Physical signs of retinal disease

a complete retinal description answers what 6 questions?

what, color, morphology, where, depth, extent/context

cotton wool spots are...

superficial ischemic lesions

what are two words used to describe CWS?

fluffy white

the fluffy white lesions associated with CWS are lesions from....

microinfarction

CWS are caused by what???

precapillary arteriole occlusion

CWS are associated with what 4 systemic conditions?

HTN, diabetes, CT disease and HIV

CWS are known as indicators of what disease?

systemic microvascular

unexplained, multiple, recurrent or bilateral CWS warrant????

targeted systemic evaluation

most CWS absorb over __-__ weeks

6 8

CWS can resolve with control of what two things?

BP BS

why are CWS often next to flame hemorrhages?

both are superficial

HARD exudates are caused by what two things?

chronic vascular leakage or damage from retinal vessels

hard exudates are what color?

yellow/white

hard exudates are yellow/white lipid/protein deposits in what two layers of the retina?

OPL (major) and NFL (minor)

what pattern are hard exudates normally found in?

circinate or macular star

hard exudates are linked with what retinal conditions? (2)

DR and hypertensive retinopathy

is macular edema fluid or a fundus color?

fluid

macular edema is macular thickening from....

fluid leakage

macular edema is common in what four findings?

DR, vein occlusion, inflammation, post-surgical

macular edema is a major cause of ____ ____ in retinal vascular disease

vision loss

what is essential for diagnosis and monitoring of macular edema?

OCT

drusen are deposits beneath the ___

RPE

what color are drusen?

yellow

if drusen are small and hard, what does that indicate?

benign finding

if drusen are large and soft, what does that indicate?

AMD risk

drusen are a waste buildup between what two layers?

RPE and Bruchs

if you find drusen, monitor the patient for what two things?

pigmentary changes and SRF

RPE atrophy and hypertrophy are _____ pigment responses

opposite

atrophy is a sign of cell loss from what two things?

retinal thinning and AMD

hypertrophy is a sign of cell enlargement from what two things?

injury and inflammation

retinal scars/pigment signify CHRONIC or PRIOR retinal _____

insult

what finding is known to obscure retinal detail?

vitreous hemorrhage

a ____ hemorrhage is superficial, feathery, and follows the NFL

flame

a _____ hemorrhage is round or oval, deeper intraretinal blood

dot blot

a ______ hemorrhage is boat or D shaped with a horizontal fluid level

preretinal

a ________ hemorrhage is a diffuse haze, clumps, strands or inferior layering that obscures detail

vitreous

a _______ hemorrhage is a dark, deep-appearing blood beneath retinal vessels

subretinal

vitreous blood may track _______ across the _____ _____

inferiorly posterior pole

flame hemorrhages are associated with what 4 blood disorders?

HTN, RVO, anemia, leukemia

disc-margin flame hemorrhages demand ____-_____ context

optic nerve

dot-blot hemorrhages are present in what two layers of the retina?

INL and OPL

dot blod hemorrhages are leakages from ___ retinal capillaries

deep

dot blot hemorrhages are findings associated with what two things?

diabetic retinopathy and RVO

mixed hemorrhage patterns suggest _____ vascular injury

diffuse

a subretinal hemorrhage lies beneath the ________ retina

neurosensory

a subretinal hemorrhage is blood between what two structures?

retina and RPE

what are the four causes for subretinal hemorrhages?

CNV, AMD, truma and high myopia

what color and shape is associated with subretinal hemorrhages

dark red/black and dome

subretinal hemorrhage can cause ____ _____ vision loss, as blood is toxic to RPE

severe fast

active _____ _______ cna produce expanding subretinal hemorrhage

choroidal neovascularization

_____ _____ are white centered hemorrhages (NOT A DIAGNOSIS)

roth spots

roth spots are found in what layer of the retina?

NFL

what constitutes the white center of a roth spot?

fibrin/WBCs

roth spots are seen in what three blood disorders?

endocarditis, leukemia or anemia

___ ____ filter/imaging improves hemorrhage detection

red free

an ____ distorts the inner retinal surface

ERM

ERM is a _______ proliferation on the ___

fibrocellular ILM

what are the three main causes for ERM?

idiopathic, post-surgical or inflammatory

ERM may cause what two things?

macular pucker or metamorphopsia

what are the two management techniques used for ERMs?

observation or membrane peel

retinal vessel straightening reveals what???

tangential traction

retinal folds reflect...

mechanical deformation

what are the three main causes for retinal folds?

hypotony, tumors or post-surgical changes

retinal folds can cause what visually?

metamorphopsia

choroidal folds create parallel ________ bands

alternating

what can you use to separate retinal folds from choroidal folds?

OCT

in a retinal fold, look for ____ ____ of the retinal tissue

focal buckling

in a choroidal fold, follow the hyperreflexive ____-____ line

RPE bruch

neovascularization is fragile vascular growth driven by _____

ischemia

what are the three causes for neovascularization?

PDR, ischemic RVO or sickle cell

what are the two risks associated with neo?

vitreous hemorrhage or tractional RD

what are two ways we can treat neo?

anti-VEGF and PRP

CWS

CWS and flame hemes

exudates

hard exudates and flame heme

macular star

mac edema

mac edema

drusen

hard drusen

soft drusen

hypertrophy and atrophy

chRPE

vitreous hemorrhage

vitreous hemorrhage

flame heme

disc margin flame heme

dot blot heme

subretinal heme

subretinal heme

roth spots

roth spots

ERM

ERM

vessel straigntening (tangential traction)

retinal folds

choroidal folds

neovascularization

NVD