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207 Cards in this Set
- Front
- Back
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(T/F) Operculated Retinal holes have a higher chance of RD. Why?
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F. No more traction b/c retina is torn clear away.
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What test should you do to see if operculated retinal holes are truly fully detached?
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Scleral depression
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(T/F) Pigment is a sign of stability for retinal holes.
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T
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(T/F) Operculated retinal hole pieces tend to shrink over time. Therefore, you can tell if it is old by comparing the size of the free floating piece to the hole.
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Operculated retinal hole management: New hole with photopsia?
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RTC 6 weeks
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Operculated retinal hole management: New hole with no symptoms?
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RTC 6 months
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Operculated retinal hole management: Multiple holes
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RTC 6 months
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Operculated retinal hole management: Cuff edema < 2 DD with no pigmentation?
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RTC 3 months
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Operculated retinal hole management: Hole with pigment?
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RTC 6 months
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Operculated retinal hole management: Cuff edema greater than 2 DD in size?
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Refer to retinal specialist.
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___% of linear retinal tears develop into retinal breaks. ___% develop into RDs.
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10-15%. 30%
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Risk factors for linear retinal tears. (4)
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High myopes, trauma history, aphakia, premature birth (ROP)
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What does a linear retinal tear look like?
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Horseshoe with red center and grey tissue around edge.
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Where do linear retinal tears normally occur?
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Posterior border of vitreal base
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What is Shaefer's Sign in the context of linear retinal tears?
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Pigmentation enters the vitreous.
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If there is so much hemorrhaging that you can't see the retina what do you do?
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Get a retinal B scan.
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What is the treatment for a linear retinal tear?
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Laser photocoagulation
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Linear retinal tear management: When you find one?
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Refer to retinal specialist.
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Retinal dialysis management: When you find one?
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Refer to retinal specialist.
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Retinal dialysis management: When a person has a recent trauma, what is the dilation schedule?
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Do at exam. Then repeat in 3-6 months b/c they they develop slowly.
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(T/F) Retinal dialysis is often asymptomatic
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T - 60%
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Name the typical retinal dialysis pt.
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Younger. Males under 40 years that had trauma.
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Why are retinal dialysis tears so slow to develop? How long does it take?
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They are often inferior. Within 140 days.
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Why might IOP go up or down during retinal dialysis or detachment??
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Up because pigment released into vitreous. Down because vitreous has another place to leave.
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Giant Retinal Tear management: When you find one?
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Refer to retinal specialist.
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What causes Commotio Retinae?
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Blunt trauma.
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What do you see with Commotio Retinae?
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At first, looks normal. Hours later it becomes swollen (opaque white, edema). Possibly hemorrhagic (black and blue).
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What might happen as the swelling of Commotio Retina subsides?
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Pt may develop holes or tears.
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What is Berlin's Edema?
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Retinal swelling that can lead to retinal dialysis because the mucopolysaccharide bonds of the retina are weakened. Associated with Commotio Retinae
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What is a typical pt complaint with Commotio Retinae?
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Blur due to retinal swelling (and black eye!)
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Why do RDs happen most often after age 60?
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PVD has vitreous pulling on retina.
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If you have RD in one eye, how likely are you to get it in the other eye?
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10-30%
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(T/F) RD symptoms are always symptomatic.
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F - can be asymptomatic because they are variable
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What are the classic symptoms of RD?
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Flashes and floaters
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What is the old was to treat RD? The new way?
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Cryopoxy. Laser photocoagulation
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What 2 things do you see in the retina when a pt has RD?
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Dissapearance of choroidal layer (Can't see ampules and other details.) Edema that makes the retina opaque.
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What technology is very usefule in outlining retinal detachments, especially when there is hemorrhaging in the vitreous?
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B Scan
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Retinal detachment management: New one
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Immediate referral
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Retinal detachment management: Old one newly detected
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Consultation within a few days
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(T/F) Flashes and floaters stop right after the retina has detached.
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F - They can continue for up to 6 months afterwards
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What is snail track degeneration?
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Thinning of parts of the retina
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Name 2 reasons why snail track degeneration pts have a higher risk of RD?
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Liquefied vitreous gets under the retina and lifts it up. Vitreoretinal traction.
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(T/F) Active PVD increases your chances for a retinal tear.
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T b/c the vitreous is peeling away and taking the retina with it.
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What does an atrophic retinal hole look like?
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Red dot. Possibly greyish edema around edges.
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How does an atrophic retinal hole lead to RDs?
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Fluid enters along the edges and lifts the retina up.
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(T/F) Linear Retinal tears have a higher risk of RDs.
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T
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(T/F) Giant retinal tears do not have a higer risk of RDs
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F
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What is degenerative retinoschisis?
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Splitting of the retina.
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Degenerative retinoschisis management: You see it for the first time.
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Refer to retinal specialist
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Degenerative retinoschisis management: Watching old one w/ no flashes and floaters
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RTC 6 months
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Degenerative retinoschisis management: Watching old one w/ flashes and floaters
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Refer to retinal specialist
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Degenerative retinoschisis management: Watching old one w/ vitreoretinal traction.
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Refer to retinal specialist
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What is lattice degeneration?
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Thinning of the retina with vitreoretinal traction on the edges with liquefied vitreous in that area
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What is a typical lattice degeneration pt?
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Young (6-10% of normal population)
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(T/F) Lattice degeneration is typically bilateral
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T
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(T/F) Lattice degeneration can lead to holes or tears. Why?
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T - Because it's thin
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What is the typical size of a lattice degeneration?
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1-4 DD in length. .5-2 DD in width.
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(T/F) RPE hyperplasia with lattice degeneration is good
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T - Pigmentation is a sign of stability
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What does Lattice degeneration look like?
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Fishboning or small crisscrossed lines.
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What 3 other things might you see with lattice degeneration?
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White without pressure. Lacunae of vitreous over the region (liquefied fluid). Choroidal retinal atrophy. Retinal tears.
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Lattice degeneration management: No symptoms
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RTC 1 year
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Lattice degeneration management: Has flashes/floaters but scleral depression does not show a hole/tear.
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RTC 6 months
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Lattice degeneration management: Flashes/floaters with holes/tears
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Retinal consultation
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Lattice degeneration management: Lattice with horseshoe tear
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Retinal consultation
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Lattice degeneration management: Asymptomatic but scleral depression shows linear retinal tears
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Retinal consultation
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Management: snail track degeneration with no symptoms, no holes/tears
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RTC 1 year
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Management: snail track degeneration with flashes/floaters and scleral depression shows inferio holes.
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RTC 6 months
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(T/F) Inferior retinal holes are worse than superior ones.
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F
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Management: superior snail track degeneration, flashes/floaters, no holes/tears
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Retinal consultation
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Management: Big retinal detachment managed for 6 months. Lattice degeneration superiorly in other eye with no holes/tears. Flashes/floaters.
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Retinal consultation
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(T/F) Snail track degeneration looks like a slimy snail track and is managed similarly to lattice degeneration.
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T
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What should be done if an atrophic retinal hole has whitish edema around it?
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Refer for laser photocoagulation because may lead to detachment
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___% of atrophic retinal holes develop into RD
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7%
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(T/F) A hole at the border of the vitreous base has less risk than a hole inside of it.
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F
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Management: atrophic retinal hole, asymptomatic, no traction, no edema
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RTC 1 year
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Management: Retinal tear with pigmentation
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Retinal consultation
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Management: Many tiny retinal holes located closely together
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Retinal consultation b/c can coalesce into a RD
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(T/F) After PVD, there is an increased risk of RD
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F - Because vitreous has already pulled away so no traction
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At what age has PVD completed pulling away so there is little traction?
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60-70
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Name 5 risk factors for RD
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Younger patients (b/c vitreous attached), family history, high myopes, history of RD in other eye, any breaks in retina
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How do you fix an RD?
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Laser photocoagulation
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Management: Isolated retinal holes, no symptoms, small edema cuff (<1DD)
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Monitor 3-6 months or retinal consultation
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Management: Isolated holes, flashes and floaters
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Retinal consultation
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Management: Isolated holes, asymptomatic, no edema cuff
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RTC 1 year
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Management: Isolated holes with flashes/floaters
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Retinal consultation
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Management: Isolated holes with flap tear
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Retinal consultation
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Management: Isolated holes with edema cuff > 1 DD
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Retinal consultation
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Management: Isolated holes > 1 DD in size
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Retinal consultation
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Management: Isolated holes with pigment
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RTC 1 year
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Management: Isolated superior holes with pigment, flashes/floaters
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Retinal consult
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How does arteriosclerotic retinopathy mess up the eye?
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HTN -> arteriole walls harden -> A/V crossing changes (pinch) -> Turbulence -> Thrombosis builds and impedes blood flow.
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What is the most common occlusive disease?
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BRVO
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(T/F) BRVO typically does not have flame hemorrhages
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F - Has mutiple flame hemorrhages
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How is hollenhorst plaque, fibrinoplatelet and calcific plaque different materials?
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Cholesterol, platelet/cholesterol, cacified heart valve piece
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Carotic occlusive disease will cause and (artery/vein) occlusion
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Artery
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(T/F) Arteriosclerotic retinopathy is always indicative of the severity of hypertension
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F. But might!
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How are the 4 grades of arteriosclerotic retinopathy different?
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Broadened light reflex w/ simple vein concealment. Deflection of veins at A/V crossings. Copper wire. Silver wire. (All cumulative)
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How are Salus', Gunn's and Bonnet's sign different?
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A deflection of vein at A/V crossing. 90 degree deflection. Venous banking (dilation of vessels distal to crossing)
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What is 'humping'?
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When an arteriole is under a vein
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Management: Pt has arteriosclerotic retinopathy
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Dilate yearly
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A pt complains of sudden vision loss because plaques are blocking things in the eye. What can we do?
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Reduce the IOP so blood vessels get bigger and clogger moves further out to less damaging area
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(T/F) The likelihood of an artery occlusion from a hollenhorst plaque is much lower than a fibrinoplatelet or calcific plaque.
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T
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(Hollenhorst, fibrinoplateley, calcific) plaques have a higher risk for artery occlusion. Why?
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Because the platelets cause clotting/stickiness and they stay longer.
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What does a fibrinoplatelet plaque look like?
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Elongated shape
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What does a hollenhorst plaque look like?
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Shiny dot
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How does the retina change if a fibrinoplatelet plaque reduces blood flow?
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Whitish and edematous
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Name 2 things that predisposes a pt to calcific plaques
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Rheumatic fever, bacterial endocarditis
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What kind of occlusion do calcific plaques most cause?
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CRAO
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What do calcific plaques look like?
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Chalky white
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Management: artery occlusions in general
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Systemic disease workup. (Especially vascular)
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If you see several flame hemorrhages in one area, it is probably a…
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BRVO
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What age and gender does CRVO's most affect?
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60's. Males.
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Name 6 things that can cause a CRVO
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HTN, diabetes, hyperviscosity syndrome diseases (leukemia, sickle cell, diabetes), glaucoma, hyperlipidemia, head injuries
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If a thrombosis builds up in a venule, how does it cause a CRVO?
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It goes to the lamina cribosa.
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What are the symptoms of a CRAO?
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Painless vision loss over 1-2 days.
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(T/F) Vision cannot improve with a CRAO
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F
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What are the 2 signs of hypoxia in the retina?
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Nerve fiber layer infarcts with Cotton wool spots. Neo.
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How does CRVO lead to glaucoma?
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Neovascularization of iris leads to neovascular glaucoma
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What are the 6 ophthalmic signs of a CRAO?
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Blood and thunder of retina. Swollen ONH with no venous pulse, although ONH may pulse. Hypoxia signs. Retinal hemorrhaging. Vitreous hemorrhaging. Venous engorgement.
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How does venous engorgement happen with CRAO?
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Blood backs up so venules engorge and things seep out causing edema.
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The (hemorrhagic/venous stasis) is the worse one.
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hemorrhagic
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With ____ days, a CRAO patient will run the risk for glaucoma to occur.
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90-100 days
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What happens with venous stasis?
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Circulation is reduced
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What is the VA range for venous stasis?
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20/20 - 20/200
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(T/F) Venous stasis pts are almost always diagnosed for diabetes or HTN
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F
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How does the retina look with venous stasis?
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Can still see most of the retina and ONH. Venous engorgement. Cotton wool spots. Hemorrhaging (dot blot and flame)
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(T/F) Venous stasis often leads to rubeosis and glaucoma
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F
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(T/F) Venous stasis can show dot blot hemorrhages and lots of flame hemorrhages
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T
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(T/F) Hemorrhagic retinopathy (ischemic) pts often have poorly controlled diabetes and HTN
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T
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(T/F) Hemorrhagic retinopathy can show lots of hemorrhaging, cotton wool spots NFL infarcts and rubeosis.
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T
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What helps reabsorb the fast growing tissue from neo?
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Anti-Vegf medication like Avastin.
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Why does neo often occur in the iris?
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It moves anteriorly from the retina to the iris.
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(T/F) With hemorrhagic CRVO, we can often see most of the retina.
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F
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What sign do we see when there is neo starting in the iris?
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little red spots.
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(HTN/Diabetes) is most often the cause of a hemorrhagic CRVO
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HTN
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What is the standard bloodwork tha should be done for a retinal vascular occlusive disease?
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CBC.
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What 3 things do retinal specialists do when there is a retinal vascular occlusive disease?
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Pan-retinal laser photocoagulation. Anti-VEGF medication. Triamcinoline (kenalog)
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How does triamcinolone help with retinal vascular occlusive disease?
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Decreases inflammation, swelling and vascular permeability. Therefore less leaking/bleeding.
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(T/F) Avastin should be used even before there is neo.
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F
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How does laser work help with hypoxia?
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Kills tissue to reduce oxygen demand
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(T/F) With lots of hemorrhaging for retinal vein occlusive disease, it is good to give blood thinners
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T b/c it can break up the thrombosis.
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How often should we follow up for retinal vein occlusive disease?
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3-4 weeks or every 6 months.
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What are the 2 risks of steroid use?
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Increased IOP and cataracts
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What is the normal name for "altitudinal" or "dual branch" occlusion?
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Hemicentral Retinal Vein Occlusion
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Where does a hemicentral retinal vein occlusion occur?
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Just past the lamina where the vessels first branches
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How does a large CD ratio cause hemorrhaging?
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The venule is kinked because the turn is too tight, causing hemorrhaging
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Hemicentral retinal vein occlusion can create what 4 things?
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Macular edema, disc edema, hypoxia of the retina, neo of the retina/iris
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Management: Hemicentral retinal vein occlusion
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Retinal consult to get FANG to determine spots to treat with laser.
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What causes BRVO to be symptomatic?
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If it's on the retina.
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Management: BRVO not threatening the macula.
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Control systemic disease and RTC in 1 month.
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What blood pressures could indicate a BRVO?
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140+ or 80+
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How does a retinal hemorrhave move to the macula?
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It is superior so gravity causes the fluid to go down to the macula
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Management: BRVO with neo
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Refer to retinal specialist.
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What might a retinal specialist do for a BRVO with neo?
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Laser photocoagulation or anti-VEGF
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Management: BRVO threatening macula.
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Retinal consult.
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What might a retinal specialist do for a BRVO threatening the macula?
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Triancinolone injection or laser photocoagulation.
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(T/F) CRAO is often bilateral.
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F
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What are the #1 and #2 causes of CRAO?
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calcific plaques. Fibrinoplatelet plaques
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What are 4 causes of a CRAO?
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Giant cell arteritis, migraines, contraceptives, man made emboli (talc from drugs)???
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What is the symptom of CRAO?
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Acute, painless monocular vision loss.
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What are the ophthalmic signs of a CRAO?
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Edema and hypoxia. Distended veins. Cherry Red spot on macula.
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(T/F) A CRAO can cause an APD
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T
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What is a sign of an old CRAO?
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Optic atrophy where retina thins and is replaced by glial tissue. Vessels look very thin.
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Neo often occurs with (CRAO/CRVO)
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CRVO
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Why does neo not occur too much with CRAO?
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Because it happens so fast.
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Why might peripheral vision be terrible but VAs be good for a CRAO?
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Cilioretinal artery can feed macula.
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What do we do for a CRAO?
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Lower IOP within 15-90 minutes.
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(T/F) Beta blockers and lumigan are good for lowering IOP for a CRAO.
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F. Too slow.
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What do retinal specialists do to reduce IOP in a CRAO?
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Paracentesis (draw out aqueous with needle)
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(T/F) The point of digital massage is to make pressure go up. How?
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F. Go down. Causes high pressure that pushes aqueous out. The pressure drops.
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How does breathing in a brown paper bag help for CRAO?
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It increases CO2 levels, which dilates blood vessels.
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What does a CRAO ophthalmically look like?
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Milky white edematous retina with cherry red spot.
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What treatment do we do for a CRAO?
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Get the IOP down (paracentesis needle), brown paper bag to dilate vessels, IV acetazolamide. Get vascular workup.
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(T/F) Topical glaucoma drugs are good for reducing IOP for CRAO
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F. Too slow
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What 3 things mimic CRAO?
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Giant cell arteritis, high blood pressure, temporal arteritis.
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How do we r/o temporal arteritis when we have a CRAO suspect?
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ESR (erythrocyte sedimentation rate) workup.
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What race gets sickle cell retinopathy?
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Blacks
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How is sickle cell and diabetic retinopathy similar?
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They both mishape RBS. Sickling. Dumbells.
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How does sickle cell retinopathy lead to RD?
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hypoxic -> neo -> traction -> RD
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What are sunbursts of melanin made of?
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Melanin and hemosiderin
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______ lesions are often found in sickle cell retinopathy.
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Salmon patch lesions/hemorrhages.
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(T/F) Fibrovascular proliferation can occur in sickle cell retinopathy.
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T
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What are angiod streaks?
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Breaks in bruch's membrane.
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(T/F) Angiod streaks are found in sickle cell retinopathy.
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T
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I see a see fan of neo. What disease does the pt have?
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Sickle cell retinopathy.
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Why does neo lead to a traction retinal detachment?
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Root is in retinal. Tops are in vitreous. Vitreous moves, but retina doesn't. Rip!
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(T/F) Rubeosis neovascularization is very common in sickle cell retinopathy.
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F. It can happen but not common
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What therapies do we do for a sickle cell retinopathy pt?
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Fluorescein angiogram, pan-retinal photocoagulation, anti-VEGF injection
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How does retinopathy of prematurity occur?
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Premature infant put in O2 rich environment. Eyes get used to it. When pulled out, the hypoxic signal makes neo grow.
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When does the nasal and temporal retinal vessels reach the ora serrata?
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8 months. After birth.
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A dragged disc appearance is caused by what?
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Retinopathy of prematurity.
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How are ROP patients treated?
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Cryoplasty or laser photocoagulation
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If an adult is seeing 20/20 but had ROP, what is the management?
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Yearly DFE
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When the peripheral retinal forms little cystic space within the sensory retina, what can you get?
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Retinoschisis
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(T/F) Retinoschisis tends to grow in size.
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F
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Retinoschisis tens to be located ____ _____.
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Inferior temporal
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Retinal detachments tend to be locate _____ ____
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superior temporal
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(T/F) Retinoschisis pts tend to be asymptomatic.
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T.
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(T/F) Retinoschisis can lead to a scotoma.
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T
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What kind of scotoma does an RD give? Retinoschisis?
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Relative. Absolute.
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Why does retinoschisis give an absolute scotoma?
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Because the retina isn't there any more!
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What does cystoid degeneration look like?
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Translucent lesion
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(T/F) Retinoschisis makes the retina look moth eaten like beaten metal.
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T
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(T/F) Flat retinoschisis is more common than bullous retinoschisis.
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F
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____ retinoschisis looks like a transparent ballooning that looks elevated. Why?
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Bullous retinoschisis. Because hyaluronic acid from the vitreous filles in the area.
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___% of retinoschisis patients have a retinal hole or tear
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32%
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What does flat retinoschisis look like? But how does it look different?
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White without pressure. No little whitish spots or snowflake specks.
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