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Ophthalmology > Pathology of the retina and choroid > Flashcards

Pathology of the retina and choroid Flashcards

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1
Q

What is pathologic myopia?

A

Type of myopia that begins during childhood and progressively worsens, resulting in severe myopia by adulthood with an axial length >/= 26mm or refractive error >/= -6.00D)

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2
Q

What are some factors that can cause pathologic myopia?

A
  • Environmental and genetic influences cause increased axial growth of the eyeball
  • Often accompanied by degenerative changes in the retina
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3
Q

How does pathologic myopia present?

A
  • Blurred vision
  • Scleral thinning
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4
Q

What will fundoscopy show in pathologic myopia?

A
  • Lacquer cracks
  • Subretinal haemorrhage
  • Fuschs’ spot - degeneration of the macula; occurs due to proliferation of RPE associated with choroidal haemorrhage
  • Posterior staphyloma - outpouching of scleral tissue typically involving the optic disc or macula
  • RPE/choroid atrophy
  • Degeneration - cystoid, paving stone, lattice
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5
Q

What is shown?

A

Pathologic myopia

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6
Q

What is shown?

A

Pathologic myopia - Evaluates development of choroidal neovascularisation

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7
Q

How is pathologic myopia managed?

A
  • Annual checkups if stable
  • If CNV develops - anti-VEGF
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8
Q

What are some causes of retinal tears?

A
  • Age-related degeneration of the retina
  • Myopia
  • Eye injuries
  • Eye surgery e.g. cataract
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9
Q

What is a retinal hole?

A

An area of progressive thinning of the retina due to chronic retinal atrophy

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10
Q

What is a retinal break?

A

A full thickness defect in the sensory retina; when a retinal break is associated with vitreous traction (PVD), it is termed a retinal tear

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11
Q

How does retinal tear present?

A
  • Asymptomatic
  • May have photopsia or see floaters
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12
Q

How are retinal tears managed?

A
  • Management ofretinal tearsaims to create adhesions between the retina and the choroid to prevent detachment
  • This can be done using laser therapy or cryotherapy
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13
Q

What is a possible complication of retinal tear?

A

Retinal detachment

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14
Q

What is retinal detachment?

A

Refers to the detachment of the inner layer of the retina from the retinal pigment epithelium

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15
Q

What are the 2 forms of retinal detachment?

A

Rhegomatogenous
Non-rhegomatogenous

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16
Q

What is a rhegmatogenous retinal detachment?

A

Detachment of the retina caused by a tear or hole, with acute posterior vitreous detachment and predisposing peripheral retinal degeneration

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17
Q

What are some risk factors of rhegmatogenous retinal detachment?

A
  • Posterior vitreous detachment
  • Pathological myopia
  • Previous intraocular surgery
  • Trauma
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18
Q

What is non-rhegmatogenous retinal detachment?

A

Detachment without any retinal tears

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19
Q

What are the 2 forms of non-rhegmatogenous retinal detachment?

A

Tractional
Exudative

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20
Q

Describe the pathophysiology of tractional retinal detachment

A
  1. Formation of vitreoretinal bands (most commonly due to proliferative diabetic retinopathy)
  2. Pressure on the band during eye movement or as a result of sudden decrease in intraocular pressure
  3. Retinal detachment
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21
Q

Describe the pathophysiology of exudative retinal detachment

A

Subretinal fluid accumulation without retinal tears

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22
Q

What are some causes of non-rhegmatogenous retinal detachment?

A
  • Choroidal tumours - primary or metastatic
  • Intraocular inflammation - Harada disease, posterior scleritis
  • Systemic - toxaemia of pregnancy, hypoproteinaemia
  • Iatrogenic - RD surgery, excessive retinal photocoagulation
  • Miscellaneous - choroidal neovascularisation, uveal effusion sydrome
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23
Q

What are some symptoms of retinal detachment?

A
  • Painless, progressive visual field loss
  • Patients may describe a curtain/shadow descending or ascending on field of vision
    • Shadow corresponds to area of detached retina
  • If detachment affects macula, central vision will be lost
  • Sudden onset of floaters/flashes can preceed visual loss - indicates posterior vitreal detachment
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24
Q

What is a possible sign of retinal detachment?

A

RAPD

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25
What are some signs of rhegmatogenous retinal detachment on fundoscopy?
- Retinal tear may be visible - Detatched retina takes a convex shape - Deep mobile elevation extending to ora serrata (junction between retina and ciliary body) - Slightly opaque with dark blood vessels - Loss of choroidal pattern
26
What are some signs of non-rhegmatogenous retinal detachment on fundoscopy?
- Detatched retina takes a convex shape - Smooth elevation - May be very mobile deep with shifting fluid - Subretinal pigment (leopard spots) after flattening - No retinal tear visible
27
What is shown?
Rhegmatogenous retinal detachment
28
What is shown?
Non-rhegmatogenous retinal detachment
29
How is retinal detachment managed?
Various surgical options which aim to reattach the retina and reduce any traction or pressure that may cause it to detach again
30
What is posterior vitreous detachment?
Detachment of the posterior vitreous cortex from the internal limiting membrane of the retina
31
What are some causes of posterior vitreous detachment?
- Age-related degeneration of the vitreous body (most common cause) - Myopia - Eye injury
32
How does posterior vitreous detachment present?
- Usually asymptomatic - Photopsia with eye movements - caused by partially detached vitreous tissue pulling on the retina - Floaters - collection of deposits in the vitreous body of the retina perceived as spots or strings drifting through the visual field
33
What is shown?
Posterior vitreous detachment
34
What is shown?
Posterior vitreous detachment
35
How is posterior vitreous detachment managed?
No treatment necessary - symptoms improve as brain adjusts
36
What is a possible complication of posterior vitreous detachment?
Can predispose to patients developing retinal tears and retinal detachment
37
What is vitreomacular traction?
Incomplete posterior vitreous detachment with the persistently adherent vitreous exerting tractional pull on the macula and resulting in morphologic alterations and consequent decline of visual function
38
How does vitreomacular traction present?
- Metamorphopsia - Decreased vision
39
What investigation is required in vitreomacular traction?
Optical coherence tomography (OCT)
40
How is vitreomacular traction managed?
Options include observation, surgical management and medical therapy
41
What is central serous chorioretinopathy?
Serous retinal detachment at the posterior pole of the eyeball (macula or perimacular region) due to a defect in the pigment epithelium which allows fluid to leak from the sclera into the subretinal space
42
Who is most commonly affected by central serous chorioretinopathy?
Men 30-50 years old
43
How does central serous chorioretinopathy present?
- Hyperopia - Metamorphopsia
44
How will central serous chorioretinopathy present on fundoscopy?
Roundish detachment of central retina
45
What is shown?
Central serous chorioretinopathy
46
How will central serous chorioretinopathy present on fluorescein angiography?
Most common finding is a small, focal hyperfluorescent RPE leak
47
What is shown?
Central serous chorioretinopathy - Most common finding is a small, focal hyperfluorescent RPE leak
48
What is epiretinal membrane?
Scar tissue formation across the inner surface of the retina which can cause visual problems
49
What causes epiretinal membrane?
- Scar tissue most commonly forms due to age-related vitreous retraction - Can also form following eye surgery or inflammation inside the eye
50
How does epiretinal membrane present?
- Metamorphopsia - Decreased acuity
51
How will epiretinal membrane present on fundoscopy?
- Retinal striae - Subretinal fluid or cystic damage - Almost always associated with PVD
52
What is shown?
Epiretinal membrane
53
How is epiretinal membrane managed?
Surgery indicated if patient has significant visual complaints of visual decline and /or metamorphopsia
54
What is a macular hole?
Central small break in the macula
55
What are some causes of macular hole?
- Idiopathic - Secondary e.g. due to vitreous detachment, trauma
56
How will macular hole present?
- Metamorphopsia - Central visual field losses - Severe reduction of visual acuity
57
How will macular hole present on fundoscopy?
- Depending on the stage, a subfoveal spot or ring can be noted - In more advanced cases, a partial or full-thickness macular break is observed
58
What is shown?
Macular hole
59
How is macular hole managed?
There are conservative, medical and surgical options depending on the stage of the hole
60
What is cystoid macular oedema?
Retinal thickening of the macula due to accumulation of fluid in the outer plexiform layer
61
What are some causes of cystoid macular oedema?
- Postoperative - Uveitis - Retinal venous occlusive disease - Choroidal neovascularisation - Epiretinal membrane /VMT - Retinitis pigmentosa
62
How does cystoid macular oedema present?
Blurred/decreased central vision
63
How is cystoid macular oedema managed?
Majority (95%) of cases spontaneously resolve
64
What is chorioretinitis?
Inflammatory and exudative condition of the choroid and the retina (form of posterior uveitis)
65
What are some causes of chorioretinitis?
- Most often seen in immunodeficient patients e.g. HIV/AIDS - Usually a response to viral, bacterial, fungal or protozoal infection
66
What are some forms of chorioretinitis?
Acute retinal necrosis Endogenous chorioretinitis Toxoplasma gondii Ocular toxocaracanis
67
What causes acute retinal necrosis?
HSV/HZV
68
What causes endogenous chorioretinitis?
- 50% bacterial, 50% fungal e.g. candida - Associated with bacterial endocarditis or indwelling catheters including central lines
69
What causes toxoplasma gondii chorioretinitis?
- Congenital or acquired - Associated with contaminated soil and undercooked meat
70
How can toxoplasma gondii chorioretinitis present?
- Results in a mild flu-like illness and rarely causes any further problems - In immunocompetent patients it enters latent phase with cysts forming, can reactivate
71
What causes ocular toxocaracanis (Roundworm)?
- Ingestion with toxocara eggs (parasite hosted by cats and dogs) leads to systemic and ocular infection - Reactive inflammatory processes lead to the organism's encapsulation and the formation of eosinophilic granulomas - can cause irreversible visual loss if the egg has migrated to the eye - No proven treatment
72
What is shown?
Acute retinal necrosis
73
What is shown?
Endogenous chorioretinitis
74
What is shown?
Endogenous chorioretinitis
75
What is shown?
Toxoplasma gondii chorioretinitis
76
What is shown?
Ocular toxoxaracanis (Roundworm)
77
How will will older patients present with chorioretinitis?
- Older patients commonly present with reduced visual acuity with floaters - Degree of symptoms depends on where the inflammatory lesions lie - Symptoms are usually unilateral and tend to develop over several days
78
How will congenital chorioretinitis present?
Congenital infections may present insidiously, with little history and few symptoms
79
What investigations are required in chorioretinitis?
- Swab - culture (bacterial/viral), serology for toxoplasma and toxocara - Serology for toxoplasma and toxocara
80
How is chorioretinitis managed?
May involve observation or antimicrobials ± topical steroid treatment - depends on causative pathogen and other criteria
81
How is toxoplasma gondii chorioretinitis managed?
Systemic treatment if sight-threatening (clindamicin/azithromycin +/- steroids)
82
What is the most common cause of blindness in individuals over 65 in developed countries?
Age-related macular degeneration
83
What is thought to be the cause of ARMD?
Not clear - age-related, underlying inflammatory process
84
What are some risk factors of ARMD?
- Increasing age - Smoking - Positive family history - Poor nutrition
85
What are the 2 main types of ARMD?
Dry ARMD Wet ARMD
86
Describe the pathophysiology dry ARMD?
Deposition of drusden (accumulation of byproducts - proteins, lipids, and inflammatory mediators) in RPE and between RPE and Bruch membrane results in slow progressive atrophy of the local RPE
87
How does dry ARMD present?
- Gradual decline in vision - Central vision 'missing' (scotoma)
88
What is shown?
Scotoma (Central vision loss)
89
What will be seen on fundoscopy in dry ARMD?
- Drusen - Atrophic patches of retina
90
What is shown?
Dry ARMD
91
How is dry ARMD managed?
- No cure - treatment is supportive with low vision aids e.g. magnifiers - Magnifiers increase retinal image size, making object easier to see as scotoma stays the same size
92
Describe the pathophysiology of wet ARMD
- Neovascularisation in choroid, mediated by VEGF - New vessels are small and fragile → more likely to haemorrhage so more likely to result in visual loss
93
How does wet ARMD present?
- Rapid central visual loss - Distortion (metamorphopsia)
94
What will be shown on fundoscopy in wet ARMD?
Haemorrhage/Exudate
95
What will be shown on fluorescein angiography in wet ARMD?
96
What will be shown on OTC in wet ARMD?
97
How is wet ARMD managed?
Anti-VEGF
98

Ophthalmology (9 decks)

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