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Flashcards in Optho path Deck (28):

Flame hemorrhages

Located in Nerve fiber layer (most superficial hemorrhage)
- Erythrocytes track along axons


Blot and dot hemorrhages

Located deeper in retina where axons perpendicular to RPE/Bruch's membrane


Scaphoid (boat-shaped) hemorrhages

Hemorrhagic detachment of Inner Limiting membrane

Subhyaloid hemorrhage


Blood-retinal barrier

Inner retina: endothelial tight junctions

RPE apical tight junctions between layers

Outer retina= leaky fenestrated choriocapillaries


Hard exudates

Pools of proteinaceous fluid in outer plexiform layer (btwn inner and outer layer= watershed area)

Macular star figure= hard exudates in radial perifoveal Henle fibers


Cotton wool spots

"soft exudates", really focal infarctions of NFL (neurofiber layer)
- Marker for ischemia, systemic disease
- Blockage of axoplasmic flow

Focally ballooned axon--> cytoid body (resembles nucleus)
- Formed when ischemic


Central retinal artery occlusion

"Mini-stroke" of retina
- Normally transparent to allow light to reach rods and cones
- Infarction of retinal cells--> opacification

Window of transparent retina shows underlying choroid= "cherry red spot"

- Atherosclerosis of CRA at/posterior to lamina cribosa
- Emboli: cholesterol, platelet fibrin (carotids), Calficific, tumor (atrial myxoma in young patients
- Vasculitis (GCA, collagen vascular disease)


Central retinal vein occlusion

Massive intraocular hemorrhage= "squashed tomato sign"


Chronic HTN on retinal arterioles

Retinal arteriosclerosis
- Fibrosis due to HTN

Normal: Healthy retinal vessels are transparent
- Can only see BLOOD in vessels

Fibrosis--> opacifies vessel wall--> obscured blood column
- "copper wire" arteriolarsclerosis

In Malignant HTN--> Spasm of vessel walls
- Leads to necrosis
- Vascular incompetence
- Optic disc edema


Background diabetic retinopathy

Hard, soft exudates
Cotton wool spots= ischemia--> progresses to proliferative diabetic retinopathy

Early stages: capillary changes
- Pericytes are lost preferentially in early stages of diabetic retinopathy
- Pericytes have inhibitory effect on proliferation of endothelial cells

Later stages--> capillary nonperfusion
- Retinal ischemia--> VEGF upregulation
- Stimulates proliferation of new vessels


Proliferative diabetic retinopathy

Vitreoretinal neovascularization
- Leads to retinal detachment
- New vessels cannot invade vitreous gel
- Grow on back surface of vitreous when it detaches

Vessels--> fibrosis--> pulls retina anteriorly (with vitreous)--> detachment (traction)

Can see adhesions blocking aqueous drainage (VEGF--> neovascularization--> adhesions--> neovascular glaucoma)



Mold infection beginning in paranasal sinuses
- Invades eye
- ocular proptosis
- Eye no longer moves, must be removed
- See vascular infiltration by fungus


Retinal detachment

Outer 1/3 separated from choriocapilaris (loses nutrients)
- Leads to death of rods and cones if not promptly treated
- Can't regenerate


Rhegmatogenous Retinal Detachment

Horseshoe tear--> vitroretinal traction--> detachment
- See flashes of light + floaters (BAD sign)
- Can develop retinal hole
- Increased risk in myopes (eye outgrows vitreous)

Exudative retinal detachment : seen in malignant melanoma


Coats disease

Abnormal retinal vessels--> leak
- Secondary retina detachment
- See cholesterol crystals and protein in sub-retinal space



Opacification or optical dysfunction of crystalline lens

Four types:
1. Normal development= nuclear sclerosis
- Lens adds new layers in periphery
- Cells in center eventually dehydrate--> accumulate yellow-brown pigment

Surgical correction: patients complain of "blue vision"


Ectopia lentis

Spontaneous dislocation of lens
Occurs in heritable connective tissue disease
Ex: Marfan's= fibrillin-1 defect



Risk factor:
- Elevation of IOP (intra-ocular pressure)
- Damages nerve as it enters globe through lamina cribosa

Excess aqueous humor produced by ciliary body
Blockage of drainage through trabecular meshwork--> Schlemm's canal (most common type

Aqueous veins of asher= dilated veins on surface of eyeball draining excess aqueous humor

Can cause death of retinal ganglion cells
- Axonal atrophy
- Ganglion cells DON'T regenerate
- Surgery to protect/preserve what's there

Mueller's cells= span thickness of retina, only thing left once ganglion cells die

See cupping of optic nerve=
- Glaucomatous optic atrophy (bean pot)

Macula lutea (yellow spot/pigment on retina)
- Protects against damaging blue light wave


Uveal Malignant Melanoma

Most common ocular tumor in Caucasians (US/European)
- 1,800 new cases yearly
- May be pigmented

Almond shape--> rupture through Bruch's membrane--> mushroom shaped tumor

**50% mortality
- Liver mets seen in 90%

- Epithelioid cells present: 63% mortality in 15 years
- No epithelioid cells: 28% in 15 years



Leukocoria= white pupil
- Classical manifestation
- Can also have physiological leukocoria (white pupil due to looking 15 degree angle in photo--> see nerve)

US mortality= almost 0%
Worldwide= 50% (poor/no access to care)

Resembles mini brain tumor
- Arises from inner retinal layer (endophytic)
- Arises from outer retinal layer (exophytic)--> detachment (can be confused with Coate's disease

See enhanced mitotic activity
- Basophilic cells
- Cells outgrow blood supply--> die--> eosinophilic
- Apoptotic cells, scanty cytoplasm
- may see seondary calcification

Tumor= Blue
Calcium= Purple
Necrosis= pink

Photoreceptor Differentiation= Rosettes, Fleurettes
- Flexner-Wintersteiner rosettes
- Neoplastic rods and cones
- Tumor entirely composed of fleurettes= precursor to retinoblastoma

If tumor gets behind lamina cribosa= CHEMO
- Resect as much of nerve as possible
- Germline cases= bilateral retinoblastoma (occurs earlier)


Orbital lesions

Space occupying
- Cause ocular proptosis/exopthalmos

Direction of displacement= indicates location of orbital lesions

Ex. Mucocele (ethmoid)- eye lateral
Maxillary sinus- eye up



Due to blow-out fracture
- Eye sinks into space below
- Can also be caused by metastatic scirrhous breast carcinoma



Most common cause= Grave's disease
- Patchy chronic inflammation sparing tendon, fat
- Enlarged EOMs--> proptosis


Cavernous Hemangioma

Benign tumor
Can cause proptosis



Child with proptosis (esp. upper orbit)
- Malignant tumor of orbit
- Can be confused with infection/inflammation because it grows so quickly
- Stain for diagnosis

Botryoid= associated with conjunctiva


Teratoma of orbit

Congenital tumor



Eyes underneath skin
- Associated with Fraser Syndrome



- Nose ABOVE eye (nasal probosis)
- 2 small eyes fused together
- Related to sonic hedgehog abnormality

Also see holoprosencephaly
- Brain does not divide into 2 hemispheres