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Retina notes 3/3

DD of posterior pigments signs:

Vitreous hge
In children:
Trauma
 child abuse ( shaken baby $)
 trauma- accidental
Non trauma
 RB
 ROP
 PHPV
 Coat’s
 XR retinoschisis
 Intermediate uveitis
In adult:
 Trauma
 Non trauma
o PDR (50%)
o retinal breaks & RD (10%)
o posterior vitreous detachment (10%)
o CRVO/BVO (10%)
o CNVM (causing break through haemorrhages) (10%)
o Others:
# macroaneurysm
# intraocular tumours
# Terson's syndrome
# valsalva retinopathy

Pre-retinal haemorrhages ( or hges at different level):

 Proliferative retinopathies (including PDR/radiation)
 CRVO
 HTN
 collagen vascular disorder
 haematological disorders (as anaemia/ hyperviscosity $)
 retinal artery macroaneurysm
 blunt trauma
 Shaken baby syndrome
 Terson's syndrome
 Valsalva retinopathy (usu sub-ILM)

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Subretinal haemorrhages: (also dd of hges at different level):
 CNVM
 trauma
 ruptured macroaneurysm

Sub-RPE haemorrhages: (very dark-red, well defined & localized)

 CNVM
 trauma
 melanoma

Choroidal haemorrhages: (very dark-red but unlike sub-RPE hge, it is often

extensive)
 choroidal neovascularization
 trauma
 melanoma
 expulsive haemorrhage
Roth's spots:
 bacterial endocarditis
 leukaemia/ multiple myeloma
 severe anaemia
 HIV retinopathy
 collagen vascular disease

Circinate mculopathy (exudate at the macula) (intraretinal hges):

• Breakdown of the IBRB

o DM
o HTN
o CRVO/BRVO
o Retinal telengiectasia
o Macroaneurysm
o Rth
o VHL
o RAP
• Breakdown of the OBRB:
o CNV/ IPCV
o choroidal melanoma

Cotton wool spots

 Pre-PDR
 CRVO/BRVO
 BRAO
 Radiation retinopathy
 sickle cell
 Hypertension/eclampsia
 OIS
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  HIV retinopathy
 Collagen vascular disorders
 optic disc vasculitis
 Purtscher retinopathy

Neovascularization (* Causes of peripheral NV)

Retinal vascular causes

• PDR*
• proliferative haemoglobinopathies *
• radiation injury
• ROP*
• BRVO-CRVO
• OIS*
• CCF*
• FEV *

Hyperviscosity syndrome*
• Waldenstrom's macroglobulinaemia
• multiple myeloma
Collagen vascular disease *
• SLE
• PAN

Inflammatory disorder
• sarcoidosis *
• Behcet's disease
• par planitis *
• birdshot chorioretinopathy

Miscellaneous
• Eale's*
• hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber disease)

Retinal emboli:
 fibrinoplatelet from carotid diseases
 cholesterol emboli from carotid diseases
 calcific emboli from cardiac vulvular diseases
 infective embolic from BE
 atrial myxoma
 talc emboli (IVDU)
 fat emboli
 metastatic tumour
 amniotic fluid

Arterial attenuation:
 systemic hypertension

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  PDR
 retinal artery occlusion
 retinitis pigmentosa

Venous dilatation and tortuosity:

• Ischemic retinal dis
o CRVO/ BRVO
o OIS (dilated but not tortous)
o DM (PrePDR)
o Sickle cell anemia
• Blood dis
o Anemia
o Hyperviscosity $
• Fabrys dis
• CCF
• hereditary (usually all arteries and veins)
• primary antiphospholipid antibody syndrome

White dot syndromes (flecked retina $)

• RPE dystrophies:(classic flecked retina)
o fundus flavimaculatus
o Stargardt
o Familial dominant drusen
o Pattern dystrophy
• Photoreceptor dystrophy= night blindness
o Retinitis punctata albescens
o Fundus albipuncta
o kandouri flecked retina
• Posterior uveitis = white dot syndromes:
• Others:
o Crystalline retinopathy
o Vitamin A deficiency

Choroidal neovascularization
• Degenerative
o ARMD
o high myopia
o angioid streaks
o optic disc drusen
CSR
• infectious
o toxoplasmosis
• inflammatory conditions
o POHS
o PIC
o serpiginous choroiditis
• choroidal tumours
o choroidal melanoma

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 o choroidal naevus
choroidal haemangioma
choroidal osteoma
 Trauma:
choroidal rupture
• retinal dystrophy
Sorsby

Isolated pigmented lesion

• choroidal naevus
• CHRPE
• choroidal melanoma

Choroidal folds
• Idiopathic esp hyperopes
• Ocular causes
o hypotony
• Intramural
o choroidal tumour
o scleral buckling
posterior scleritis
• Orbital causes
o thyroid ophthalmopathy
pseudotumour
orbital tumour

Choroidal detachments
• ocular hypotony
o wound leak
o overfiltering bleb
o cyclodialysis cleft
o penetrating ocular trauma
• elevated uveal venous pressure
o CCF
o Sturge-Weber syndrome
vortex vein compression by scleral buckle
o malignant hypertension
• inflammatory factors
o after photocoagulation or cryotherapy
o scleritis
o uveitis
• secondary to abnormal sclera
o nanophthalmos
o idiopathic uveal effusion syndrome

Vascular lesion: (red orange mass in relation to blood vs)

• Macroaneurysm
• Vascular tu  search systemic $
o Capillary haemangioma

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 o Cavernous haemangioma
o Racemose haemangioma
• Telengiectasia
o Coat’s
o Leber’s

Macular oedema
• vascular cause
o DMO
o CRVO/BRVO
o CNV/RAP
• chronic intraocular inflammation
o intermediate uveitis
o post uveitis
• retinal diswases
o macular surface disease*
o RP*
o Gyrate atrophy
• surgery
o cataract surgery (Irvine Gass $)
o YAG capsulotomy
o retinal detachment surgery
 medications
o topical latanoprost?!
o topical adrenaline eye drop in aphakics
o nicotinic acid high dose*
• familial dominant

Psuedo CMO: CMO with no late leakage

 XL retinoschisis
 RP
 Nicotinic acid
 Favre Goldmann

Macular star (lipid in OPL)

• HTN
• macular neuroretinits (leber's idiopathic stellate retinopathy)
• papilledema
• capillary angioma/von-hippel-lindau
• IRVAN

Ischemic maculopathy:
• DM
• CRVO
• Sickle cell anemia
• Vasculitis

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Cherry red spots
• Aquired
o CRAO
o macular hole
o solar retinopathy
o commotion retinae
• Congenital
o Niemann-pick disease (cermide/sphingomyelin, , splenomgealy, corneal
opacity, hyperlipidemia)
o Gangliosidosis
o Tay-Sachs (TYPE I) (Ashkenazi's jews, convulsions, deafness, blindness)
o SanhoffS (TYPE II) (visceral organs)
o Mucolipidosis (MPS)
o Farbry's disease (glycolipid, FTT, s/c nodules, hoarse cry, progressive
arthropathy, early mortality)

Retinal elevation in the macula

• RD:
o ERD
 Choroidal tumors: melanoma, hemangioma, metastasis,
osteoma, leukemia
 CNVM
 Optic N: pits/ coloboma
 Inflammatory conditions: Harada's disease, sarcoidosis,
posterior scleritis
 Infections: Histoplasmosis
 CSR (must rule out CNVM if pt >50y/ diagnosis of exclusion)
o RRD: Retinal hole
• PED
• Macular edema

Dragged disc:

• Proliferative vascular dis

o ROP
o DM
o FEVR
o IP
• Uveitis:
o Toxocara
o Pars planitis
• Tumour
o Combined hamartoma of retina & RPE

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Dropped vision in an adult with no obvious cause
( including normal pupil & fundus)

 Refractive: refraction and pinhole

 Corneal  Keratoconus
 Macular dystrophy
 Optic nerve disease  esp LEBER’s/ heredieryb
 bilateral retrochiasmatic esp cortical blindness : bilateral decrease in VA
 Amlyopia: history
 Functional = non organic visual losss
 Orbital mass
Order
1. Refractive
2. ERG/VEP
3. FFA
4. MRI scan orbit and brain

Nycatalopia

• Congenital R.P

o CSNB
o Choroideremia
o Gyrate atrophy
o Favre Goldmann.
o Uncorrected Myopia

• Acquired

o Vitamin A defeciency
o After PRP

Choroidal thickening by US:

 Scleritis
 Hypotony
 Vascular congestion (carotid-cavernous fistula)
 Endophthalmitis
 Uveitis

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