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RETINA Flashcards

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1
Q

DDX of CSR

A

Non inflammatory:

  • HTN
  • optic pit
  • CNV
  • polypoidal
  • tumour- hemangioma/melanoma
  • CSR

Inflammatory:

  • VKH
  • SO
  • uveal effusion - posterior scleritsi

Infectious:

-TB/syphilis

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2
Q

Pigmentary disturbance

A
  1. Systemic disease
    1. Refsum
    2. ushers
    3. bardet biedel
    4. alstrom
    5. cockayne
    6. myotonic dystrophy
    7. kearns sayre
  2. Vascular occlusion
    1. OA, CRAO, BRAO occlusion
  3. Inflammatory
    1. diffuse uveitis
    2. DUSN
    3. WDS- AZOOR
  4. Infectious
    1. syphilis
    2. Toxo
    3. Rubella
  5. Trauma
    1. IOFB
    2. siderosis
    3. chronic RD
  6. Other
    1. paraneoplastic
    2. XLRS
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3
Q

Increased risk PVD

A
  1. increased AL
  2. age
  3. aphakia
  4. myopia
  5. uveitis
  6. trauma
  7. VH
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4
Q

worst prognosis in re attachment of RD

A
  1. uveitis
  2. PVR
  3. giant tear
  4. choroidal detachment
  5. posterior breaks
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5
Q

Peripheral NV

A
  1. vascular diseases
    1. PDR
    2. BRVO
    3. BRAO
    4. CCF
    5. sickle cell
    6. ROP
    7. FEVR
    8. ROP
    9. IRVAN
  2. inflammatory
    1. sarcoid
    2. retinal vasculitis - SLE
    3. pars planitis
    4. BSR
    5. toxo
    6. MS
  3. other
    1. IP
    2. chronic RD
    3. RP
    4. retinoschsis
    5. melanoma
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6
Q

Thickened choriod

A
  1. Non inflammatory
    1. CSR
    2. choroidal hemangioma
    3. melanoma
    4. primary CNS lymphoma
  2. Inflammatory
    1. VKH
    2. SO
    3. BDUMP
    4. uveal effusion syndrome
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7
Q

Retinoschisis

A
  1. degenerative
    1. typical or reticular
  2. congenital
    1. X linked
  3. secondary forms
    1. optic pit
    2. myopia
    3. vit traction
    4. retinal venous occlusion
    5. goldman favre
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8
Q

bulls eye maculopathy

A
  1. stargardts
  2. cone and cone rod dystrophies
  3. hydroxychloroquine/chloroquine
  4. ARMD
  5. chronic macular hole
  6. central areolar choroidal dystrophy
  7. olivopontocerebellar atrophy
  8. batten disease
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9
Q

Cherry Red spot

A
  1. Gangliosidosis
  2. Tay Sachs
  3. Sandhoff disease
  4. Niemann Pick
  5. Sialidosis
  6. metachromatic leukodystrophy
  7. CRAO
  8. trauma
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10
Q

Pigmentary retinopathy and hearing loss

A
  1. Usher
  2. Alport
  3. Alstrom
  4. Cockayne
  5. Refsum
  6. Rubella
  7. Hurler
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11
Q

hydroxychloroquine toxicity

A

Risk of toxicity- <1% 5 years, <2% at 10 years and 20% at 20 years

Risk factors: DIRT: High dose, duration of use, concomitant renal disease, or use of tamoxifen

Dose: maximum daily HCQ use of 5.0 mg/kg real weight, CQ 2.3 mg/kg real weight

Screening schedule: A baseline fundus examination, annual screening after 5 years for patients on acceptable doses and without major risk factors.

Screening Tests: 10-2 or 30-2 (asians) and SD OCT, other multifocal ERG and FAF

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12
Q

Crystalline retinopathy

A
  1. Systemic diseases
    1. hereditary primary oxalosis
    2. oxalosis from renal failure or hemodialysis
  2. Drug induced causes
    1. tamoxifen
    2. talc
    3. nitrofurantoin
    4. canthaxanthine
    5. methoxyflurane
    6. ethylene glycol
    7. koala nut
    8. triamcinolone injection
  3. Ocular causes
    1. bietti
    2. calcific drusen
    3. gyrate
    4. retinal telangiectasia
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13
Q

DDX of CNV

A

Degenerative

  • AMD
  • Myopic degeneration
  • angioid streaks
  • osteogenesis imperfecta
  • JXT
  • retinochoroidal coloboma
  • tilted disc

Heredodegenerative

  • vitelliform
  • optic nerve drusen
  • choroideremia
  • RP with exudate

Tumour

  • nevus
  • hemangioma
  • metastatic tumour
  • hamartoma of the RPE
  • choroidal osteoma
  • melanoma

inflammatory

  • OHS
  • WDS - MFC, PIC, serpiginous, BSR
  • toxo
  • rubella
  • sarcoid
  • syphilis
  • uveitis
  • SO
  • CSR
  • VKH

Trauma

  • choriodal rupture
  • IOFB
  • surgical truam
  • intense photocoagulation
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14
Q

DDX CWS

A

H - HTN (systemic)

A - AIDS / HIV (CMV retinitis)

R - Radiation retinopathy

D - Diabetic Retinopathy (#1)

C - Cardiac embolic disease, carotid artery obstructive disease

A - anemia (hyperviscosity syndrome) - leukemia / lymphoma

V - Vasulitis (lupus, collagen vascular disease)

E - Eales disease

S - Sickle cell retinopathy, Syphilis, Sarcoid

Others: Purtscher’s

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15
Q

CME that does not leak

A

XLR

Nicotinic acid

Goldmann-Favre

Xalatan / Epinephrine

Racemose angioma

Retinal cavernous hemangioma

RP

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16
Q

Myopia findings

A

Optic disc tilt

Peripapillary chorioretinal atrophy

Lacquer cracks

Isolated, round, deep subretinal hg that clear spontaneously

Forster-Fuchs spots

Posterior staphyloma

Elongation and atrophy of the ciliary body

Gyrate areas of atrophy of the RPE and choroid

Cystoid, paving-stone, and lattice degeneration

Thinning or hole formation in the peripheral retina

Thinning and rearrangement of the collagen layers of the sclera

CNV

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17
Q

DDX of vasculitis by causes

Study These Flashcards
A

Non-infectious / Autoimmune

Sarcoidosis, Bechet’s Whipple’s, MS, Crohn’s

CT disease

Wegener’s, PAN, Sjogren’s, Dermatomyositis, Polymyositis

Infectious

Bacterial (syphilis, TB), viral (ARN,HSV, HZV, CMV), Parasitic (toxoplasmosis,

toxocara)

Ocular

Birdshot, pars planitis, frosted branch angiitis, Eale’s disease, AMHV

Neoplastic

lymphoma, leukemia, mets, paraneoplastic, CAR

18
Q

DDX CME

Study These Flashcards
A
  1. post op - irvine gass, corneal surgery, retinal surgery, laser iridotomy, cryo for retinal tear, PRP, laser, aphakia, pseudophakia
  2. inherited/dystrophies - RP, JXRL, goldmann favre
  3. medications - xalatan, epinephrine, nicotinic acid
  4. tumours - melanoma, nevi, hemangioma
  5. tractional - ERM, VMT
  6. inflammatory - pars planitis, behcet, sarcoid, toxoplasmosis, BSR, CMV, scleritis,
  7. vascular - DR, CRVO, BRVO, OIS, CNVM, coats, JXT, radiation
19
Q

choroidal folds

Study These Flashcards
A
  • Thin RPE
  • T – Tumours- choroidal melanomas, mets, osteoma
  • H- hypotony – overfiltration, cyclodiag
  • I- inflammation –posterior scleritis, TED, orbital inflammation
  • I- idiopathic (hyperopes)
  • N – neovascular mem (CNV)
  • R – retrobulbar mass
  • P – disc swelling
  • E – extraocular hardware
20
Q

Neovascular AMD DDX

Study These Flashcards
A
  1. macroaneurysms
  2. vitelliform
  3. polypoidal
  4. CSCR
  5. inflammation (VKH, SLE, scleritis)
  6. Trauma, tumours
  7. Sorsby
21
Q

Types of emboli

Study These Flashcards
A

cholesterol (refractile yellow Hollenhorst from carotids)

platelet-fibrin (large vessel arteriosclerosis)

calcified (chalky white from valves)

complement-induced leukoembolization (Purtscher’s)

long bone # (fat / air)

childbirth (amniotic fluid)

IVDU (talc / pieces of cannula)

bacterial endocarditis (septic)

cardiac atrial myxoma (tumour cells)

coagulation

MVP

arrhythmias

depot drug preps (corticosteroids / anaesthetic)

22
Q

Disc edema, heme, vein congestion

Study These Flashcards
A

incomplete CRVO

diabetic papillopathy

hypertensive optic neuropathy

AION

radiation retinopathy

acute macular neuroretinitis

23
Q

Retinal vasculitis by vascular type affected

Study These Flashcards
A

arteritis

  • SLE
  • PAN
  • syphilis
  • HSV/VZV
  • IRVAN
  • churg struss
  • GCA

phlebitis

  • sarcoidosis
  • MS
  • behcets
  • BSR
  • HIV
  • eales
  • IU
  • TB

arteritis/phlebitis

  • toxo
  • relapsing polychondritis
  • wegners
  • crohn
  • frosted branch angiitis
  • neoplastic causes

Vascular occlusion: TB**, syphilis, eales, SLE***, MS, bechets****, relapsing polychondritis, susac, ARN, sarcoid

Retinal necrosis: Toxo, ARN, CMV

24
Q

Electronegative ERG

Study These Flashcards
A

CSNB (Oguchi’s)

CRVO / acute CRAO

JXLR

Siderosis

Coats

Myotonic dystrophy

Duschenne muscular dystrophy

Batten’s disease

Quinine toxicity / methanol

MAR / CAR (melanoma-associated retinopathy / cancer-associated

retinopathy)

retinoschisis

25
yellow foveal lesion
Bests' Adult vitelliform pattern dystrophy basal laminar drusen serous PED resolving subretinal H early macular hole solar maculopathy
26
straightened vessels around macula
ROP FEVR toxocara incontinentia pigmenti RPE hamartoma epiretinal membrane
27
macular dragging
ROP FEVR Incontinentia pigmenti Toxocara JXLR
28
conjunctival vascular anomalies
Fabry’s ataxia telangiectasia CC fistula hyperviscosity syndrome (multiple myeloma, polycythemia rubra vera) sentinel vessels for underlying tumor sickle cell Sturge Weber
29
Spontaneous VH
* PDR #1 * retinal break without detachment * PVD * RRD * BRVO/CRVO * Trauma * JXLR * peripheral NV (pars planitis, fevr, coats) * polypoidal * AMD * tersons * HTN/macroaneurysms
30
Leopard spots of IVFA
uveal effusion syndrome infiltrative lesion (lymphoma, leukemia) longstanding exudative RD choroidal metastasis with overlying pigment clumping organ transplantation (serous RD's with geographic zones of leopard pattern of RPE clumping) BDUMP
31
Roth spots
* bacterial endocarditis * leukemia * anemia * thrombocytopenia * sepsis * HTN * DR * anoxia * CO posioning * MM * shaken baby * sickle cell * lupus
32
exudative RD
**Vascular** * CNV * HTN * Coats * FEVR * Eales * VHL * CRVO * Retinitis/vasculitis **Inflammation** * VKH * Posterior scleritis * SO * POHS * Idiopathic uveal effusion syndrome **Choroidal tumours** * Melanoma * Hemangioma * Mets * MM * retinal capillary hemangioblastoma **Congenital abnormalities** * morning glory disc * coloboma * optic pit **Other:** * CSR * nanophthalmos * infectious retinochoroiditis (toxoplasmosis, syphilis, CMV)
33
night blindness
LCA CSNB RP gyrate atrophy choroideremia Goldmann-Favre (rare) vit A deficiency Norrie’s Stickler’s Night myopia advanced glaucoma status PRP
34
parafoveal telangiectasia
Coats (kid onset) Idiopathic parafoveal DR BRVO / CRVO ERM Radiation Sickle cell Macroaneurysm (single) carotid artery obstruction tuberous sclerosis
35
Frosted branch angiitis
idiopathic Systemic: * leukemia / lymphoma * SLE * crohns Infecious * TB * CMV * toxo
36
Retained IOFB
Inert: stone, sand, glass, porcelain, plastic cilia Reactive: aluminum, zinc, copper, iron....zinc and aluminum tend to cause minimal inflammation, may become encapsulated COPPER: if pure- prompt removal needed, causes acute chalcosis with severe inflammation may lead to loss of eye, late removal may not cure.... if alloyed with another metal to final copper content of \< 85% chronic chalcosis can occur * affinity for basement membranes * see: KF ring, green aqueos particles, green discoloration of iris, lens capsule, brownish red vit opacities, metallic flecks on retinal vessels and ILM IRON: * affinity for neuroepithelial tissues such as iris sphincter, dilator muscles, nonpigmented cilariy epitheliun, lens epi, retina, RPE * oxidation and dissemination of ferric ions promotes FENTON reaction, iron catalyzes the generation of oxidant such as hydroxyl radicals--\> cell membrane damage and enzyme inactivation * see: ust colored K stromal staining, heterochromia, mydriasis, brown deposits on lens, ret pig degeneration, optic disc atrophy
37
Pigmented lesion in fundus
1. Melanoma 2. nevus 3. AMD disciform scar 4. suprachoroidal hemorrhage 5. RPE hyperplasia 6. CHRPE 7. melanocytoma 8. choroidal osteoma 9. metastatic carcinoma 10. choroidal hemangioma
38
Signs suggesting malignancy of iris lesion
1. ectropion iridis 2. prominent vascularity 3. sectoral cataract 4. 2ndary glaucoma 5. seeding of peripheral angle structures 6. extrascleral extension 7. lesion size 8. progressive growth
39
COMS study
**Small - 1-2.4mm height 4-8mm diameter** Observed 1% mort @ 5 years clinical growth factors: greater thickness and basal diameter, orange pigmentation, absence of rpe change/drusen, presence of tumour pinpoint hyperF on IVFA **Medium - 2.5 - 10mm height 6-16mm diameter** I-125 brachy therapy vs. enucleation 20% mort at 5 years, no difference between groups mets at 5 years 10% both groups Enuc group: 2/660 were misdx Brachy group: 10% local tumour recurrence, 13% enuc risk at 5 years, va decreased to 20/200 in 40% at 3 years, quadruple visual angle in 50% pts at 3 years **Large - \>10mm height \>16mm diameter** Radiation + Enuc. vs. Enuc alone. 5 year mort rate 50% no differences in survival between groups adjunctive radiotherapy no improvement to survival established appropriateness of primary enucleation in managing large choroidal melanoma
40
Dystrophy couselling
1. proper refraction 2. Amsler grid to detect CNVM or CME 3. referral to low vision 4. communicate with teacher about childs visual abilities and limitations 5. Annual follow up to rule out any treatable vision threatening diseases (cataract, glaucoma)
41
DDX of RD
* exudative RD * RRD * tractional RD * acquired/age related degenerative retinoschisis * X linked retinoschisis * choroidal detachment RECALL: visual outcomes for mac off detachments do not change if surgery is performed within 7 days
42
DDX of chorioretinal lesion
Infection * syphilis * DUSN * Toxo * POHS * TB * ARN Inflammation * SO * VKH * lymphoma * sarcoid * WDS

DDX (6 decks)

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