Posterior pole lesions

Question 1

Where is a naevus likely to be?

Answer 1

Choroid or sclera

Question 2

What is a risk factor for naevi?

Answer 2

Caucasian

Question 3

What are the signs of a naevus?

Answer 3

Slate grey colour
Feathery margins
No subretinal fluid
Maybe drusen and/or a hypopigmented halo

Question 4

What investigations can be done for a naevus?

Answer 4

OCT
Ultrasound
Auto fluorescence

Question 5

How should naevi be managed in primary care?

Answer 5

6/12 recall if not suspicious, then 12/12

Question 6

How should naevi be managed in secondary care?

Answer 6

1-2 suspicious features: 4-6/12 recall
3+ suspicious features: refer to ocular oncology

Question 7

What is a risk factor for melanoma?

Answer 7

Older age (peaks at 60)

Question 8

What are the signs of melanoma?

Answer 8

Elevation
Sub-retinal
Grey-brown or no colour
Overlying lipofuscin
Possible haem/subretinal fluid
Close to disc (60% within 3mm)

Question 9

What investigations can be done for melanoma?

Answer 9

MRI
Biopsy
Tumour analysis
Systemic investigation

Question 10

How should melanoma be managed?

Answer 10

Urgent referral - will be further referred to ocular oncology

Question 11

What are some further signs of melanoma?

Answer 11

Feeder vessels
Choroidal folds
Inflammation
Iris neovasc
Glaucoma
Cataract

Question 12

How can melanoma be treated?

Answer 12

Brachytherapy (small tumours with good chance of saving sight)
External beam radiotherapy
Sterotactic radiotherapy
Enucleation
Trans-pupillary thermotherapy
Trans-scleral choroidectomy

Question 13

What acronym can help identify a melanoma?

Answer 13

To Find Small Ocular Melanoma (Using Helpful Hints Daily)
Thickness over 2mm
Fluid (present subretinally)
Symptoms (present)
Orange pigment (lipofuscin)
Margin (within 3mm of disc)
Ultrasound Hollowness
Halo (none)
Drusen (none)

Question 14

What are the signs of a choroidal hemangioma?

Answer 14

Oval
Orange
Indistinct margins
Subretinal fluid
Hyperfluorescence on ICG

Question 15

What is a choroidal haemangioma?

Answer 15

Mass of vascular channels within choroid

Question 16

What can a choroidal haemangioma cause?

Answer 16

Exudative RD

Question 17

When does a melanocytoma usually present?

Answer 17

50 years old

Question 18

What are the signs of a melanocytoma?

Answer 18

Heavy pigment, usually at ONH
No sxs

Question 19

How should a choroidal haemangioma be managed?

Answer 19

Routine referral

Question 20

What are the risk factors for osteoma?

Answer 20

Female
Young adults

Question 21

What are the signs of an osteoma?

Answer 21

Flat
Orange
Well defined, scalloped edges
Near disc or posterior pole
Slow growth or regression
Possibly fine vessels/bone spicules

Question 22

What are the signs of metastatic disease?

Answer 22

Yellow (pale)
Elevated
Fast growing
Indistinct margins
Possibly overlying pigment changes
Multifocal and bilateral (often)

Question 23

Where does metastatic disease usually come from?

Answer 23

Lungs
Breast
GI tract
Kidney
Skin
Rarely, prostate

Question 24

What is the management for metastatic disease?

Answer 24

Urgent referral - systemic review if primary unknown

Question 25

What are the signs of retinoblastoma?

Answer 25

Leukocoria Strabismus Pain Red eye Secondary glaucoma Inflammation

Question 26

What are the signs of retinal astrocytoma?

Answer 26

Yellow Semi-transparent Nodular/mulberry like

Question 27

Does retinal astrocytoma need treatment?

Answer 27

No

Question 28

What are the signs of capillary haemangioma?

Answer 28

Round Orange/red Tortuous artery and vein to and from lesion Vision loss (due to haem, fibrosis, RD, secondary glaucoma)

Question 29

What is the treatment for capillary haemangioma?

Answer 29

Observation Laser Cryotherapy Brachytherapy Surgery PDT

Question 30

What are the signs of a cavernous haemangioma?

Answer 30

'Bunch of grapes' appearance Possible vitreous haem

Question 31

When would a cavernous haemangioma be treated?

Answer 31

When there is vitreous haem

Question 32

What are the signs of racemose haemangioma?

Answer 32

Enlarged tortuous vessels Possible VF defect

Question 33

What can a vasoproliferative tumour be secondary to?

Answer 33

Uveitis Trauma Retinal dystrophy

Question 34

What are the symptoms of a vasoproliferative tumour?

Answer 34

Blurred vision

Question 35

What are the signs of a vasoproliferative tumour?

Answer 35

Red/yellow globular, vascular mass

Question 36

What are the possible complications of a vasoproliferative tumour?

Answer 36

Exudation RD Macula oedema Fibrosis Haem

Question 37

What is the treatment for a vasoproliferative tumour?

Answer 37

Cryotherapy Brachytherapy

Question 38

What are the signs of primary vitreo-retinal lymphoma (PVRL)?

Answer 38

Intermediate uveitis Large multifocal sub-retinal infiltrates

Question 39

What is a sign of Hodgkin's intraocular lymphoma?

Answer 39

Multifocal lesions

Question 40

What is a sign of non-Hodgkin intraocular lymphoma?

Answer 40

Uveal infiltrates

Question 41

What is a sign of CNS B-cell intraocular lymphoma?

Answer 41

Sub-RPE infiltrates

Question 42

What are the signs of a CHRPE?

Answer 42

Flat or minimal elevation Dark grey/black Round/oval 4-5mm diam Well defined Depigmentation halo Lacunae Peripheral May enlarge

Question 43

What are multifocal CHRPE's also known as?

Answer 43

Bear tracks Polar bear tracks (if hypopigmented)

Question 44

What are the signs of atypical CHRPE?

Answer 44

Oval/spindle/comma/fishtail shape Bilateral Hypopigmented margins

Question 45

What are the signs of multifocal CHRPE?

Answer 45

No haloes/lacunae Often one quadrant only Unilateral

Question 46

What are the signs of combined harmatoma of retina and RPE?

Answer 46

Slight elevation Deep grey/brown Blends into RPE Vessel tortuosity Posterior pole - drags disc or macula Likely associated ERM and traction Poor vision (<6/60 in 50%) Strabismus

Question 47

When would combined harmatoma of retina and RPE be treated?

Answer 47

If CNV present

Question 48

What are the signs of congenital simple hamartoma of the RPE?

Answer 48

Small (<1.5mm) Jet black Nodular Well defined margins Full thickness RPE and retina, poss into vitreous

Question 49

Does congenital simple hamartoma of the RPE need treatment?

Answer 49

No

Question 50

What are the signs of adenoma and adenocarcinoma of the RPE?

Answer 50

Oval Pigmented Peripheral (often near CHRPE) Possibly prominent vessels