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- Macular degeneration
- Diabetic Retinopathy
- Central Retinal Artery Occlusion (CRAO)
- Optic Neuritis
EpiscleritisRA, IBD Iritis Pain, no discharge IBD, Reiter’s
Retinitis Etiology: infectious (e.g. CMV [pic], candida [pic]), mitochondrial myopathies, autoimmune (e.g. Behçet’s), other HSV retinitis 30% recurrence / branching, dendritic form Retinitis pigmentosa Abetalipoproteinemia, neuronal ceroid lipofuscinosis, Usher’s Uveitis Presentation: abrupt onset of pain, photophobia / may have iritis, iridocyclitis (constriction of pupil increases pain) / may have hypopyon [pic] Causes: Sarcoidosis, Still’s disease, Reiter’s, Ankylosing spondylitis, Behçet’s, IBD, HSV, Tb, leprosy, onchocerciasis / most cases are idiopathic Diagnosis: slit-lamp exam shows keratic precipitates Treatment: topical steroids, mydriatics (decreases pain but also reduces formation of synechiae) Scleritis Pain, recurs Treatment: steroids – subconjunctival
Mechanism: macular edema, neovascularization Presentation: decreased vision, ocular pain, photophobia, circumcorneal redness - ? Retinal findings: flame – nerve layer blot and dot – deeper cotton-wool spot – microinfarct of nerve fiber layer (soft lesions) microaneurysms/hard exudates (lipid, protein material) chronic disease - lose vision – but don’t go blind proliferative disease – lose vision & go blind – can get huge bleed Treatment: can do laser surgery to create scar in peripheral retina and save central vision / if patient has a lot of bleeding vitrectomy and endolaser
widespread hemorrhages and edema (wavy, distinct pattern seen on retina) [pic][pic][pic][pic] / usually due to thrombus / painless / non-ischemic vs. ischemic (worse prognosis) Central Retinal Artery Occlusion (CRAO)sudden onset, total loss of vision / usu. embolization (may be preceded by amaurosis fugax) Findings: cherry red spot (there is slightly less edema in the macula allowing the well-perfused choroid to show through creating a small red dot) [pic][pic][pic] / boxcar pattern (stasis in retinal vessels) Treatment: emergent optho consult, can try things like external ocular pressure (?helps allow flow around occlusion), give carbon dioxide/oxygen mixture to induce vasodilation Optic NeuritisVision impaired, ocular movement usually painful, early on retina appears normal “patient sees nothing, doctor sees nothing” / most likely due to attack of MS Retinal Vasculitis Bacterial: endocarditis, Tb, Syphilis, Lyme, Bartonella, Whipple's Viral: VZV, HSV (1 or 2), CMV, EBV, Rubella, Rubeola, Mumps, Coxsackievirus B4, Rift Valley fever virus, HIV, HTLV Fungus: candida, cryptococcus Parasite: malaria, toxoplasma Presentation: decreased visual acuity, cloudy vision, decreased color perception, photopsias, floaters Findings: vascular sheathing, vessel attenuation, vessel occlusion, optic disc and macular edema, optic nerve pallor, cystoid bodies, cotton wool spots, hemorrhages, Roth spots [pic], and central scotomata / often an accompanying vitritis
vasoocclusive arteritis/phlebitis of retinal/choroid vessels and confluent necrotizing retinitis (+/- peripheral retina/vitreous) Treatment: empiric acyclovir, systemic corticosteroids, and even antithrombotic therapy / get an ophthalmology consult
Do NOT use anesthetics with corneal abrasion (slows healing) Red, tearing, pain, photophobia, decreased visual acuity, small pupil (ciliary spasm, aching pain)
Topical antibiotics / pressure patch 24-48 hrs / oral analgesic Download 3.95 Mb. Share with your friends:
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