Blue 2-4 Flashcards
(35 cards)
What is seen on temporal artery biopsy in GCA
Intimal thickening of the blood vessels
Necoriss of part of arterial wall
Granulomas containing muli-nucleated giant cells
Halo sign on US - thickening of arterial wall
Diagnostic criteria for IID
NOrmal nuerological evaluation
Normal neurimagine without hydrocephalus or mass
Normal CSF constituents
PResence of papilloedema
Elevated CSF opening pressure during LP
More than 25 cm H2O in adults, 28 in children
What drugs are associated with IIH
STAIN LONG
Steroid withdrawal
Tetracyclines
Vitamin A retinoids
Indomethacin
Nitrofurantoin
Lithium
OCP
Nalidixic acid
Growth hormone
What is the course and prognosis of NAAION. Risk of recurrence? Risk of fellow eye?
Vision deteriorate over 2 weeks, stabilises by 2 months
Prognosis of affected eye is good - 50% will have final vision of 6/9 or better
25% have final vision of 6/60 or worse
15-40% of eyes will recover 3 Snellen
10-20% change of deterioration of vision of affected eye at 2 years
3-8% change of recurrence
15-25% risk in fellow eye over 5 years
Features of Adie tonic pupil
Dilated pupil with sluggish response to light and poor response to near
Vermiform movements of iris
ciliary ganglion/short ciliary nerve damage
Accommodation more likely to be spared
Females 3:1
What test to assess Horner’s
Topical cocaine 4% or 10%
Topical apraclonidine 0.5% or 1%
How does cocaine test for Horner’s work?
Cocaine blocks reuptake of norepinerprine at NMJ which dilates normal pupil - Horner’s pupil dilates poorly as little/no norepinephrine
How does apraclonidine test for horners work
Alpha 2 agonist - in normal patients causes pupil constriction
Weak alpha 1 agonist promotes pupil dilation
In pupil that has lost sympathetic innervation, the pupil dilator muscle develops super senistivty to alpha 1 dilation of apraclonidine so Horner’s pupil will dilate
What tumours cause CAR
Small cell lung cancer
Gynae
Breast
What cells are affected in CAR and MAR
CAR - Cones>Rods
MAR Rods<cones
What antibody is associated with CAR
Antirecoveris
What are symptoms of CAR
Photosensitivty
Photopsia
Glare
Reduced central vision
Reduced colour vision
What does CAR appear in later stages
RPE thinning, mottling
Mimics retinitis pigmentosa
What is seen on ERG in CAR? OCT?
Global retinal dysfunction with severely reduced photopic a and b waves
OCT shows severe macular atrophy
Loss of photoreceptors
and IS/OS junction
Hamartoma vs choristoma
Hamatoma - abnormal tissue normal location
Choristoma - normal tissue abnormal locationh
What is seen in tamoxifen reitnoapthy
White intraretinal crystals int eh macular or paramacular area with or without oedema
What is myopic CNV
Small flat greying membrane that may have a hyperpigemented border if chornic or recurrent
3 stages
1 direct damage to photoreceptors
2 regression of CNV - formation of fibrous pigemented scar (Forster-Fuch’s spot)
2-atrophy around regressed CNV
What is Forster-Fuchs spot?
Fibrous pigmented scar from regression of myopic CNV
What trials for IVI in myopic CNV?
REPAIR RADIANCE
PRN regimens of ranibizumab
2-4 injections median required
What is photodynamic therapy?
Vertrporfin is used
Causes release of free radicals when activated by laser energy
Reacts with blood vessel endothelial cell membranes to cause histamine, thromboxane, TNFa release
Anti-inflammatory response leads to vasoconstriction, thrombosis, staiss and hypoxia
TReats CSCR, Choroidal haemangioma, polypoidal choroidal vasculopathy
What is treatment for MAcTel type 2
No treatment unless CNV (then anti-VEGF)
What vitamin can cause CMO
Vitamin B3 (niacin/nicotinic acid)
Toxic effect on Muller cell resulting in intracellular oedema - no leakage on FFA
Which TB drug can treat non-resolving CSCR
Rifamipicin - causes catabolism of endogenous steroids - increase in cyp450 catabolism
What are vasoproliferative tumours
REtinal lesion that may be primary or secondary
May be unilateral/bilateral
Inferotemporal quadrant
Subreitnal exudation
Can be associated with ERM/CMO
