Ocular Dz 4: Disorders Of The Macula 2

Front 1

Refers to a situation where progressive elongation of the globe mechanically stretches the tissues of the eye causing problems.
- Usually involves an eye > 6 D myopia or > 26 mm axial length
- Damage to macula is usual cause of vision loss

Back 1

Degenerative Myopia

Front 2

Symptoms:
- Slow or abrupt vision loss

Signs:
- Thinned retina ("tigroid" or tessellated)
- Focal Chorioretinal Atrophy
- Breaks in Bruch's membrane ("lacquer cracks")
- Subretinal hemorrhages
- Fuch's Spot
- Distorted optic disc w/temporal peripapillary atrophy
- Posterior staphyloma

What's the Dx and Tx?

Back 2

a) Degenerative Myopia

b) Tx:
1. Consider refractive error

2. Management of complications:
- Amblyopia: occlusion therapy
- RD: surgical referral
- CNV: PDT &/or anti-VEGF therapy possibly
- Foveal schisis or hole formation: vitrectomy may be indicated.

Front 3

Represent breaks in an abnormally brittle Bruch's membrane (encircling disc & radiating outward)
- Associated with systemic disease about half the time
- May lead to hemorrhages either from CNV or trauma

Back 3

Angioid Streaks

Front 4

What are some systemic associations with Angioid Streaks?

Back 4

1. Pseudoxanthoma elasticum (PXE)
2. Paget's Disease
3. Hemoglobinopathies
4. Various connective tissue disorders

Front 5

What's the treatment for Angioid Streaks?

Back 5

Treatment for Angioid Streaks:
1. Counsel on avoidance of contact sports and use of protective eyewear
2. If NO known associated systemic condition, communicate findings with patients PCP
3. Coordinate care of ocular complications with retinal specialist
- choroidal rupture
- CNV

Front 6

- Most patients' eyes affected after teen years
- mottling of RPE (looks like orange peel or "peau d'orange") may be more noticeable than Angioid Streaks.
- associated with CV disease, GI bleeding

Back 6

Pseudoxanthoma Elasticum (PXE)

Front 7

What's Paget's Disease?

Back 7

A bone disorder associated with CV disease that is found in Angioid Streaks.

Front 8

Represents a wrinkling of the inner choroid, Bruch's membrane, and RPE.
- A finding associated with compression of the choroid (sometimes idiopathic)
- Maybe associated with sight or life-threatening conditions

Back 8

Choroidal Folds

Front 9

What are some SIGNS of Choroidal Folds?

Back 9

1. Alternate parallel light and dark bands correspond to adjacent areas of thinner "stretched" RPE and thicker "compressed" RPE
2. Usually horizontal, but orientation probably depends on vector forces involved
3. May be asymptomatic (particularly if long standing) or cause blurred/distorted vision
4. Additional signs may relate to specific causes

Front 10

What are some CAUSES of Choroidal Folds?

Back 10

1. Idiopathic (often hyperopic patients)
2. Pressure effects:
- Papilledema
- Hypotony
3. Mass effects:
- Tumors (orbital or choroidal)
- Scleral Buckle
- Thyroid Ophthalmopathy
- Posterior Scleritis = get inflammation on back of the eye ball will push on the choroid and cause wrinkles

Front 11

What are some evaluation methods of Choroidal Folds?

Back 11

1. Aimed at identification of underlying cause
2. OCT or FANG can be used to differentiate from retinal folds
3. Ultrasound, MRI, or CT scans may be used to determine cause

Front 12

What's the treatment/management for Choroidal Folds?

Back 12

Tx/Management:
- It depends on underlying cause

Front 13

Denotes impaired macular function secondary to severely decreased IOP.

Back 13

Hypotony Maculopathy

Front 14

What are some CAUSES of hypotony?

Back 14

1. Glaucoma filtering surgery
2. Wound leak
3. Penetrating trauma
4. Inflammation
5. Cyclodialysis
6. Retinal Detachment

Front 15

What is the IOP for hypotony patients?

Back 15

Hypotony patient's IOP < 5 mmHg

Front 16

Pt c/o of reduced CENTRAL vision

Signs:
1) Chorioretinal folds radiating out from disc (often affecting the macula)
2) Retinal folds radiating out from the fovea
3) Low IOP (3-4 mmHg)

What is the Dx and Tx?

Back 16

a) Hypotony Maculopathy

b) Tx:
1. Restore normal IOP
- seal "leak" if from penetrating surgery or trauma
- treat inflammation or repair retinal/ciliary tear

2. Prognosis variable
- chronic cases can lead to phthisis bulbi & loss of eye
- substantial improvement possible even after years

Front 17

Term used to describe foveal damage caused by staring at the sun.

Back 17

Solar Maculopathy

Front 18

Pt c/o of blurry CENTRAL vision (or central scotoma) that occurred a couple of hours ago.

Signs:
- Sharply demarcated yellow or reddish foveal spot, which fades over weeks leaving a foveal defect with pigmentary changes or lamellar hole.

What's the Dx and Tx?

Back 18

a) Solar Maculopathy

b) NO Treatment!!!

Front 19

Which group of individuals are more likely to have Solar Maculopathy?

Back 19

1. Major psychological disorders
2. A history of psychotropic drug use
3. Religious or personal reasons for staring at sun

Front 20

What's the PROGNOSIS for Solar Maculopathy?

Back 20

Good prognosis!
- Most recover normal or near-normal vision within months