Ocular Disease:posterior Flashcards

Question

Symptoms of vitreous hemorrhage

Answer 1

usually causes painless vision loss and/or black spots that can have corresponding flashing lights

Answer 2

located between the retina and an intact posterior vitreous face; appears very red and often has a keel shape

Answer 3

located within the vitreous (anterior to the posterior vitreous face). A mild vitreous hemorrhage will be characterized by blood that obscures only part of the fundus. Severe hemorrhages will completely obscure the view of the fundus. Chronic cases will appear yellow ‣ A B scan is indicated if the fundus cannot be viewed throught the vitreous hemorrhage

Answer 4

Preretinal and chorodial

Answer 5

leads to preretinal or vitreous hemorrhage and/or tractional retinal detachement. Remember DR VOS for preretinal neo

Answer 6

within the subretinal space (CNVM) that results in a subretinal and/or subREP heme, pigment epithelial detachment, and serous retinal detachment. Remember CHBALA for choroidal neo

Answer 7

prevalence 0.1-0.4%. CRVOs are the 3rd most common vascular cause of vision loss (DR is the second most common). An estimated 7% of patients will have a CRVO in the fellow eye

Answer 8

HTN, DM, cardiovascular disease, and open angle glaucoma

Answer 9

◦ Glaucoma is the ocular disease that is most commonly assocaited with CRVOs; up to 40-60% of patients with CRVO have POAG

Answer 10

oral contraceptive pills, protein S/C/antithrombin III deficiency, factor XII deficiency, antiphospholipid Ab syndrome, collagen vascular disease, and AIDs

Answer 11

result from compression of an artery on a vein; this leads to turbulent blood flow, venous vessel wall damage, and thrombus formation. CRVOs are usually caused by a thrombus at or near the lamina cribrosa

Answer 12

characterized by a sudden, unilateral, painless visions loss in an elderly patient. (90% of patients with a CRVO are > 50 years old)

Answer 13

thrombus formation leads to ischemia and release of VEGF which characteristic retinal findings including retinal hemorrhages in all 4 quadrants, collaterals, dilated torturous retinal veins, CWS, and optic disc edema

Answer 14

‣ Collateral veins become visible over several weeks to months; they are often on the disc and permit blood flow between the retina and chorodial circulations, helping to accelerate drainage of excessive fluid (Retinal edema) into the choroidal circulation after a CRVO

Answer 15

◦ Vision threatening complications include macular disease and complication from neo. VEGF stimulates neo of the posterior and anterior segment and has been prove to cause capillary leakage leading to macular edema ‣ 1. Macular disease-macular ischemia, macular edema, and intramacular hemes ‣ 2. Neo-neovascular glaucoma, preretinal/vitreous hemorrhage, and tractional RD

Answer 16

◦ Neovascular glaucoma is a major concern in patients with a CRVO and is most likely to develop within the 1st 3 months of Dx (90 day glaucoma). 60% of ischemic cases develop iris neo and up to 33% develop neo glaucoma. 6% of non ischemic cases develop rubeosis or angle neo

Answer 17

Macular edema

Answer 18

‣ Ischemic CRVO is defined as 10 disc diameters or more of non-perfusion on FA. 90% of cases present with 20/200 vision or worse, and the prognosis is poor. 16% of nonischemic cases progress to ischemic CRVOs

Answer 19

BRVOs are by far the most common retinal vascular occlusive disease; patients have a similar health history as patients with CRVOs

Answer 20

HTN, cardiovascular disease, increased body mass index at 20 years old, and open angle glaucoma

Answer 21

BRVOs are usually caused by a thrombus after compression of an artery on a vein at an AV crossing. 60% occur at an AV crossing within the superior/temporal quadrant

Answer 22

• BRVOs that do not occur at an AV crossing should be evaluated with vasculitis. Remember that retinal arteries and veins share a common adventitia at AV crossings; this allows a thickened artery to compress the vein

Answer 23

BRVOs are characterized by sudden, unilateral, painless visual field loss, blurred vision or no symptoms (if the macula is spared)

Answer 24

retinal signs occur in the area of the distribution of the occluded vessel and include dilated torturous retinal veins, CWS, collateral vessels, and intraretinal hemorrhages

Answer 25

◦ Vision threatening complications include macular disease and complications from neo ‣ 1. Macular disease-macular ischemia, macular edema, and intramacular hemorrhage ‣ 2. Neo complications-preretinal/vitreous hemorrhage

Answer 26

ask about transient loss of vision (amaurosis Fugax). Commonly occurs in elderly patients. Patietns have a 10% risk of CRAO occurring in the fellow eye

Answer 27

HTN, DM, carotid occlusive disease, cardiac valve disease

Answer 28

IV drug usage and BC

Answer 29

CRAOs most commonly arise from heart and/or carotid artery emboli ‣ Calcific emboli-large dangerous emboli from calcified heart valves often located in the CRA near the optic nerve ‣ Carotid Emboli-smaller cholesterol plaques (hollenhorst plaques)

Answer 30

Calcific | Usually from heart valves

Answer 31

◦ Although retinal emboli are by far the most common etiolgoy for arterial occlusions, there are several other culprits to consider, including GCA, acute elevation in IOP, collagen vascular diseases, IV drug use, oral BC, sickle cell disease, and syphilis

Answer 32

acute, profound vision loss (often 20/400 or worse). Unless a cilioretinal artery is present to spare the macula. If VA is LP or worse, strongly consider an ophthalmic artery occlusion

Answer 33

‣ A cilioretinal artery branches form the SPCAs of the choroid and allows the macula to remain functional in a CRAO. It is present in 15-30% of patients

Answer 34

superficial whitening of the inner retinal layers (returns to the normal color after perfusion is restored but does not regain function!), narrowed arterial vasculature, a cherry red spot in the foveola, and an afferent pupillary defect r(secondary to optic disc pallor from orthograde degeneration of RGC axons). Hollenhurst plaques or other emboli are also noted in 20-40% of cases

Answer 35

similar risk factors to CRAOs

Answer 36

90% of cases are caused bu retinal emboli (hollenhurst plaques (most common), calcium, fibrin, and platelet emboli)

Answer 37

often asymptomatic; may complain of a VF defect or sudden unilateral painless vision loss if the area of occlusion is close to or involving the macula

Answer 38

superficial whitening of the retina in the distribution of the affected vessels due to retinal infarction and edema; hollenhurst plaques or other emboli are found within the area of occlusion in 62% of cases. The edem and retinal whitening eventually resolves within weeks, but the retinal tissue remains non functional and the patient with have permanent VF defect

Answer 39

are congential, benign, white patches in the superficial retina with feathery edges that represent abnormally myelination of ganglion cell axons anterior the lamina cribrosa. Myelination follows the distribution of the axons, can obscure the retinal vessels, and is typically located near the optic nerve. Differential diagnosis include BRAO and CWS

Answer 40

Within 3-5 years of diagnosis

Answer 41

At the time of diagnosis For patietns with no diabetic retinopathy, repeat exams every year For patients with mild to moderate retinopathy, repeat exams every 6-12 months For patietns with severe NODR or PDR, repeat examinations every 2-4 months

Answer 42

diabetic retinopathy

Answer 43

Duration of disease ‣ Patients who are dx with DM before age 30 have a 2% risk per year for developing DR; after 7 years-50%, after 25 years-90% with have DR

Answer 44

DR occurs because of a loss of pericytes and damage to the retinal capillary BM, resulting in a breakdown of the blood retinal barrier. DR can be divided into non proliferative DR (NPDR or background DR) and proliferative DR (PDR)

Answer 45

Can be divided into mild, moderate, severe, and very severe

Answer 46

5% in 1 year

Answer 47

15% in 1 year

Answer 48

52% risk in 1 year

Answer 49

75% in 1 year

Answer 50

When two or more criteria are met within the 4-2-1 rule 1. Severe retinal hemorrhages in 4 quadrants 2. Venous beading in 2 quadrants 3. IRMA in 1 quadrant

Answer 51

The patient meets one criteria from the 4-2-1 rule 1. Severe retinal hemorrhages in 4 quadrants 2. Venous beading in 2 quadrants 3. IRMA in 1 quadrant

Answer 52

1. Severe retinal hemorrhages in 4 quadrants 2. Venous beading in 2 quadrants 3. IRMA in 1 quadrant

Answer 53

occurs in 5% of patients with DR and is diagnosed based on the presence of neovascularization. If left untreated, PDR can progress to devastating outcomes. Patients with PDR who are most at risk for visions loss have high risk characteristics (HRCs)

Answer 54

1. Neovascularization of the disc (NVD) greater than 1/4 DD within 1DD of the optic nerve 2. Any NVD or NVE with an associated vitreous or preretinal hemorrhage

Answer 55

patietns are often asymptomatic or May experience vision and metamorphopsia

Answer 56

although there are numerous signs of DR, the most important threats to vision include macular disease and neovascularization

Answer 57

Macular ischemia | Macular edema

Answer 58

may look normal or thickened; a FA can be used to differentiate macular ischemia from macular edema (macular ischemia will appear as an enlarged fovea avascular zone (hypofluoresce))

Answer 59

it can occur at ant stage of DR. CSME is based not he following 3 criteria (based on the presence of retinal thickening within the fovea) • A. Retinal thickening within 500um (1/3DD) of the fovea center • B. Hard exudates within 500um of the fovea center with adjacent retinal thickening • C. Retinal thickening of at least 1DD within 1DD of the fovea center The patient only needs to have one of the three to be diagnosed with CSME

Answer 60

* A. Retinal thickening within 500um (1/3DD) of the fovea center * B. Hard exudates within 500um of the fovea center with adjacent retinal thickening * C. Retinal thickening of at least 1DD within 1DD of the fovea center The patient only needs to have one of the three to be diagnosed with CSME

Answer 61

Threats to vision from neo include the following ‣ 1. Preretinal/vitreous hemorrhages ‣ 2. Neovascular glaucoma ‣ 3. Tractional RD

Answer 62

60 million Americans over the age of 18 years of age have HTN; more prevalent in AA. Essential HTN accounts for 95% of all cases of HTN and is defined as elevated blood pressure with no known cause

Answer 63

recall that retinal arteries are able to auto regulate their vessel diameter based on changes in blood pressure; autoregulation is altered at extremely high or chonrically elevated systolic pressures and retinopathy results. Systemic blood pressure must typically be at least 140/110 for the latter stages of HR to occur

Answer 64

commonly asymptomatic. Vision is typically unaffected unless vascular changes cause macular edema (macular star), papilledema, a serous retinal detachement, or a vein occlusion

Answer 65

1-4, 4 being the worst

Answer 66

mild to moderate diffuse narrowing of the retinal arteries (but no focal constriction)

Answer 67

stage 1 plus focal constriction of the retinal vasculature (AV nicking) and exaggerating of the arterial light reflex

Answer 68

stage 2 plus retinal hemorrhages, CWS, hard exudates (likely in a star configuration within the OPL radiating away from the fovea), and retinal edema

Answer 69

stage 3 plus papilledema (malignant HTN). Patients with malignant HTN must be hospitalized immediately due to high risk of stroke. BP at this stages is usually 220/120.

Answer 70

vascular occlusion, retinal macroaneurysms, NAION, ocular motor palsies, and worsening of DM.

Answer 71

choroidal infarcts that occur in severe HR

Answer 72

more common in elderly women (7th decade) with HTN or atherosclerosis

Answer 73

usually asymptomatic, but can have gradual vision loss from macular edema or sudden vision loss from a vitreous hemorrhage

Answer 74

unilateral focal area of dilation in a retinal artery (100-250um in diameter) with multi-level hemorrhages (subretinal, intraretinal, preretinal, and/or vitreous hemorrhage) from a ruptured aneurysm with surrounding circulate exudates; often located at an AV crossing

Answer 75

multi-level hemorrhages (subretinal, intraretinal, preretinal, and/or vitreous hemorrhage)

Answer 76

Men | Ages 50-80

Answer 77

caused by occlusion of the ICA and/or ophthalmic artery (less common), usually secondary to atherosclerosis; may also occur as a result of GCA

Answer 78

common symptoms include gradual vision loss, dull periorbital pain or HA, and amaurosis fugax

Answer 79

unilateral (80%) dot/blot hemorrhages of the midperipheral fundus, dilated non-tortuous retinal veins, narrowed retinal arteries, and possible neo of the disc and/or anterior segment (67% of patients with OIS have NVI/NVA at the time of diagnosis)

Answer 80

‣ If a patient has these retinal findings and carotid artery obstruction, but no anterior segment signs, the condition is called venous stasis retinopathy ‣ The presence of both posterior and anterior segment signs and symptoms is referred to as OIS. OIS is most common in male patients 50-70 years old

Answer 81

systemic HTN, DM, and cardiac disease; the latter is most common cause of a 40% 5 year mortality rate in these patients

Answer 82

type of TIA characterized by transient monocular vision loss that typically lasts seconds to minutes; vision returns to normal after the ischemic event. A carotid artery embolus is the most common cause of amaurosis fugax

Answer 83

characterized by temporal neurological defects due to transient loss of blood flow to the brain. Perfusion is always resorted in less than 24 hours (usually less than 15 minutes), resulting in complete resolution of the patient’s symptoms without any permanent damage. In contrast, a stroke is characterized by permanent neurological deficits due to prolonged loss of blood flows that results in irreversible damage to the brain

Answer 84

``` Proliferative Neo DRVOS -DM -ROP -Vein occlusions -OIS -Sickle cell ```

Answer 85

Proliferative, DRVOS 1. Preretinal/vit heme 2. Tractional RD (vit pulls on neo) 3. VEGF=NVG

Answer 86

- HTN | - Plaques from the heart

Answer 87

1. HTN/DM (artery prob) 2. Artery compressing vein 3. Bad/turbulent blood flow 4. Thrombus formed 5. VEGF released

Answer 88

Respects horizontal midline, Mimics glaucoma

Answer 89

1. Preretinal/vit heme 2. Tract RD 3. VEGF-NVG 4. Ischemic macula 5. Macular edema

Answer 90

- autoregulation problem - ONH - retinal vessels Break down of BRB - between RPE cells - retinal BV

Answer 91

Ischemia is decreased O2, it initally swells and then thins

Answer 92

``` Mac star (3 or 4) Papilledems (4) ```

Answer 93

``` CRAO, BRAO, CRVO, BRVO NAION EOM palsy Worsening DM Macroaneurysms ```

Answer 94

Viagra Imitrix Amiodarone SPCA not doing its job

Answer 95

Carotid Doppler

Answer 96

an increase in resistance to blood flow secondary to elevated levels of proteins, RBCs, and/or WBCs, resulting in impaired circulation of blood flow and oxygen though the microvasculature. As blood flow decreases, blood vessel walls become damaged, causing leakage of fluid and retinal ischemia

Answer 97

hyperglobulinemia, a condition found in Waldenstrom’s macroglobulinemia, multiple myeloma, serum positive RA, SLE, and HIV infection

Answer 98

retinal venous dilation, retinal hemorrhages, CWS, and exudates. Central retinal vein occlusion may also occur and is bilateral in 10% of patients

Answer 99

◦ The most common ocular manifestation of HIV/AIDS. Signs include CWS and retinal hemorrhages, similar appearance to DR and early CMV retinitis ◦ Patients are typically asymptomatic. The condition is non infectious in origin

Answer 100

◦ Patients on interferon therapy can develop retinal findings similar to DR, including CWS and retinal hemorrhages within the posterior pole. ◦ Retinopathy typically occurs within 3-5 months after interferon is started, and tends to resolve without treatment after interferon has been discontinued

Answer 101

◦ Patients on interferon therapy without retinopathy should be followed every 4-6 months; if retinopathy is present, follow ups should occur more frequently

Answer 102

◦ Presents bilaterally in IV drug users who use talc as a filler ◦ The talc gets caught in the retinal capillaries and will appear as multiple, yellow, refractile, deposits that tends to be clustered near the macula ◦ The talc may cause capillary occlusion and retinal ischemia

Answer 103

Sarcoidosis -lac gland, CN VII, OHN, vessels, vitreous AA female Hard exudates that leak Vasculitis=inflammation

Answer 104

Vascualr sheathing/periphlebitis

Answer 105

syphilis, sarcoidosis (known as candle wax drippings), pars planitis, and sickle cell disease

Answer 106

◦ Diagnostic systemic lab testing should be done based on the revive of systems and case history to determine the systemic cause of the vascular sheathing

Answer 107

All bilateral=hereditary

Answer 108

Most of them are nonhereditary

Answer 109

abnormal perifovea capillaries present within the juxtafoveal region. IJXT is divided into three categories

Answer 110

occurs in men in the 4th decade; results in 20/25-20/40 vision

Answer 111

occurs in middle aged men; reuslts in 20/25 or better acuity

Answer 112

equal sex distribution in the 5th or 6th decade. Poor visual prognosis

Answer 113

Decreased vision

Answer 114

right angle venules and dilated tortuous vessels, hemes, varying degrees of exudates (moderate to none at all) within or nearby the fovea, macular edema, and/or CNVM

Answer 115

peak incidence in males less than 20 years old; 2/3 of cases present prior to age 10. Progression is more rapid in children under 4 years old, simulating retinoblastoma

Answer 116

idiopathic peripheral vascular disease. If left untreated, coats disease will gradually progress to a total exudative RD

Answer 117

decreased vision, strab, leukocoria

Answer 118

unilateral, telangiectatic dilated vessels that display a characteristic “lightbulb” appearance. Progression of the disease can lead to marked hard exudates (classic for coats), intraretinal hemorrhagehs, exudative retinal detachement, and NVG (results in red painful eye and potentially blind eye)

Answer 119

A chronic extensive serous detachment in coats disease results in retinal ischemia, which leads to the development of anterior segment neovascularization similar in pathology to the DR VOS conditions. NVA and NVI result in NVG

Answer 120

occurs in premature infants (less than 32 weeks) or low birth weight infants (<1500g) who have received oxygen therapy

Answer 121

immature blood vessels vasoconstriction and stop developing in response to high oxygen concentration, leading to proliferative retinopathy. Threatens to vision include preretinal/vitreous hemorrhages, and tractional RDs

Answer 122

leukocoria, strab, vitreoretinal traction, preretinal/vitreous hemorrhages, and tractional RDs

Answer 123

white pupillary reflex that resutls from fibrovascular scarring secondary to a tractional RD in cases of ROP

Answer 124

The anterior temporal retina is the last area of the retina to achieve mature vascular development during the 9th month of gestation. This area is most susceptible to neovascularization and subsequent tractional RDs in pre term infants with ROP

Answer 125

the most common intraocular malignancy in kids and the second most common of all age groups (choroidal melanoma is the most common). 95% of cases are diagnosed by 5 years of age. No gender or race predilection

Answer 126

choroidal melanoma

Answer 127

tumor derived from cells in the developing retina (retinoblasts) as a result of mutations in the Rb tumor suppressor gene

Answer 128

40% all bilateral cases and about 10-20% of unilateral cases. However, only 6% of these have a positive family Hx of the condition because the tumor has such a high spontaneous mutation rate. Bilateral affected patients have a 50% chance of passing the disease on to each offspring

Answer 129

60% | 85% of all unilateral cases of RB are non heritable. Affected pateitns will not pass the disease on to their offspring

Answer 130

leukocoria, strab, intraocular inflammation, and decreased vision

Answer 131

Coat’s disease, toxocariasis, RB, and ROP

Answer 132

the lesions are thought to be congenital with no race or sex predilection

Answer 133

benign, pigmented (brown to black), non-progressive lesions with sharp borders and central hypopigmetned lacunae. ‣ CHRPEs are typically unilateral and solitary, measuring 1-6mm in diameter. Bilateral multifocal (4 or more) CHRPEs are assocaited with Gardner’s Syndrome-colonoscopy needed

Answer 134

common condition that occurs in 1-6% of the population and is most commonly in whites

Answer 135

common benign focal accumulation of melanocytes within the choroid. Choroidal nevi are thought to be present at birth and are typically non progressive

Answer 136

‣ Growth during puberty is not unusual, but any growth in an adult should raise concern for conversion to malignant melanoma ‣ 10% of suspicious nevi progress to malignant melanoma

Answer 137

To Find Small Ocular Melanomas, Use Helpful Hints” • T=thickness (elevation >2mm) • F=fluid (subretinal) • S=symptoms (blurred vision and floaters) • O=orange pigment (lipofuscin on surface of lesion) • M=margins (irregular borders) • UH=ultrasonographic hollowness (acoustically hollow with low internal reflectivity) • H=halo absence • The nevus should also around suspicion if it has a large diameter (>4DD or 6mm) or if its close proximity to the ONH

Answer 138

the lesion is typically flat or slightly elevated, less than 5mm in size, and often contain overlying drusen

Answer 139

Choroidal melanoma

Answer 140

CHBALA - Choroidal rupture - Histo - Bests - Angioid streaks - Lacquer cracks - ARMD Problems with Burch’s

Answer 141

Plasma - clear - dont treat - small break - detachment (PED) RBCs - red - treat - large break - hemorrhage - looks grey/green

Answer 142

Wet PED =break in bruchs Dry PED -drusenoid PED, no break in bruchs

Answer 143

Inner collagenous zone of bruchs

Answer 144

1. Drusenoid PED 2. GA 3. Progression to wet

Answer 145

RPE Bruchs membrane Choriocapillaris

Answer 146

most common in patients over the age of 50. It is the second leading cause of blindness for patients 45-64 (DM number 1); exudative ARMD is the chief cause of vision loss in patients over the age of 50

Answer 147

increasing age (esp >75), ethnicity (whites), positive family history, light iris color, cigarette smoking, hyperopia, HTN, HLD, female gender, and cardiovascular disease Nutritional factors and light toxicity play roles

Answer 148

Hyperopia greater than 0.75D is assocaited with a 2.5X increased risk of exudative ARMD. 10-20% of patients with ARMD have at least one first degree family member with vision loss from ARMD.

Answer 149

Current smokers are 2.5x more likely to develop ARMD and 1.7-2.2x more likely to have recurrence of CNV compared to those who have never smoked

Answer 150

No exudative (Dry)

Answer 151

presence of drusen (hallmark); assocaited RPE abnormalities (mottling, granularity, focal hyperpigmentation) may also be present

Answer 152

Most patients with dry ARMD do not have severe vision loss; metamorphopsia, gradual vision loss (over months to years), and blurred visions are common complaints

Answer 153

1. Multiple soft drusen (especially if confluent) 2. Focal hyperpigmentation 3. HTN 4. Smoking

Answer 154

metamorphopsia, central scotoma, and rapid vision loss

Answer 155

drusen that are associated with signs of a CNVM. CNVMs can leak blood or plasma into two potential places: 1. Sub-RPE space or 2. Subretinal space.

Answer 156

CNVMs can either leak blood or plasma into two potential spaces; 1) subRPE, 2) subretinal space. This creates 4 potential presentations of wet ARMD 1. Subretinal hemorrhage (blood under retina) 2. SubRPE hemorrhage (blood under RPE 3. Subretinal detachment (plasma under the retina, AKA serous retinal detachment) 4. SubRPE detachment (plasma under the RPE, AKA pigmented epithelial detachement (PED))

Answer 157

Serous retinal detachement

Answer 158

Pigmented epithelial detachment (PED)

Answer 159

can also occur with dry AMD due to a build up a confluent soft drusen on Bruch’s membrane, creating a space between the RPE and the choroid. This type of sub-RPE detachment is called a drusenoid pigment epithelial detachement. CNVMs can develop over time within drusenoid PEDs

Answer 160

FA can be used to detail exact ares of leakage and classify them as occult or classic • Classic CNVMs are characterized by a well defined membrane that fills will dye during the early stages of FA • Occult CNVMs are characterized by a poorly-defined membrane with late appearing and less intense leakage • Most patients with wet ARMD have a CNVM with a combination of classic and occult features. The term “predominantly classic” means that over 50% of the entire lesion is composed of a classic CNVM

Answer 161

incidence of involvement of the fellow eye with wet ARMD is estimated to be 28-36% during the first 2 years; the annual rate of bilaterality is about 6-12% per year for the next 5 years. The overall 5 year risk ranges from 40-85%

Answer 162

commonly occurs in young to middle aged men (20-50) with a type A personality; associated with stress, pregnancy, steroid use, hypochondriasis, and HTN. A history of similar episodes is common-recurrences occurs in as high as 50% of cases

Answer 163

unknown etiology. CSR results in RPE and/or choroidal dysfunctions, with resulting accumulation of submacular serous fluid

Answer 164

unilateral sudden onset of blurred visions (20/20-2/200); metamorphopsia and a relative scotoma may also occur. Patients may have symptoms even if acuity is 20/20

Answer 165

localized macular serous detachment; 3% of cases will have an RPE detachment as well. FA will reveal a gradual pooling of Fl into a pigmented epithelial detachment or a “smokestack appearance”. OCT can also be used to dx and monitor the condition (now used more frequently than FA). Patietns may also have a hyperopic shift and loss of the foveal light reflex

Answer 166

Patients often have permanent residual RPE changes within the macula after resolution of the condition.

Answer 167

Most patients improve without treatemtn by 1-3 months; 94% of patients will regain >20/30 acuity. 66% of patients achieve 20/20 acuity

Answer 168

There is NONE! | This is a choroiditis, not a retinitis

Answer 169

Break in bruchs membrane | -can get the 4 different types of nets

Answer 170

Bilateral choroiditis with 1. Peripapillary atrophy 2. Peripheral histo spots 3. Maculopathy

Answer 171

Toxo - parasite - retinitis=breakdown in BRB=vitritis - one eye - one lesion Histo - fungus - choroiditis - BRB fine, no vitritis - both eyes - multiple lesions

Answer 172

Lacquer cracks - young males - yellow - coming from macula Angioid streaks - always from the disk - PXE, ED - PEPSI - dont want streak across macula - red in appearance

Answer 173

Glial cells on the ILM 1. From vitreous 2. From within the retina

Answer 174

rare in AA, most comm in the Ohio-Mississippi-river valley.

Answer 175

infection caused by histoplasmosis capsulatum, a fungus that grows in soil and material contaiminted with bird or bat droppings. ‣ Recurrences of histo (30% of cases) occur through preexistent histo spots ‣ If spots are present in the disc or macular area, the chance of a symptomatic recurrence is appx 20% over 3 years

Answer 176

asymptomatic unless maculopathy develops; the earliest symptom is metamorphopsia

Answer 177

characterized by bilateral choroiditis and the clinical triad of bilateral peripapillary atrophy of the optic nerve, multifocal leasions in the periphery, and maculopathy (including CNVM). The vitreous is always clear in histoplasmosis! ‣ CNVM is a late manifestation: if it occurs, it is most likely to happen between the ages of 20 and 45

Answer 178

Although toxoplasmosis and histoplasmosis are both types of posterior uveitis, they are characterized by very different etiologies and presentations • Toxoplasmosis is caused by a parasite that results in retinitis, which is characterized by WBCs in the vitreous due to a breakdown in the blood retinal barrier. Remember ONE EYE, ONE LESION • Histoplasmosis is caused by a fungus that leads to choroiditis; it does NOT cause a breakdown in the blood retinal barrier and does NOT present with a vitritis! Remember BOTH EYES and MULTIPLE LESIONS

Answer 179

pathological myopia has a genetic predisposition, with elongation of the globe beginning in early childhood. Occurs in 2% of the population, most commonly in women during young adulthood. The condition is also referred to as myopic degeneration

Answer 180

defined as a refractive error >-6.00D spherical equivalent and/or axial length >26.5mm. Axial lengthening in the anterior-posterior direction results in scleral thinning and choroidal atrophy

Answer 181

>-6.00D | >26.5mm

Answer 182

patient may be asymptomatic or complain of decreased vision and metamorphopsia

Answer 183

* Posterior staphyloma (the hallmark of pathological myopia): posterior bulging of the weakened sclera * Oblique insertion of the optic nerve * Fuch’s spots (focal subretinal hyperpigmentation secondary to scarring or CNVM * Lacquer cracks * Macular holes

Answer 184

* Lattice degeneration * Snail track degeneration * Pavingstone degeneration * Retinal breaks * Retinal detachments

Answer 185

* Premature cataracts (NS and esp PSC) * Extensive vitreous syneresis * PVD

Answer 186

occur in about 5% of high myopes. They appear as fine yellow irregular lines that represent large breaks in Bruch’s membrane. Choroidal neo can result and lead to severe vision loss. Lacquer cracks frequently present in young males and may be one of the earliest findings in pathological myopia

Answer 187

discrete, circular areas of yellow-white chorioretinal atrophy in the retinal periphery. Also referred to as cobblestone degeneration. This condition is not a predisposing factor for a RD and has no clinical importance

Answer 188

more common in females. Prevalence increases with age; occurs in 2% of patients older than 50, and 20% of patietns older than 75 ‣ The condition is often idiopathic but may be caused by PVDs, retinal breaks, cataract or other intraocular surgeries, and trauma

Answer 189

ERMS result from glial cell proliferation on the ILM. Vitreous traction can result in residual glial cells from the posterior hyaloid (back of the viteous) on the ILM, or can cause small pores to develop in the ILM; this allows intraretinal glial cells to gain access to the anterior side of the ILM for proliferation

Answer 190

may be asymptomatic or complain of decreased vision and/or metamorphopsia

Answer 191

mild ERMS are characterized by fine, glistening membrane (cellophane maculopathy). Advanced ERMS appear as thick, gray-white membranes with associated retinal folds (macular pucker)

Answer 192

83% of cases are associated with aging; women are more commonly affected

Answer 193

results from posterior vitreous traction on the macula. Most commonly idiopathic (senile), but may also develop after trauma, surgery, CME, or inflammation. The condition has a bilateral onset in 25-30% of cases. The risk of developing a macular hole in the fellow eye varies from 5-16% (there is no risk of a PVD has occurred)

Answer 194

decreased vision and/or metamorphopsia. Full thickness macular holes are assocaited with 20/200 or worse vision

Answer 195

condition is characterized by a round, red, well delineated spot in the macula.

Answer 196

impending hole with loss of the foveal depression and a yellow spot or ring at the fovea

Answer 197

round, small, full-thickness hole with a pseudo-operculum

Answer 198

large, full thickness hole with an operculum. Patients will report a positive Watzke-Allen sign

Answer 199

stage 3 plus a PVD

Answer 200

characterized by a complete break in the middle of a thin line of light projected within the macula

Answer 201

determine the patients BCVA prior to starting the test. Howl a bright light 2cm from the patient’s eye and instruct the patient to look at the light for 10s. Measure the time it takes for the patient to read one line less than his/her BCVA. Norma recovery time is less than 60s.

Answer 202

Waves within the choroid, Bruchs membranes, and RPE that develop secondary to mechanical stress on or within the choroid. Characterized bu alternating light and dark striations within the fundus. Macular involvement may lead to symptoms of metamorphopsia and reduced VA

Answer 203

◦ Commonly the result of ocular or systemic conditions that cause mechanical stress on the choroid, including choroidal, optic nerve, or orbital tumors, posterior scleritis, choroidal detachment, choroidal inflammation, orbital pseudotumor, TED, orbital myositis, hypotony, and intracranial HTN

Answer 204

group of disorders characterized by a mutation in the genes responsible for the production of melanin. Albinism may affect the skin and eyes (oculocutaneous) or the eyes only (ocular albinism)

Answer 205

characterized by hypopigmetnation of the skin and fundus, it is translucency, foveal hypoplasia, ON hypoplasia, icrocornea, nystagmus, strab, and mis-routing of the temporal optic nerve fibers through the optic chiasm

Answer 206

photophobia and reduced VA

Answer 207

Hermanksy-Pudlak and Chediak-Higashi syndromes.

Answer 208

the most common retinal dystrophy and can be non-heritable or heritable (most commonly AD), or in association with uncommon systemic disorders; Ushers syndrome (5% of RP patients) is the most common associated systemic condition. The average age of diagnosis is 9-19.

Answer 209

Ushers - AR - hearing loss

Answer 210

generic term given to a group of hereditary conditions (29 loci associated with various phenotypes) characterized by a progressive loss of PR and RPE function. Although rods and cones are involved, rod damage is more dominant. There is tremendous variability in presentations, which correlates with the mode of inheritance

Answer 211

night blindness (most common symptom) and peripheral vision loss (only in dim light in early stages). It often takes years to decades for symptoms to develop; by 30 years of age, over 75% of patients are symptomatic

Answer 212

classic triad of retinal bone spicule pigmentation (pigment clumping in the mid-periphery), arteriolar attenuation, and waxy optic nerve pallor ‣ Other signs include PSC, optic disc drusen, macular changes (atrophy, CME, ERMs), keratoconnus, myopia, and progressive contraction of the VF

Answer 213

can be utilized for dx; in the early stages of RP, the scotopic ERG is reduced, and the photopic ERG is relatively normal.

Answer 214

Stargardts disease is the most common hereditary macular dystrophy. The onset is typically in the first Ir second decade of life, most commonly between the ages of 6 and 20. The inheritance is typically AR. There is no sex predilection

Answer 215

most often due to a mutation in the ABCA4 transmembrane protein that is responsible for moving all-trans retinal from the photoreceptor disc lumen to the cytoplasm. This results in a toxic accumulation of all-trans retinal within the PR discs, leading to degeneration of the PRs and the RPE. Fundus flavimaculatus and stargardts disease are considered variants of the same disorder

Answer 216

diagnosis is reserved for patients WITHOUT macular dystrophy signs; it often presents later in life. Patients are commonly asymptomatic, although vision loss can still occur if fleck like lesions involve the macula

Answer 217

rapid vision loss and color vision abnormalities. The level of decreased vision is often out of proportion with the fundus appearance in the early stages of the disease. Acuity is typically 20/200 bu the third decade and is stable or slowly progressive thereafter

Answer 218

early stages are characterized by bilateral yellow flecks scattered in a pisciform configuration throughout the posterior pole and mid-periphery. Non-specific RPE mottling of the macula May also be apparent. Later stages are characterized by a classic “beaten bronze” macular appearance (“bulls eye maculopathy”) and “salt and pepper” pigmentary changes in the periphery.

Answer 219

ERG is normal in the early stages of the disease, but becomes abnormal as the condition progresses

Answer 220

inheritance is X linked recessive, so only males are affected and all daughters are carriers. Onset is typically within the 1st decade

Answer 221

due to deficiency in rab geranyl-geranyl transferase, an enzyme utilized in membrane metabolism

Answer 222

night-blindness and peripheral vision loss. Night blindness occurs early in life in males and progresses to total night-blindness within a period of 10 years. Most patients have good visions until 50-60 years of age. In females, the condition is benign and non-progressive.

Answer 223

progressive, bilateral, diffuse atrophy of the ROE and choriocapillaris, causing exposure of the underlying sclera. The macula is often spared until late stages of the disease. The optic disc and retinal blood vessels are often unaffected

Answer 224

gyrate atrophy, choroidermia, and RP

Answer 225

onset within 1-3rd decade. Inheritance is variable, but most commonly AD

Answer 226

slowly progressive decrease in central vision, severe photophobia, and severe color vision loss; symptoms are worse during the day. Cone dystrophy has a poor prognosis, with vision deteriorating to 20/400 by the 4th decade

Answer 227

‣ Early-normal fundus appearance by abnormal cone function on the ERG ‣ Late-central GA of the RPE with a bulls eye macular appearance, vessel attenuation, and temporal pallor of the optic nerve (similar to RP) with severe deutan-tritan color defects, an abnormal photopic ERG, and fine nystagmus

Answer 228

stargardts disease, progressive cone dystrophy, chloroquine and hydroxychloroquine toxicity, and thioridazine toxicity

Answer 229

uncommon condition. Inheritance is AD. The age of onset varies but the condition classically presents in early childhood

Answer 230

due to abnormal accumulation of material (posibly lipofuscin) in the RPE

Answer 231

the majority of cases are detected with little or no patient symptoms (75% better than 20/40). Patients eventually complain of decreased vision

Answer 232

characterized by a bilateral, yellow, round, subfoveal (“egg yolk”) lesion

Answer 233

thought to be an abnormal accumulation of lipofuscin within the RPE cells. The egg-yolk can remain stable for years with only a mild reduction in VA (20/30-20/50) into midlife

Answer 234

previtelliform): characterized by an abnornal EOG (Arden ratio < 1.8) with a normal fundus in an asymptomatic patient

Answer 235

vitelliform): egg-yolk macular lesion appears; this is most likely to occur between the ages of 3-15

Answer 236

pseudohypopyon): the entire lesion can become absorbed with little to no affect on vision.

Answer 237

vitelliruptive): the egg yolk starts to break up (scrambled egg), mild VA loss is expected at this stage

Answer 238

(end stage): characterized by moderate to severe vision loss due to choroidal neovascularization, hemorrhage, atrophy, and/or macular scarring

Answer 239

normal ERG but abnormal EOG (even prior to vision loss or fundus signs)

Answer 240

present in patients aged 30-50. Although similar signs to Bests, overall prognosis is better with minimal metamorphopsia, mild VA loss, normal EOG and ERG and slight tritan color defect.

Answer 241

inheritance is AR, symptoms are prevalent in most patients by age 10

Answer 242

bilateral chororetinal degeneration due to a deficiency in the mitochondrial enzyme ornithine aminotransferase. Ornithine blood plasma levels will be high and can help in the dx if the clincal picture is unclear

Answer 243

nyctalopia (night blindness), decreased vision, constricted VF

Answer 244

multiple, well-defined, scalloped areas of peripheral chorioretinal atrophy; the lesions being in the midperiphery during childhood and then coalesce to engulf most of the posterior pole, with the macula being spared until the 4th or 7th decade. Associated with PSC, high myopia, and astigmatism

Answer 245

occur more often in males, typically over the age of 45 years old. Risk factors for RRD include ‣ Previous ocular surgery. Pseudophakic RDs often reuslts from small retinal holes at the vitreous base ‣ PVD: 10-15% of patients with an acute symptomatic PVD will have a retinal break ‣ Trauma ‣ Family history of RRD or previous occurrence of RRD. Both eyes are eventually involved in about 10% of cases. ‣ Myopia: 40% of all RDs occur in myopic eyes ‣ Lattice degeneration

Answer 246

result from retinal breaks (full thickness retinal defects) that allow vitreous into the subretinal space, leading to separation of the sensory retina from the underlying RPE. Breaks include atrophic holes and vitreo-retinal traction tears

Answer 247

The term BREAK=atrophic HOLES and traction TEARS. Thus an RRD refers to a retinal detachment that was caused by a hole or a tear

Answer 248

round, often small, full-thickness defects that are NOT associated with vitreoretinal traction and therefore have a low risk for subsequent detachment. Holes are caused by chronic atrophy of the sensory retina and are most likely to be located in the temporal retina (superior > inferior quadrant)

Answer 249

caused by vitreous traction. Types of retinal tears include flap (horseshoe) takers and operculated tears

Answer 250

more serious)-the flap is present because of uneven vitreous traction; vitreoretinal traction often persists in these cases (vitreous stays attached to the flap), increasing the risk of a retinal detachment compared to operculated tears

Answer 251

the initial vitreoretinal traction resutls in an even, symmetric tear. After forming the tear, the vitreous pulls away and vitreoretinal traction no longer persists, reducing the risk for a RD

Answer 252

classic symptoms include vitreous floaters, flashing lights (photopsia), a curtain or veil over the vision, and decreased acuity

Answer 253

The quadrant location in which a patient reports flashes of lights is of no value in predicting the location of a the primary retinal break; however, the quadrant location for VF defects is often valid. For example, if the field defect is reported in the inferior nasal quadrant, a superior temporal retinal break is expected

Answer 254

convex undulating retina with clear subretinal fluid that does not shift with body position; Shafer’s sign (pigment cells in AC) may or may not be present. Additional signs may include a mild iritis and lower IOP in the affected eye

Answer 255

pigment demarcation line will be present (3 months or longer). Additional signs include intraretinal cysts, fixed folds, and/or subretinal precipitates

Answer 256

the ST quadrant is the most likely location for a retinal break in patients with and RRD. 50% of eyes with an RRD will have more than one retinal break; in most of these cases the breaks are located within 90 degrees of one another.

Answer 257

◦ Lattice is present in 6-10% of patients; 20-33% of patients with RRDs will have lattice degeneration; however only 1% of patients with lattice degeneration develop RRDS ◦ Lattice is an area of peripheral retinal thinning that is typically circumferential and concentric with the ora serrata. ◦ The inner portion of the lesion is atrophic (thin), while the outer margins of the lesions have a firm adhesion to the vitreous. The majority of lesions DO NOT contain the criss cross pattern of white sclerosed vessels; only 12% of patients have this classic appearance

Answer 258

often bilateral and mor commonly located temporally and superiority

Answer 259

Patients with Marfans syndrome, Sticklers syndrome, and Ehlers Danlos syndrome can have lattice like lesions (atypical lattice) that increase the risk of RD

Answer 260

small, focal areas of vitreous traction located in the retinal periphery. They occur in 5% of the population and are the second most common peripheral retinal lesion associated with RD (lattice is first); less than 1% of patients with vitreoretinal tufts develop a RD

Answer 261

Serous | Tractional

Answer 262

result from subretinal disorders that damage the RPE and a,low fluid accumulation under the retina. Examples include ARMD, inflammatory conditions, vascular conditions, neoplasms, and miscellaneous causes. Patients with exudative RDs are typically asymptomatic, unless the detachment involves the macula

Answer 263

most commonly caused by PDR, ROP, and proliferative sickle cell retinopathy. Patients with TRDs usually do not have complaints of flashes and floaters and may be completely asymptomatic. Possible symptoms include decreased vision or progressive VF defects

Answer 264

occurs in 4-7% of the general population; more common in patietns 40 years or older

Answer 265

degenerative process that results from a splitting of the OPL and the INL, resulting in elevation of the inner retina that mimics a RD

Answer 266

typically asymptomatic; vision loss is rare

Answer 267

dome shaped bullous elevation most commonly located inferiorly/temporally. Unlike a RD, the retina i immobile, bilateral findgins are common, and an absolute VF defect will correspond to the area of elevation ‣ 70% of patietns are hyperopic ‣ “Snowflake” or “frosting” and sheathed retinal vessels occur in the elevated retinal layer of the retinoschisis ‣ Inner wall breaks and outer wall breaks can occur in a retinoschisis. Outer wall breaks are more dangerous- they are required to cause a retinoschisis-associated RD. Outer wall breaks will appear “pock marked” on scleral depression. They can be surrounded with laser treatment to prevent an RD

Answer 268

‣ Inner wall breaks and outer wall breaks can occur in a retinoschisis. Outer wall breaks are more dangerous- they are required to cause a retinoschisis-associated RD. Outer wall breaks will appear “pock marked” on scleral depression. They can be surrounded with laser treatment to prevent an RD

Answer 269

large breaks in Bruch’s membrane that result from damage to the elastic core of Bruch’s membrane. 50% of cases are idiopathic; the remaining cases are caused by systemic disease

Answer 270

Remember PEPSI for the most common causes of angioid streak: PXE (by far the most common cause), Ehlers Danlos Syndrome, Paget’s disease, Sickle-cell disease, and idiopathic

Answer 271

may be asymptomatic or have profound vision loss from CNVM. 70% of patients will eventually have some form of vision loss

Answer 272

spoke like (around the disc), linear, well-demarcated red/orange or brown lines within the elastic core of Bruch’s membrane

Answer 273

caused by toxocara canis or cati, which is the intestinal nematode in dogs or cats

Answer 274

patients may complain of floaters and blurred vision

Answer 275

ocular infection causes a significant unilateral inflammation response, resulting in optic nerve edema, RD, vitritis, endophthalmitis, and subretinal granulomas. large, white chorioretinal scars are present after the active infection has resolved

Answer 276

form of posterior uveitis that is characterized by inflammation of the choroid and retina. Examples include toxoplasmosis, toxocariasis, sarcoidosis, syphilis, CMV, serpiginous choroidopathy, birdshot, TB, and onchocerciasis

Answer 277

◦ Occurs acutely in young adults, typically after a viral illness. Characterized by bilateral, yellowish, flat, subretinal lesions. Disc edema and RD may also occur ◦ Usually resolves without treatment after a few weeks

Answer 278

◦ An AD condition characterized by bialteral large areas of GA in the macula. Will cause vision loss in the 4-5th decade. Poor prognosis

Answer 279

results from choroidal thinning and may cause an exaggerated tigroid fundus appearance due to increased visibility of the choroidal vasculature

Answer 280

Tractional

Answer 281

the most likely source of an optic neuropathy. It is a leading cause of irreversible blindness worldwide. In the US, it is estimated that 2.79mill people have POAG, and this number is expected to increase in the future. The following will focus on subjects related to glaucoma

Answer 282

Ocular HTN

Answer 283

◦ IOP-the only risk factor we can control! ◦ Race-AA-4-5x more likely to develop glaucoma ◦ Family Hx:overall proportion of POAG related to genetics is around 16%. Having a first degree relative (parent, sibling, child) with glaucoma is associated with a 3 to 4 fold increase risk of POAG ◦ Age-greater than 90% of those with glaucoma are over the age of 55 ◦ Thin corneas

Answer 284

* <555um=higher risk * 555-588um=no change of risk based on CCT * >588um=lower risk

Answer 285

damage to the optic nerve. Larger C/Ds, asymmetry between the optic nerves, focal vertical thinning or notching, nerve fiber bundle defects, and vascular signs (baring, hemorrhages) are important clinical signs. Recall that the larger the optic disc, the larger the expected cup size

Answer 286

suggests that normal optic nerves should have the most rim tissue in the inferior quadrant, then superior, nasal, and the temporal quadrant (thinnest). However, glaucoma may initially damage the inferior OR superior rim

Answer 287

◦ Initial field loss is variable, but nasal steps are the most common. Paracentral and arcuate defects are also relatively common

Answer 288

usually asymptomatic until later stages when significant peripheral or central vision is lost

Answer 289

vascular birthmarks that have a high association with ipsilateral glaucoma (45% of cases). It is rarely associated with systemic disorders-most notably Sturge-Weber syndrome (5% of cases)

Answer 290

age related systemic condition that is most commonly in caucasians, especially those of Scandinavian decent. PXE is the most common identifiable cause of elevated IOP and resultant glaucoma

Answer 291

Pseudoexfoliation syndrome

Answer 292

characterized by abnormal, white, flaky despots whose exact compilation and cause of formation remain unknown. The flaky deposits are found throughout the body and may have systemic implications ◦ In the eye, these deposits can be found on the pupillary margin, on the lens capsule in a bulls eye pattern, on the lens zonules, and in the TM ◦ Gonio often reveals a Sampoalesi’s line due to the accumulation of pigment that is releases as the deposits rub against the posterior iris epithelium.

Answer 293

increased pigmentation anterior to Schwalbes line; it is assocaited with PES and PDS

Answer 294

poor pupil dilation and an increased risk of lens subluxation and cataract surgery complications due to weak lens zonules

Answer 295

majority of patients present with unilateral or bilateral asymmetric pseudoexfoliative glaucoma. The risk of developing glaucoma is 15% within 10 years

Answer 296

Condition that is usually bilateral, more common in caucasians, and presents in young patients. The condition is more common in myopes and males. ‣ Pigmentary dispersion Syndrome is thought to resutls from higher anterior chamber pressure that causes excessive bowing of the iris posteriorly, resulting in more contact between the iris and lens zonules; this leads to pigment shedding off the posterior edge of the iris

Answer 297

often asymptomatic, but may have blurred vision and halos around lights after exercising or pupil dilation

Answer 298

TIDs, Krukenburg’s spindle (vertically oriented line of pigment on the corneal endo), pigment on the anterior capsule of the lens and the iris surface, and TM hyperpigmentation

Answer 299

Pigment dispersion syndrome may burn out over time as the lens thickens, resulting in less contact between the posterior iris epithelium and lens zonules

Answer 300

risk of glaucoma at 5 years is 10% and 15 years is 15%

Answer 301

characterized by a wide open angle with a recessed iris and widened ciliary body band. It is most often unilateral and results from blunt trauma. Although the angle appears wide open, the TM is damaged, resulting in an increased risk of glaucoma over time. 10% of patietns with angle recession involving at least 2/3 of the angle will develop glaucoma

Answer 302

Females are at a greater risk and the condition has the highest prevalence among Japanese patients. Additional risk factors include vascular disorders such as Raynaud’s phenomenon or migraines, low blood pressure, sleep apnea, hypercoagulation, and taking BP meds before bedtime (may decrease ocular perfusion pressure)

Answer 303

Before dx NTG, it is important to take diurnal IOP readings to ensure the diagnosis is truly NTG rather than POAG. This who develop NTG typically have IOPs in the high teens.

Answer 304

similar to those of POAG, but Drance hemorrhages are more common in NTG. Initial VF defects in NTG are usually more focal (but more dense) and closer to fixation because the temporal and interotemporal rim tissue is more commonly affects first (compared to POAG)

Answer 305

Since IOP is within the normal range in NTG, it is important to rule out other possible sources of the optic neuropathy, especially cases of suspected unilateral NTG. Consider asking about a history of hemorrhagic shock, myocardial infarction, anemia, syphilis, and vasculitis

Answer 306

• can be acute or intermittent (sub acute) and occurs as a result of the posterior pressure in the posterior chamber pushing the peripheral iris anteirorly into contact with the TM, blocking part or all of the TM and impeding aqueous outflow. The pupil may or may not be blocked in angle closure glaucoma

Answer 307

Pupillary block | PI

Answer 308

occurs in patients with anatomically narrow angles (hyperopes) when the aqueous flow through the pupil is blocked (usually by the lens but can also be the vitreous). Patients are most at risk for angle closure when the pupil reaches the mid position after coming down from dilation, as this is the point of greatest iris-lens contact

Answer 309

hyperopes, advancing cataracts, Asians and eskimos, and lens subluxation

Answer 310

characterized by anteriorly positioned ciliary processes that push the peripheral iris forward into contact with the TM. Slit lamp and gonio reveals a flat iris plane, a normal central anterior chamber depth, but a convex peripheral iris.

Answer 311

peripheral iridotomy or iridectomy can be performed to differentiate pupillary block from plateau iris configuration; in the latter, the peripheral iris proximity to angle structures will be unchanged after the procedure.

Answer 312

occurs when part of the angle closes, causing episodes of elevated IOP without patient symptoms. Subacute angle closure is more common than acute angle closure. Chronic angle closure should be expected in patients with occludable angles and any of the following signs ‣ PAS or pigment splotching the TM ‣ Progressive optic nerve damage with corresponding VF loss

Answer 313

defined as angle closure (no TM visible with gonio) causing an acute IOP spike (50-100mmHg) and patient symptoms. Signs and symptoms include: ‣ Vomiting, intense ocular pain, HA, halos, nausea, and progressive vision loss. ‣ Prominent signs include a hazy cornea, mid-dilated pupil that responds poorly to light, ciliary flush, and glaucomflecken ‣ IOP must be quickly lowered so that corneal edema will resolve, allowing for a peripheral iridotomy

Answer 314

anterior subcapsular opacities that resutls from lens epithelial cell ischemia and necrosis secondary to high pressures

Answer 315

CRAO | occurs when IOP is higher than the prefusuion pressure of the CRA

Answer 316

used for treating migraines, weight loss, epilepsy, can cause acute secondary angle closure. It causes supraciliary effusion, which moves the lens and iris forward into contact with the TM, resulting in angle closure. This typically occurs within the first month of use or if the dosage is increased

Answer 317

higher risk for developing open angle component of glaucoma due to TM and ONH damage. Will manifest as high IOP with ON damage with an open angle on gonio, and may be immediate or years later. Pts with narrow angle AND open angle component of glaucoma have mixed mechanism glaucoma

Answer 318

Pts with narrow angle AND open angle component of glaucoma have mixed mechanism glaucoma

Answer 319

CRVO | -followed by PDR, OIS, and RD. Carotid artery disease and CRAO are less common causes

Answer 320

rubeosis of the iris. The pupillary margin should be examined closely for capillary tufts or early signs of neo.

Answer 321

‣ Neo of the angle is always accompanies by fibrous tissue that forms a membrane over the TM, preventing aqueous outflow. A significant fibrous membrane can develop even with only 1-2 vessels on the angle ‣ The fibrovascular membrane can stick to the iris, pulling it into contact with the TM and causing secondary angle closure. This is known as “zippering of the angle”

Answer 322

Uveitic glaucoma

Answer 323

will only cause an elevation in IOP when there is 360 degrees of attachment between the iris and the lens. This results in iris bombe and pupillary block, which moves the iris anteriorly into contact with the TM

Answer 324

PAS will cause varying degrees of IOP elevation depending on the extent of angle involvement

Answer 325

very important to manage uveitis aggressively to prevent the formation of PS and PAS. If PS occur during the current epidose of inflammation, every effort should be made to break them. Once the current uveitis episode resolves, PS can only be removed surgically

Answer 326

◦ Onset is typically birth to 3 months of age; the condition is most often bilateral and is more common in males. Congenital glaucoma results from a developmental abnormality in the AC that impedes aqueous outflow

Answer 327

Buphthalmos

Answer 328

ICE syndromes

Answer 329

‣ Essential Iris atrophy-iris thinning with resultant heterochromia, polycorea, corectopia, and ectropion uvea ‣ Chandler’s syndrome-the corneal endothelium will have a”Beaten metal” appearance with corneal edema and corectopia ‣ Iris-Nevus-Syndrome (Cogan-Reese Syndrome)-Nodules will be present on the anterior iris surface

Answer 330

- glaucomatocyclitic crisis (Posner-Schlossman syndrome) - Fuch’s Heterochromic iridocyclitis - Phacolytic glaucoma

Answer 331

• Glaucomatocyclitic Crisis: AKA Posner-Schlossman syndrome

Answer 332

Fuchs heterochromic iridocyclitis

Answer 333

Pahcolytic glaucoma

Answer 334

glaucoma is characterized by retinal ganglion cell death and corresponding RNFL loss. Upon clinical exam, the RNFL loss can be difficult to see, especially if it is early or mild. In an effort to detect structural optic nerve damage earlier, computerized instruments have been developed to detect mild changes in the RNFL. They may also be helpful to detect progression

Answer 335

‣ GDx uses scanning laser polarizer to detect thinning of the RNFL ‣ OCT uses optical coherence tomography ‣ HRT uses confocal scanning laser ophthalmoscopy for a topographical evaluation of the ONH and peripapillary rim

Answer 336

• The OCT Stratus (zeiss) is a time domain system and the Spectralis (Heidelberg) and Cirrus (zeiss) are spectral domain systems. Spectral domain results in better resolution and is faster and more sensitive. Swept source, the newest technology, is even better than spectral domain because if higher sensitivity and speed

Answer 337

the retinal ganglion cells are densest in the macula; studies have shown that patients with glaucoma show thinner areas in the macula that correspond with VF loss. There are 3 instruments that are capable of analyzing macular ganglion cell thickness: RTVue Ganglion Cell Complex Analyzer (optovue), Spectralis Posterior Pole Asymmetry Analyzer (Heidelberg), and CIrrus Ganglion Cell Analysis (Zeiss)

Answer 338

‣ RTVue measures the three innermost macular layers and compares the patients data to a normative database ‣ The spectralis does NOT have a normative database but allows for inter and intra-eye asymmetry results ‣ The cirrus measures only the ganglion cell-IPL complex and compares resutls to a normative database

Answer 339

performed in order to Dx the appropriate type of glaucoma. Additional indications include narrow angles on Van Herick, signs of PDS (TIDs and Kruckenberg spindle), iris neo, suspicious iris lesion, Hx of ocular trauma, or when following a CRVO

Answer 340

performed in order to Dx the appropriate type of glaucoma. Additional indications include narrow angles on Van Herick, signs of PDS (TIDs and Kruckenberg spindle), iris neo, suspicious iris lesion, Hx of ocular trauma, or when following a CRVO

Answer 341

: I Can See The Stupid Line=iris, CB, scleral spur, TM, Schwalbes line

Answer 342

the Humphrey VF is the most popular SAP threshold used

Answer 343

uses a yellow background with blue stimuli to detect early glaucomatous damage that is not detected with SAP

Answer 344

fast (90s per eye) screening field that uses sinusoidal gratings as the stimulus

Answer 345

100 degrees temporal, 60 degrees nasal and superior, and 70 degrees inferior. The blind spot is located 15 degrees temporal and 7.5 degrees in diameter

Answer 346

fixation loses, FP, FN, and short term fluctuations (STF)

Answer 347

determined by randomly retesting certain points. Poor performance on STFs could indicate poor reliability of early glaucoma

Answer 348

this is a gross representation of the VF. The darker areas indicate reduced sensitivity. This can be used for patient education purposes but has minimal value in interpretation

Answer 349

compares how well the patient did compared to the database of healthy, age-matched samples • A zero indicates the patient scored the same as the normative database. A positive number means the patient performed better than expected. A negative number means the patient performed worse than expected • The darker the probability box on the total deviation probability plot, the greater the patients response deviated from the expected response

Answer 350

filters out diffuse loss (cataracts) to show only focal areas of deviation that are more typical in glaucoma

Answer 351

compares sensitivity levels between the upper and lower hemifields. Remember that glaucoma often causes asymmetric ONH damage, resulting in an asymmetric field loss above and below the horizontal midline. The GHT will state WNL, borderline, ONL, or reduced sensitivity

Answer 352

this gives a measure of the rate of visual field loss over time and is given as a % of normal. 100% means no loss of the VF, 0% means total blindness

Answer 353

Mean deviation (MD): the average of the differences between the patients overall sensitivity and the overall sensitivity of the normative database. MD is an indication of diffuse loss; the more negative the MD, the more general depression in the VF

Answer 354

compares the patients shape of the hill of vision to the shape of the hill of vision of the normative database. PSD indicates focal areas of depression that are typical in glaucoma. It is always an absolute value; higher PSD means greater focal VF loss.

Ocular Disease:posterior Flashcards

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