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Flashcards in Vascular Diseases of the Eye - Stagner Deck (16)
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Describe Diabetic Retinopathy

leading cause of blindness in patients 20-64 years

prevelence increases with duration of diabetes and age of patient



Describe the retinal capillary changes in diabetic retinopathy (4)

  1. microaneurysms
  2. leakage of blood and fluid
  3. poor blood supply/ischemia
  4. growth of new abnormal blood vessels


Identifity the condition and describe the treatment:

pt is a type 2 diabetic of 10 years

opthalamoscopic examination shows: microaneurysms, nerve fiber layer infarcts (cotton wool spots) and macular edema hard exduates



Non-Proliferative Diabetic Retinopathy


  • tight glycemic control
  • Rx hyperlipidemia
  • control hypertension

other microvascular changes are confined to the retina

  • capillary non-perfusion
  • IRMAs
  • dot-and-blot intraretinal hemorrhages
  • dialtion and bleeding of retinal veins


What is a microaneurysm?

pericyte loss - local structural weakness within the vessel wall

NO vision changes result


What are hard exudates?

Extracellular lipid which has leaked from abnormal retinal capillaries

fluid in the macula = blurry vision


Describe Macular Edema

most common cause of vision loss from diabetes

considered clinically signifiicant if close to the fovea or large area

diagnosis: exam, optical coherence tomography, fluroescein angiography

treatment: focal laser (zap microanuerysms), anti-VEGF, intra-ocular steroid


Severe Non-Proliferative Diabetic Retinopathy

4:2:1 Rule

4 Quadrants of diffuse intraretinal hemorrhages and microaneurysms

2 Quadrants venous beading

1 Quadrant IRMAs

15% chance of progessing to proliferative diabetic retinopathy within 1 year


Identify the condition and describe the pathophysiology and treatment

ophthalmoscopic exam shows neovascularization elswehere, decreased red reflex and vitreous hemorrhage;

pt reports increasing floaters, hx of type 1 DM


Proliferative Diabetic Retinopathy

retina is so ischemic that it responds by growing new blood vessels that break through the retina and bleed

  • if growth off of the disc = NVD
  • if growth off of the retina = NVE

this new growth can cause vitreous hemorrhage (floaters)

decreased red reflex

recurrent bleeding leads to fibrosis


  • virectomy
  • panretinal photocoagulation


4 Common Diabetic Nerve Problems

  1. Diabetic Retinopathy
  2. Transient refractive errors
  3. Higher incidence of cataract
  4. Neovascular glaucoma
    • neovascularization of iris and closure of the angle


Identify the condition and descirbe the treatment:

ophthalmoscopic examination shows: microaneurysms, arterial venous nicking, flamed shaped hemorrhages, and Elscnig Spots

Hypertensive Retinopathy


clinical features: microanerusysms, IRMA's, blot hemorrhages, hard exudates, venous beading, Elschnig spots- nonperfusion of choriocapillaries

Acute: associated with preeclampsia, eclampsia, pheochromocytoma or renal hypertension

Severe: flame-shaped hemorrhages, blurring of the disc marginas, exudates

aterial venous nicking - related to vascular sclerosis - see the image on the left


Identify this condition and describe the treatment:

ophthalmoscopic examination shows cotton-wool spots in a sector of the retina

patient reports vision loss, no pain

Branch Retinal Vein Occlusion

superficial hemorrhages, retinal edema, cotton-wool sports in a sector of the retina drained by the affected vein

if macula is affected - painless vision loss

occurs most commonly at arteriovenous crossing

risk factors: hx systemic hypertension, cardiovascular disease, increased BMI at age 20, hx of glaucoma

tx: anti-VEGF, sector photocoagulation


Identify this condition and describe the treatment:

ophthalmoscopic examination shows: retinal hemorrhages in all 4 quadrants



Central Retinal Vein Occlusion

retinal hemorrhages in all 4 quadrants

dilated, toruous retinal veins

can be ischemic which leads to neovascularization

tx: anti-VEGF, panretinal photocoagulation


Identify this condition and describe the treatment:

pt reports: sudden painless vision loss in his left eye

physical exam findings: RAPD, decreased visual acutiy

ophthalmoscopic examination:  cherry red spot, retinal edema


Central Retinal Artery Occlusion

****irreversible vision loss within 90 minutes

tx: ocular massage, reduce IOP via needle or drops, hyperbaric oxygen - none have great evidence

poor prognosis

central occlusion due to artherosclerotic disease, emboli, vascultitis, coagulopathy (branch - emobli)

boxcarring of retinal vessels


Identify this condition and describe the treatment:

pt reports - painless vision loss in her right eye, but vision has since returned


Carotid Stenosis Related Eye Diseases

Amaurosis fugax - painless transient monocular vision loss

descriptors: "curtain" coming down over the eye, blindness, dimming, fogging, or blurring

may see Hollenhorst plaque

**can be an emboli from the heart; patient is at high risk for a stroke


Identify this condition and describe the treatment:

pt reports transient vision loss, scalp tenderness, arthralgia, and recent weight loss

exam shows: tenderness over temproal artery, thickened temproal artery, bruits

Giant Cell Arteritis =

Temporal Arteritis

medium vessel vasculitis in older people (>65)

scalp tenderness, tender over temporal artery, jaw claudication, fever, weight loss, joint pain

transient vision loss, double vision, sudden marked vision loss from ischemic optic neuropathy

tx: high dose steroids to save the other eye


Other Causes of Retinal Vascular Disease/Ischemia

  • Radiation
  • Congenital AV malformations of the retina
  • Lupus
  • Bechet
  • IBD
  • Sarcoidosis
  • Sickle Cell Disease