benign peripheral retina disorders

Benign peripheral retina disorders - white without pressure

-asymptomatic

-white grey appearance of border

-has well demarcated scalloped borders

-seen without scleral indentation

What does it look like

-scalloped border (white jagged part)

Who does it occur in

30% of all px

Common in dark skinned, bilateral, benign

What is the differential diagnosis

Subclincal retinal detachment

Retinoschisis

Congenital hypertrophy of retinal pigment epithelium CHRPE

-bear tracks , is congenital thickening of the RPE

Three types of CHRPE

Solitary - unifocal

Grouped - multifocal

Atypical - bilateral and multifocal

Prevalence and risk factors

1.2%

-risk factor - typically benign

-no associated preceding event

-atypical associated colonic polyps and carcinoma - cancer

Signs of CHRPE

Is asymptomatic

-typically round flat pigmented lesions -dark black/grey

-has distinct margins

-can have areas of chorioretinal atrophy w lesions (lacunae)

-deep pigmented halo around lesions - no vitreous traction

Where is it located

Around the equator

What could these cause?

Scotoma

CHRPE with halo around lesion present

What are the differential diagnosis

Choroidal melanoma , naevus

-melanocytoma

-focal pigmentation - injury inflammation or drug toxicity

Prognosis of CHRPE

Generally benign

-relationship to colonic polyps /carcinoma

When signs indicate further testing

Multiple lesions more than 4

Bilateral lesions

Family history of colon cancer

Management

No active intervention usually indicate

Chorioretinal scar

Area of retinal pigmentary changes/fibrosis

What is it a result of /cause

Inflammation or trauma

-asymptomatic unless macula involved

VF defects

How does it appear

White to yellow intraretinal fibrosis with accompanying RPE hyperplasia

-can have vitreous condensation and strands

What else does it involve

Can involve choroidal -retina - vitreous

-possible vitreous traction -retinal tears

-can reactivate so need to monitor

RPE window effect

Common, results from absence of melanin in RPE

-is a round well circumscribed white yellow area

-no surrounding RPE hyperplasia -unlike in chorioretinal scar

How do they differentiate from retinal holes

Appear red brown with oedema and can have hyperplasia

Window effect image

Choroidal naevus

Causes of choroidal naevus

Is an area of choroidal pigmentation

Benign , common , prevalence increases w age

-Is asymptomatic

What are the signs

Small,flat,grey lesions

-mottled - can have drusen

-round to oval size with irregular indistinct margins

-usually no chorioretinal atrophy , no haloes around the lesion

Differential diagnosis of choroidal naevi

Choroidal melanoma

How do we manage choroidal naevi

Baseline colour photography

-OCT + autofluoroscence to see sub retinal fluid and lipofuscin

Referral

Urgent 2 weeks (if we think its gonna convert to melanoma)

-any one of - thickness more than 2mm, colllar stud configuration ,documented growth

-any two of - thickness more than 1.5mm, orange pigment ,serous detachment ,symptoms

Otherwise is routine exam

Paving stone degeneration

What is it

Occurs in 30% px

-peripheral retinal degeneration

Small pale non elevated ,depigmented areas

-usually bilateral, inferiorly placed

-choroidal vessels seen due to RPE and outer retinal loss

-benign, can increase w age

What do we need to differentiate it from

Chorioretinal scars

Retinal holes

Lattice degeneration

=these all lead to retinal detachment

Peripheral pigmentary (reticular) degeneration

Polygonal ,honeycomb pattern of granular pigmentation

When does it occur

20% of over age 40 and increases w age , is benign

What is differential diagnosis

Retinitis pigmentosa

Cystoid degeneration

Present in 100% eyes over age 80

What is it

Tiny vesicles w indistinct boundaries on greyish white background

-usually close to ore serrata

-benign

What can it resemble

Lattice degeneration -cystoid is elevated while lattice is depressed

Equatorial drusen

Peripheral drusen

What is it

Deposits of material on Bruchs membrane

-found in over 70% px 50 years and over

-histologically similar to macula drusen

Benign?

Benign - as long as not approaching macula and not associated with any other conditions

Pars plana cyst

Clear bulbous elevation of non pigmented ciliary epithelium of pars plana

Where is this seen

5-10% of px

-seen at vitreous base

-is harmless