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RETINA ANAMOLIES DX/WU/TX > RETINA - VASCULAR RETINOPATHIES > Flashcards

RETINA - VASCULAR RETINOPATHIES Flashcards

1
Q

what are the 3 types of plaques? What is the site of origin for each?

A
  1. Fischer plaque - carotid origin
  2. Hollenhorst (carotid) plaque - carotid origin
  3. Calcific plaque - aortic /mitral valve origin
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2
Q

which plque is the most common of the 3?

A

Hollenhorst plaque

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3
Q

Which one appears at vessel bifurcations as a yellow spot?

A

Hollenhorst plaque

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4
Q

Which plaque is the most dangerous of the 3? why?

A

Calcific plaque - not malleable, thus can lead to complete blockage.

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5
Q

which plaque appears close to the ONH?

A

Calcific plaque

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6
Q

Why does a hollenhorst plaque travel further than a calcific plaque?

A
  • Hollenhorst plaque is small, mallable and can easily break and travel further.
  • Calcific plaque are bigger and not malleable thus harder to break and which keeps it at a closer location.
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7
Q

what is a CRAO? what plaque is associated with CRAO?

A
  • CRAO is occlusion of the central retinal artery.
  • associated with hollenhorst or calcific plaques (most common).
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8
Q

what systemic Dz are associated with CRAO/BRAO (in order from greatest)?

A

HTN > DM > Cardiac Dz > Carotid Dz

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9
Q

what are some signs of CRAO?

A
  • pale retina
  • cherry red spot
  • chronic - whitening is resolved.
  • optic disc pallor
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10
Q

what are symptoms of CRAO?

A
  • acute, painless unilateral vision loss
  • amaurosis fugax
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11
Q

what is a BRAO? what plaque is associated with a BRAO? why?

A
  • occlusion of a branch of the central retinal artery.
  • hollenhorst plaque - b/c it is smaller thus travels further.
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12
Q

what are signs of BRAO?

A
  • one quadrant will be pale.
  • permanent VF defect
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13
Q

what other condition must be r/o in someone with CRAO/BRAO?

A

GCA

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14
Q

how to tx/manage CRAO/BRAO?

A

tx is aimed at reducing eye pressure:
* hypervetilation into paper bag
* digital massage
* systemic acetazolamide (diamox)
* topical hypotensive gtts (timolol) x15minutes
* paracentesis

monitor regularly - to check for neo - if neo then PRP or anti-VEGF injections.

urgent referral to PCP - have higher risk of heart attack and stroke.

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15
Q

what is CRVO? what causes a CRVO?

A
  • occlusion of the central retinal vein of the retina.
  • caused by a thrombus that forms w/in the Central Retinal Vein.
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16
Q

what is a BRVO? what causes a BRVO?

A
  • Occlusion one of the branch retinal veins.
  • caused by a thrombus that forms in one of the small retinal veins prior to drainage into the central retinal vein.
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17
Q

what systmic Dz are are associated with CRVO/BRVO?

A

HTN > DM > cardiovascular Dz > POAG.
younger pts - oral contraceptives.

18
Q

what are the signs of CRVO/BRVO?

A
  • blood & thunder - hemes (flame hemes) / exudates / cws.
  • dilated tortuous veins
  • optic disc or/and macular edema.
  • chronic - collateral vessels.
  • serious - neovascularization of iris –> 90 day glaucoma.

CRVO - signs in all quadrants.
BRVO - signs in one quadrant (mainly superior temporal).

19
Q

what are symptoms of CRVO/BRVO?

A
  • sudden, painless, unilateral vision loss.
  • amaurosis fugax.
  • pain, if neo.
20
Q

tx for CRVO/BRVO?

A
  • no tx indicated unless there is edema or neo –> if edema/neo - tx w/ PRP/anti-VEGF
  • monitor monthly for the 1st 6 months to check for edema or 90-day glaucoma.
  • urgent referral to PCP for full cardiac eval.
  • d/c oral contraceptives
  • take aspirin prophylactically.
21
Q

what is the % of those that may develop CRVO/BRVO in the fellow eye?

A

7%

22
Q

what is OIS?

A

hypoperfusion of the anterior and posterior segments of the eye due to carotid obstructive disease (internal carotid artery is 90% blocked due to plaque build-up).

23
Q

what is epidemiology for OIS?

A
  • M >F
  • > 50 yrs
24
Q

systemic associations of OIS (greatest >least)

A

HTN > DM > cardiac > GCA.
- suspect cardiac DZ - #1 cause of mortality.

25
Q

what are signs of OIS?

A
  • mid-peripheral retinal hemes.
  • dilated, non-tortuous, retinal veins.
  • NVD/NVE
  • rubeosis iridis - leads to NVG.
  • corneal edema

will have both posterior and anterior findings!!!

26
Q

tx/managment for OIS?

A

ocular tx aimed at halting neo and reducing any increased IOP:
* neo –> PRP/anti-vegf.

urgent referral to PCP for tx of HTN or cardiac Dz - OIS has high morbidity.

27
Q

What is venous stasis

A
  • same thing as OIS but only posterior segment findings.
  • hypoperfusion to only posterior seg w/out anterior seg findings - due to carotid obstruction via plaque build up.
28
Q

what are symptoms of venous stasis

A
  • no complaints
  • amaurosis fugax
29
Q

what signs of venous stasis

A
  • mid-peripheral hemes in all quads.
  • no ischemia
30
Q

tx for venous stasis?

A
  • referr to PCP for managment of underlying DZ (HTN or cardiac DZ)
  • do carotid doppler
31
Q

what is the definition of hypertension?

A

BP above 140/90

32
Q

what is HTN retinopathy?

A

signs of retinopathy 2/2 HTN

33
Q

symptoms of HTN retinopathy?

A
  • asymptomatic
34
Q

signs of HTN retinopathy?

A
  • flame hemes, CWS, exudates (macular star), vascular changes (narrowing, nicking, copper/silver wring).
  • malignant HTN retinopathy –> inlcudes ONH swelling
35
Q

define malignant HTN

A

BP above 220/120

36
Q

tx/managment of HTN retinopathy

A
  • check BP
  • refer to PCP for HTN managment
  • Malignant HTN – emergent (same day) referral to hospital.
37
Q

what population is HTN more prevalent?

A

black

38
Q

what is retinal artery macroaneurysm (RAMA)?

A
  • it is isolated dilated area of a major retinal arterial branch
39
Q

epidemiology of RAMA?

A

elderly woman w/ HTN or atherosclerosis

40
Q

**

what systemic Dz is RAMA associated with?

A
  • HTN
  • artherosclerosis
  • cardiovascular Dz
41
Q

s/s of RAMA?

A

**symptoms: **
* Asymptomatic, but can have:
* Gradual vision loss - from macular edema.
* Sudden vision loss - from vitreous hemorrhage.

**signs: **
* UNILATERAL
* Unilateral focal area of dilation (ballooning) in a retinal artery.
* if rupture –> pre-retinal or vitreal hemorrhage & exudates.
* Scleroses - Once bleeding occurs.
* Macular edema - possible.

42
Q

tx/managment for RAMA?

A
  • no tx b/c usually resolve.
  • if leaking –> PRP
  • sub-foveal and vitreal heme can be tx with vitrectomy.
  • refer to PCP for HTN managment.

RETINA ANAMOLIES DX/WU/TX (11 decks)

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