Posterior Chamber and Retinal Disorders Flashcards
(42 cards)
Describe what happens with a retinal detachment
Primary event is a retinal tear. Fluid vitreous passes though the tear and lodges behind the sensory retina.Combined traction and pull of gravity results in progressive detachment.
What are predisposing factors of retinal detachment?
Age – 50-75. Myosis. Cataract extraction. Trauma
Family history. Advanced diabetes
What are signs and symptoms of a retinal detachment?
Blurred vision in one eye, becoming progressively worse. Floaters, sometimes described as a large horsefly (photopsias). Flashing lights- caused by the tugging on the retinal surface by the separating vitreous (significant indicator).
What are treatments of retinal detachment?
Cryotherapy (freezing). Scleral buckle. Intravitral gas. Vitrectomy
Describe what happens with a central retinal artery occlusion.
Emboli enter and occlude the retinal artery
What are predisposing factors to a central retinal artery occlusion?
Age – mean is 60-80. Carotid artery disease. Atrial fibrillation. Hypertension. Diabetes. Temporal Arteritis
What are signs and symptoms of a central retinal artery occlusion?
Sudden profound monocular visual loss, Can be preceded by amarousis fugax, Painless, Can detect hand movements but can’t count fingers
What does a fundascopic exam show with central retinal artery occlusion?
Ischemic retinal whitening. Cherry red spot on macula or fovea. Arteriole narrowing. “boxcar” segmentation of the retinal veins.Marked afferent pupillary defect
What is a marked afferent pupillary defect?
When a light is shone in the abnormal eye of a patient with an APD, the pupil of the affected eye paradoxically dilates rather than constricts
What is treatment of central retinal artery occlusion?
Ocular massage. Anterior chamber paracentesis.
Revasularization techniques-Thrombolysis
What are systemic etiologies that are predisposing factors to a central retinal vein occlusion?
Increasing age. HTN. Coagulation disorders. Diabetes
What are ocular etiologies that are predisposing factors to a central retinal vein occlusion?
Raised intraocular pressure (> 25 mmHg) vein inflammation (vasculitis)
What are signs and symptoms of central retinal vein occlusion?
Visual impairment is commonly first noticed upon waking. Usually a sudden monocular loss of vision
PAINLESS
What does a fundoscopic exam reveal for a central retinal vein occlusion?
Minimal AfferentPupillaryDefect (APD). venous tortuosity / dilatation. Retinal hemorrhages. variable cotton-wool spots. mild to moderate disc edema. macular edema
What do patients who have a central retinal vein occlusion need to also be screened for?
diabetes, systemic HTN, hyperlipidemia and glaucoma.
What are patients who have a central retinal vein occlusion at high risk of developing?
neovascular glaucoma / proliferative retinopathy ~ 3 months later
What is amaurosis fugax?
Monocular loss of vision described as “a curtain passing VERTICALLY across the field of vision leading to complete loss of vision and then a similar curtain effect as the vision returns” lasting a few minutes with complete recovery
What is the usual cause of amaurosis fugax?
retinal emboli from ipsilateral carotid disease
What further testing should be done for amaurosis fugax?
evaluation of carotids by doppler ultrasound or CT/MRI angiography, have EKG to ensure A. Fib is not cause of emboli
What is treatment for amaurosis fugax?
low dose ASA,Ocular massage is <24 hours, Lower IOP
What are differential diagnoses of amaurosis fugax?
Impending central retinal artery/vein occlusion. Impending OPHTHALMIC artery occlusion. Carotid stenosis. Temporal arteritis. Ocular migraine
What labs should be done for amaurosis fugax?
CBC. Fasting blood sugar. ESR and CRP. Lipid profile
When should you suspect optic neuritis?
young patient with vision loss and no immediately obvious exam findings
What are signs and symptoms of optic neuritis?
Unilateral decreased vision over 1-3 days. Occasional pain with eye movement. Age 18-45 female
