Vascular Diseases of the Eye - Stagner Flashcards Preview

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Flashcards in Vascular Diseases of the Eye - Stagner Deck (16)
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1

Describe Diabetic Retinopathy

leading cause of blindness in patients 20-64 years

prevelence increases with duration of diabetes and age of patient

 

2

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

3

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

Treatment:

  • 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

4

What is a microaneurysm?

pericyte loss - local structural weakness within the vessel wall

NO vision changes result

5

What are hard exudates?

Extracellular lipid which has leaked from abnormal retinal capillaries

fluid in the macula = blurry vision

6

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

7

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

8

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

treatment:

  • virectomy
  • panretinal photocoagulation

9

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

10

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

11

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

12

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

13

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

14

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

15

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

16

Other Causes of Retinal Vascular Disease/Ischemia

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