c/s deficiency
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7
Q

causes of RAO

A
  1. vessel wall occlusion - atheroma, arteritis
  2. embolisation - carotid atheromatous plaque, heart valve lesions (bac endocarditis), cardiac wall problems (mural thrombus, atrial myxoma)
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8
Q

types and sources of emboli

A
  1. cholesterol emboli: from carotid arteries
  2. platelet fibrin emboli: from atherosclerotic vessels
  3. calcific emboli: from abnormal cardiac valves
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9
Q

most common cause of RAO in elderly

A

carotid artery atherosclerosis

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10
Q

symptoms of RAO

A
  1. profound visual loss
  2. marked RAPD
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11
Q

fundoscopic findings in RAO

acute

A
  1. pale retina
  2. cherry red spot
  3. attenuated arterioles
  4. emboli (+/-)
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12
Q

fundoscopic findings in RAO

chronic

A
  1. pale retina
  2. disc pallor
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13
Q

acute mx for RAO

treat the eye

A
  1. ocular massage
  2. anterior chamber paracentesis
  3. IV diamox (acetazolamide)
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14
Q

underlying mx for RAO

treat the source/pt

A
  1. lifestyle changes - smoking cessation, dietary changes
  2. carotid US
  3. refer cardio
  4. anti-platelet therapy
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15
Q

clinical presentation in RVO

non ischemic CRVO vs ischemic CRVO vs BRVO

A
  • non-ischemic CRVO: mild to moderate visual loss
  • ischemic CRVO: marked visual loss
  • BRVO: BOV or VF defect (visual loss may be subtle)
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16
Q

causes of RVO

A
  1. pressure on vein: raised IOP
  2. vessel wall disease: DM, HTN, HLD, vessel wall inflammation (eg sarcoidosis, SLE)
  3. hypercoagulability (young): hyperviscosity (polycythemia, leukemia), prothrombotic tendencies (protein C,S def)
17
Q

fundoscopy findings in RVO

A
  • Scattered flame and blot hemorrhages in a segmental fashion (BRVO) or diffusely through the eye (CRVO)
  • Cotton wool spots
  • Dilated tortuous retinal veins
  • Disc swelling
  • Retinal and macular edema
  • New vessels of disc, retina, iris
18
Q

complications of RVO

A
  • neovascularisation
  • macular edema
  • microaneurysms
  • visual loss due to macular involvement, neovasular glaucoma, viterous haemorrhage from NVD or NVE
19
Q

inx for RVO

A
  • FBC, Fasting glucose, BP, Lipid profile
  • VDRL/RPR (unless suspecting vasculitis, RF for vein occlusion)

Eye tests
* FFA (ddx ischemic vs nonischemic CRVO) = Fundus fluorescine angiography
* OCT

20
Q

mx for RVO

A
  1. Treat underlying predisposing factors
  2. Laser photocoagulation
  3. Intravitreal anti-VGEF agents/steroids for recalcitrant macular edema
21
Q

vitreous haemorrhage

A

bleeding into vitreous cavity

22
Q

causes of VH

A
  • Proliferative diabetic retinopathy
  • After RVO
  • Trauma
  • Retinal tear/detachment
  • Age-related macular degeneration
23
Q

presentation of VH

A
  • Sudden BOV
  • Painless , no red eye
  • +/- floaters
  • Poor red reflex
  • Confirm with dilated examination
24
Q

conditions a/w hypertensive retinopathy

A
  • Retinal artery occlusions: BRAO, CRAO
  • Retinal vein occlusions: BRVO, CRVO
  • Non-arteritic anterior ischemic optic neuropathy
25
Q

hypertensive retinopathy

A
  • Bilateral, symmetrical microangiopathy (small vessel damage)
  • form of end organ damage
26
Q

fundoscopy findings of HR

keith wagener barker classification

A

Grade 1
Mild generalized arteriolar narrowing/sclerosis
Grade 2
* Generalised/focal arteriolar narrowing
* silver/copper wiring
* AV nicking/nipping
**Grade 3 **
* Haemorrhages (dot/blot/flame)
* Microaneurysms
* cotton wool spots
* hard exudates
Grade 4 (Malignant hypertension)
Moderate changes + Disc swelling

27
Q

management of HR

A
  1. Treatment of underlying HTN
  2. If patient previously undiagnosed, refer for assessment:
    * Grade 1 and 2: non-urgent referral
    * Grade 3: more urgent referral to GP
    * Grade 4 hypertensive retinopathy: medical emergency, immediate referral to ED for urgent BP control
28
Q

age related MD, RD

eye (7 decks)

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