SYSTEMIC DISEASE MANIFESTATIONS 4.

Neovascularization

 80% of globe is vitreous a. Neovascularization of the disk (NVD)

 Macula is inferiorly and temporally located
 Optic disk is nasally located b. Neovasularization elsewhere (NVE)
RETINA
 Rods-for night vision, peripheral, loosely packed, density • Do not develop papilledema
of 160,000/mm2
 Cones- color vision, compacted to corpora centralis, • Macular star: special type of lesion composed of hard
density of 140,000/mm2 exudates at Henle’s nerve fiber
 Blood supply: Choriocapillary supply
 Hemorrhages and retinal infarcts are commonly seen in Treatment
the NERVE FIBER LAYER 1. Medical
 Muller’s cells- storehouses of glucose
 2. Surgery (scleral buckling vitrectomy)
CLASSIFICATION OF RETINAL DISEASES
1. CIRCULATORY 3. Laser photocoagulation
 Hypertensive retinopathy
 Arteriosclerotic retinopathy Complications
 Diabetic retinopathy 1. vitreous hemorrhage
 Central retinal artery occlusion
 Central retinal vein occlusion 2. traction retinal detachment
2. MACULAR DISEASE
3. PIGMENTARY DEGENERATION
3. neovascular glaucoma
4. RETINAL DETACHMENT
5. RETINOBLASTOMA
4. macular diseases (edema)
SYMPTOMATOLOGY OF RETINAL DISEASE
1. Visual blurring( central or peripheral)
2. Photopsia- flashes of lights
3. Sector visual field defect CENTRAL RETINAL ARTERY OCCLUSION (CRAO)
4. Disturbance of image shape and size
5. Nyctalopia
Causes:
HYPERTENSIVE RETINOPATHY
1. VASOCONSTRICTION due to high pressure outflow 1. emboli (older individuals)
2. ANOXIA
 Retinal edema due to ischemia 2. thrombus (older individuals)
 Hemorrhage
 Exudates –hard( chronic, with distinct shape) and 3. spasm (younger individuals)
cotton wool(acute/ischemic)
 Neovascularization- not true blood vessels, these
Symptom: marked blurring or complete loss of vision
vessels break easily

CLASSIFICATION OF HYPERTENSION Signs:

 Grade 1- AV ratio 1:2
 Grade 2- AV ratio 1:3 1. constricted arterioles
 Grade 3-Hemorrhage and exudates
 Grade 4-Papilledema 2. white fundus background
CLASSIFICATION OF ARTERIOSCLEROSIS
 Grade 1- slight widening of median reflex 3. creamy red spot
 Grade 2- moderate widening of median reflex and AV
crossing change Management:
 Grade 3- copper wire arteries
 Grade 4- silver wire arteries
1. paracentesis
ARTERIOSCLEROTIC RETINOPATHY BASIC LESIONS
 Hyalinization of median coat causes widening of median
light 2. vasodilators
 Hardening of the artery results in AV crossing change
 Increase in length Golden period: 90 minutes
 Boxcar appearance
Two real emergencies:
DIABETIC RETINOPATHY
Anoxia results to the following: 1. CRAO
1. Basement membrane pathology
2. Chemical burns
2. Loss of neural cells

3. Blood changes (thickening of the blood)

CENTRAL VEIN OCCLUSION
Lesions:
1. Dilatation of veins
Causes:

2. Aneurysm and small round hemorrhage

a. Young- inflammatory

3. Waxy & cotton wool exudates

 b. Old- arteriosclerosis 2. Loss of pigment

- Diabetic hypertension 3. Fibrovascular membrane

Symptoms: fairly rapid loss of vision Management:

Signs: 1. Medical

a. marked venous congestion & tortousity 2. Laser photocoagulation

b. superficial hemorrhage

c. exudates

Management:

a. Medical

b. Laser photocoagulation

PIGMENTARY DEGENERATION

• Premature cell death

Symptoms:

1. Night blindness

2. Loss of peripheral vision

Signs:

1. Ring scotoma

2. ERG

3. Fundus picture

MACULAR DISEASES

A. CENTRAL SEROUS RETINOPATHY

Cause: undetermined

Symptoms:

a. Blurring of central vision

b. Metamophosia

c. Micropsia or macropsia

Sign: macular edema

Management

1. Medical: oral prednisone

2. Laser photocoagulation

B. SENILE MACULAR DEGENERATION

Cause: degeneration

Symptom: impaired central vision

Signs:

1. Exudates