Retino-vitreal disorders

Question 1

Central & branch vein occlusions- Eti

Answer 1

• DM, HTN, Hyperlipidemia & glaucoma

- Estrogen tx

Question 2

Central & branch vein occlusions- Sx

Answer 2

• No pain or redness
• Sudden monocular loss of vision, noticed upon waking
• Widespread hemorrhages, venous dilation, cotton wool spots

Question 3

Central & branch vein occlusions- Dx

Answer 3

• Screen for underlying cause

Question 4

Central & branch vein occlusions- Tx

Answer 4

• Lasar photocoagulation

- VEGF inhibitor

Question 5

Central & branch artery occlusions- Eti

Answer 5

• Giant cell arteritis

- Carotid & cardiac emboli

Question 6

Central & branch artery occlusions- Sx

Answer 6

• Sudden, profound monocular visual loss
• Highly reduced visual acuity
• Pallid swelling of retina, cherry red spot on fovea
• Box-car segmentation of veins

Question 7

Central & branch artery occlusions- Dx

Answer 7

Determine underlying cause:

• ESR & CRP for giant cell arteritis
• DM, hyperlipidemia
• Emboli

Question 8

Central & branch artery occlusions- Tx

Answer 8

• Lay flat, ocular massage, O2, acetazolamide

- Corticosteroids for GCA

Question 9

Retinal detachment- Eti

Answer 9

• Spontaneous tears of holes due to degenerative changes
• > 50
• Nearsightedness & cataract extraction most common cause

Question 10

Retinal detachment- Sx

Answer 10

• Rapid loss of vision with curtain of spreading across field of vision
• No pain or redness
• Detachment seen on ophthalmoscope
• Increase in floaters
• photophobias

Question 11

Retinal detachment- Tx

Answer 11

• Lasar photocoagulation

- Cryotherapy

Question 12

Posterior uveitis- Eti

Answer 12

• Sarcoidosis, Tb, toxo, syphallis, alopecia, HIV

Question 13

Posterior uveitis- Sx

Answer 13

• Gradual loss of vision in quiet eye
• Inflammatory lesion in retina
• Bilateral
• Vitreous haze

Question 14

Posterior uveitis- Tx

Answer 14

• Systemic corticosteroids and immunosuppression

- Tx underlying antimicrobial infection

Question 15

Diabetic retinopathy- Eti

Answer 15

• 35% diabetic patients
• 20% type 2 at dx
• Within 3 yrs in type 1
• Leading cause of blindness

Question 16

Diabetic retinopathy- Sx

Answer 16

• Non-proliferative: Hard exudates, hemorrhage, edema, microaneuryisms, macular ischemia leading to vision loss
• Proliferative: Neovascularization from optic disc. May lead to retinal detachment

Question 17

Diabetic retinopathy- Dx

Answer 17

Screening is impairative

• Yearly fundal photography, slit lamp examination
• More frequent screening in pregnancy

Question 18

Diabetic retinopathy- Tx

Answer 18

• Control DM, HTN, renal fxn, lipids

- Lasar photocoagulation

Question 19

Hypertensive retinopathy- Eti

Answer 19

• Systemic HTN
• Young pts with abrupt changes
• Pheochromocytoma, malignany HTN, pre-eclampsia

Question 20

Hypertensive retinopathy- Sx

Answer 20

• Atherosclerosis
• Silver/ copper wiring
• AV nicking
• Flame shaped hemorrhages
• Cotton wool spots

Question 21

Hypertensive retinopathy- Tx

Answer 21

Reduce & control BP

Question 22

HIV retinopathy- Eti

Answer 22

• Most common opthal abn

Question 23

HIV retinopathy- Sx

Answer 23

• Cotton wool spots
• Retinal hemorrhages
• Micro-aneurysms
• Reduced contrast sensitivity
• CMV retinitis- progressively enlarging yellowish- white patches
• Other opportunistic infections

Question 24

HIV retinopathy- Tx

Answer 24

• Valganciclovir & HAART

Question 25

Ischemic optic neuropathy- Eti

Answer 25

- Anterior most common - Inadequate perfusion of ciliary arteries - Giant cell arteritis - Congenitally crowded disc - HTN, DM, vasculitis, thrombophelia, apnea

Question 26

Ischemic optic neuropathy- Sx

Answer 26

- Sudden, painless visual loss | - Optic disc swelling

Question 27

Ischemic optic neuropathy- Tx

Answer 27

- High dose corticosteroids

Question 28

Vitreous hemorrhage- Eti

Answer 28

- Retinal tear, DM or sickle cell retinopathy, | - vasculitis, trauma

Question 29

Vitreous hemorrhage- Sx

Answer 29

- Sudden visual loss - Abrupt onset of floaters, increasing in severity - Wide range of visual acuity - Bleeding in the eye

Question 30

Vitreous hemorrhage- Dx

Answer 30

- Inability to see fundal details with presence of clear lens - Collection of blood in front of retina

Question 31

Macular degeneration- Eti

Answer 31

- Age related, >50 yrs - Genetically determined variations in complement & lipoproteins - Wet (90%) or dry - White, female, cigarettes, aspirin

Question 32

Macular degeneration- Sx

Answer 32

- Acute or chronic deterioration of central vision - Atrophic: progressive, bilateral loss - Neovascular : New vessels, serous fluid, hemorrhage, fibrosis, rapid onset, uni to bilateral - Retinal drusen- discrete yellow deposits - No pain, redness - Distortion/ abn size of images

Question 33

Macular degeneration- Tx

Answer 33

- Oral antioxidants | - VEGF inhibitors