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Ocular Disease II > Final Exam > Flashcards

Final Exam Flashcards

1
Q

How can you tell the difference between drusen and exudates

A

Drusen are round and have dull borders.

Exudates are angularly shaped and have sharp defined borders

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2
Q

Location of drusen vs exudates

A

Drusen: between RPE and bruch’s

Exudates: OPL

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3
Q

What is flecked retina?

A

White, pisciform lesions that occur on a beaten-bronze colored macula in Stargart’s dystrophy

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4
Q

What’s the one green retinal finding we learned about in the basics lecture?

A

Choroidal neovascularization

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5
Q

What’s the one orange retinal finding we learned about in the basics lecture?

A

Lipofuscin

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6
Q

How common is Toxoplasmosis? How common are its retinal findings?

A

There is serologic evidence that 30-70% of people carry the infection. Less than 1% develop retinitis. However, over 80% of congenital cases develop retinitis.

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7
Q

Toxoplasmosis ocular symptoms

A
  • Blur
  • Floaters
  • Red eye
  • No pain
  • VF loss if papillitis present, or if scar in area of retina that corresponds to visual field area
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8
Q

Toxoplasmosis diagnosis

A

-Based upon clinical findings
-Serologic findings are supportive but not diagnostic
-ELISA - for detection of toxo specific IgG and IgM antibodies
-FTA-ABS to r/o syphilis
PPD/CXR to r/o TB

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9
Q

Indication to treat toxoplasmosis

A
  • Active lesion
  • Lesion threatens ON or macula
  • Lesion is large, regardless of location
  • 2 line drop in VA
  • Hemorrhage
  • Persists > 1 month
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10
Q

Toxocariasis ocular signs

A
  • Round, raised white granuloma in posterior pole ~ 1DD in size, often with RPE hyperplasia and fibrotic bands radiating from lesion
  • Possible anterior uveitis and vitritis
  • Possible RD
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11
Q

Toxoplasmosis ocular prognosis

A

Good, so long as macula is not involved

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12
Q

Toxocariasis ocular prognosis

A

Guarded to poor: can involve a macular scar, and can reactivate

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13
Q

Histoplasmosis ocular signs

A
  • Circumpapillary choroidal scarring
  • Peripheral choroidal “punched-out” histo spots
  • Macular compromise secondary to neovascular net
  • No anterior uveitis or vitritis
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14
Q

Amsler grid is good at monitoring which infectious ocular disease? Idiopathic/viral complication?

A

Histoplasmosis (POHS)

Multifocal choroiditis

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15
Q

Syphilis ocular signs (acquired)

A
  • Multiple, non-elevated yellowish grey, ill-defined chorioretinal lesions  heals  chorioretinal atrophy with hyperpigmentation
  • Anterior uveitis – unilateral or bilateral, recurrent
  • Posterior uveitis
  • Vasculitis
  • Maculopathy
  • RD
  • SRNM
  • Conj involvement
  • Corneal involvement
  • Glaucoma
  • Retinal necrosis
  • Optic neuritis

THATS A LOT!

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16
Q

Syphilis ocular signs (congenital)

A
  • “Salt and pepper” fundus
  • Glaucoma

Hutchinson’s triad:

  • Interstitial Keratitis
  • Deafness
  • Notched incisors
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17
Q

TB ocular signs

A

Rare but possible

Anterior uveitis – unilateral or bilateral, granulomatous
Posterior uveitis/vitritis
Choroiditis - yellow white nodules (tubercles)
Periphlebitis
Phlyctenular keratoconjunctivitis (PKC) ?

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18
Q

Lyme ocular signs

A

Stage one - conjunctivitis (11%) and periorbital edema

Stage two - granulomatous anterior uveitis (rare manifestation - may occur in late stage), retinal vasculitis and choroiditis

Stage three - episcleritis, stromal keratitis

Other ocular presentations:

  • Vitreous inflammation -“spider web”
  • Ocular motility problems
  • ON inflammation
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19
Q

Sarcoidosis ocular signs

A
  • Lacrimal gland disorders 70%
  • Granulomatous, alternating anterior uveitis 40%
  • Posterior uveitis
  • Nodules – iris, conjunctiva
  • Periphlebitis (“candle wax drippings”)
  • Vitreous opacities (“string of pearls”)
  • ONH edema
  • Choroidal granulomas
  • Conj granulomas/conjunctivitis
  • Keratitis
  • Macular edema
  • Lid granules
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20
Q

Sarcoidosis #1 systemic manifestation

A

Fatigue

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21
Q

Can you cure sarcoidosis?

A

No, but can manage symptoms with prednisone

22
Q

SLE retinal disease

A

Main problem is retinal vascular disease in about 10% of patients with SLE

More common: retinal hemorrhages and cotton wool spots (CWS)

Rare retinal vein and artery occlusions

Less common: retinal vasculitis, periphlebitis (sheathed narrow retinal arterioles with white exudates adjacent to the vessels)

Neurological, choroidal, scleral complications

23
Q

Pars Planitis retinal findings

A
  • Asymptomatic, or floaters and hazy vision
  • Usually no pain, redness or photophobia

Objective/Signs:

  • Initial dirty, yellow exudates aggregate near vessels in extreme periphery
  • “Snowballs” – coalesced infiltrates in vitreous
  • “Snowbanking” - exudates may coalesce & break off into the vitreous
  • CME
  • Cataract
  • Periphlebitis
24
Q

VKH ocular findings

A
  • Granulomatous anterior uveitis
  • Multifocal choroiditis
  • Detachments of sensory retina
  • Vitritis/posterior uveitis
  • Retinal hemes
  • “Sunset glow”: choroid depigmentation 3-4+ months after uveitis, associated with systemic disease
25
Q

What is the most important sign of an endophthalmitis?

A

Hypopyon

26
Q

Initial ocular presentation of HIV/AIDS

A

Cotton Wool Spots

27
Q

What commonly causes CMV retinitis to manifest

A

Reactivation of latent CMV infection (very common) due to immunosuppression in HIV/AIDS. Usually not seen until CD4 drops below 200

28
Q

Ocular CMV clinical features

A
  • Necrotizing retinitis with or without hemorrhages is usual presentation
  • Patchy yellow-white areas with secondary hemorrhage along the edges
  • Occurs most frequently along the major vascular arcades or near the ONH
  • ALL retinal layers affected  full thickness retinal destruction
  • Spread centrifugally - direct extension from diseased to healthy retina
29
Q

Types of CMV retinitis presentations

A

1) Hemorrhagic
2) Brushfire
3) Granular

30
Q

CMV retinitis treatments

A

Anticytomegaloviral medications:

HAART = highly active antiretroviral therapy

Ganciclovir (Cytovene)

  • Inhibits viral DNA polymerase
  • Nausea, vomiting, neutropenia, thrombocytopenia
  • Vitrasert is an eye implant that delivers ganciclovir

Foscarnet (Foscavir)

  • Inhibits viral DNA polymerase and reverse transcriptase
  • Anemia, renal dysfunction, hypo- and hyperphosphatemia, hypocalcemia

Cidofovir (Vistide)

  • Inhibits viral DNA polymerase and reverse transcriptase
  • Renal failure
31
Q

Typical CMV retinitis cocktail

A

1) IV Cidofovir
2) Intravitreal Vitrasert implant (ganciclovir)
3) Intravitreal injections of ganciclovir or foscarnet

32
Q

Absorption and Emission peaks of NaFl

A

Absorption: 490nm - transmitted through excitation filter

Emission: 520nm - transmitted through the barrier filter

33
Q

What is caused when the transmission curves of the excitation and barrier filters overlap?

A

Psuedofluorescence

34
Q

Complications to NaFl injection

A

Mild

  • Injection site reaction
  • Nausea
  • Vomiting

Moderate

  • Urticaria
  • Shortness of breath
  • Vasovagal reaction
  • Skin necrosis

Life Threatening

  • Anaphylaxis
  • Seizure
  • Cardiac collapse
35
Q

Is NaFl angiography okay for pregnancy?

A

NO NO NO NO

36
Q

Do you want to take some fundus photos before NaFl injection?

A

Yep - color and red-free-green!

37
Q

NaFl angiography timing, in general

A

Fluorescein should start appearing in the eye in about 8-12 seconds

  • 8 seconds for younger individuals
  • 12 seconds for older individuals

Take photos every 1.5-2 seconds in the transit eye for about 30 seconds until the initial transit is complete

After, the fluorescein recirculates and the concentration of fluorescein begins to decrease

Option of taking photos of fellow eye & periphery

Wait (for late staining) ~3-5 minutes, take additional photo

Option of taking 10 minute photo

38
Q

NaFl angiography stages timing

A

Choroidal Flush: 8-12s after injection

Arterial Phase: 2 seconds after

Arteriovenous & Venous phases: ?????

Mid Phase: 2-4m after injection

Late Phase: 7-15m after injection

39
Q

Be sure to compare hypofluorescence on the angiogram to the color fundus photo. If the hypo is the same shape as a finding on the color photo, then it’s a “blockage.” If there’s nothing corresponding on the color photo it’s a vascular filling defect

A

Free Card

40
Q

How will hemorrhages appear on NaFal angiogram?

A

Hypofluorescence. It’s old blood, so it’s not full of the NaFl dye. Anything that would normally fluoresce that’s being blocked by the heme won’t shine through because of the density of the blood in the way

41
Q

Name the two autofluorsescent things we learned about

A

1) Optic Disk Drusen

2) Astrocytic hamartomas (tumors of astrocytes)

42
Q

What has a petaloid appearance on FA?

A

CME

43
Q

What has a smokestack or ink blot appearance on FA?

A

Central serous retinopathy

44
Q

What has a light bulb appearance on FA, complete with gradual brightening over time?

A

Pigment epithelial detachment (PED)

45
Q

How can you differentiate drusen and exudates on FA?

A

Drusen stain, exudates do not

46
Q

How is are the anterior and posterior corneal stroma different?

A

Anterior is more disorganized

Posterior is more uniform: will peel like an onion

This is maybe true? I hope so. The notes are unclear

47
Q

What process has make DALK better in recent years

A

Big Bubble

48
Q

Most common cause of congenital cataracts

A

Rubella

49
Q

Most common senile cataract

A

Nuclear

50
Q

Least common senile cataract

A

Subcapsular (visually debilitating)

Ocular Disease II (1 decks)

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