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Signs of Retinal Diseases Dr Monika Pradhan Dr Tahira Malik Consultant Ophthalmologists

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Page 1: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Signs ofRetinal Diseases

Dr Monika Pradhan Dr Tahira MalikConsultant Ophthalmologists

Page 2: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Case Scenario LinksSigns of Retinal Diseases

• Annual eye screen for patient with diabetes (Oph11)

• Gradual deterioration in visual acuity over time (Oph07)

• Sudden painless loss of vision (Oph04)

• Type 2 diabetes mellitus (Endo11)

Page 3: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Blood Supply of the Retina

3

•CRA - real artery•atherosclerosis•AV crossings•capillary-free zone –

foveal avascular zoneRetinal artery

Choroid

400 µm

Page 4: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Signs of Retinal Vascular Disease

Lens

• Vascular changes – arteriolosclerosis, AV crossing changes, venous tortuosity

• Microaneurysms

• Haemorrhages

• Hard exudates

• Cotton wool spots

• Neovasclarisation

Page 5: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Vessel Wall Changes

Normal

Silver wiring of arterioles

Copper wiring of arterioles

Arteriolar attenuation

AV crossing changes

Page 6: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Vascular Changes

AV crossing changes

Venous dilatation and tortuosity

Page 7: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Microaneurysms

• Tiny round red dots

• In inner nuclear layer

• Saccular outpouchingsfrom vessels due to lack of pericytes

Page 8: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Retinal Haemorrhages

Appearance Localisation Aetiology

• Dot & blot haemorrhages – middle compact retinal layers –diabetic and hypertensive retinopathy

• Flame-shaped haemorrhages – superficial nerve fibre layer –vein occlusion

• Pre-retinal haemorrhages – between posterior hyaloid face and retina – trauma, Valsalva manouvre, neovascularisation

Page 9: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Dot and blot haemorrhages Flame shaped haemorrhages Pre retinal haemorrhage

Page 10: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Retinal Haemorrhages- Roth Spots

• Endocarditis• Anaemia• Haematological

diseases

Page 11: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Hard Exudates

Lipid deposition

Outer plexiform layer

Abnormal vascular permability

Circinate (circular) pattern

Macular star

Page 12: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Hard Exudates

Page 13: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Cotton Wool Spots

• Ischaemic infarction• Nerve fiber layer• Axoplasmic transport defect

• Diabetes• Hypertension• SLE• Leukemias• Infective - HIV

Page 14: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Neovascularisationhypoxia ⇒ vasoformative factors ⇒ neovascularisation• in the retina NVE• on the optic disc NVD• on the iris NVI / rubeosis iridis• in the angle NVACauses:• Diabetes• Retinal vein occlusion• Retrolental fibroplasia• Sickle-cell disease• Inflammatory diseases

Page 15: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Retinal neovascularisation

Page 16: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Iris neovascularisation

Image used with patient permission

Page 17: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Occlusive Vascular Diseases: Signs

Venous occlusion:• Dilated venules• Haemorrhages• Oedema

Page 18: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Occlusive Vascular Diseases Signs

Page 19: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Occlusive Vascular Diseases Signs

Page 20: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Occlusive Vascular Diseases SignsRetinal arteries occlusion:

• constricted arterioles• column interruptions• retinal oedema• cherry red spot• visible emboli

Page 21: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Occlusive Vascular Diseases Signs

Page 22: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Occlusive Vascular Diseases Signs

Page 23: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Degeneration/dystrophy signs

• Drusen• Atrophy• Pigmentation• Scarring

Result of diseaseor Iatrogenic e.g. laser scars

Page 24: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Degeneration/dystrophy signs

• Drusen• Atrophy• Pigmentation• Scarring

Result of diseaseor Iatrogenic e.g. laser scars

Page 25: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Degeneration/dystrophy signs

• Drusen• Atrophy• Pigmentation• Scarring

Result of diseaseor Iatrogenic e.g. laser scars

Page 26: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Degeneration/dystrophy signs

• Drusen• Atrophy• Pigmentation• Scarring

Result of diseaseor Iatrogenic e.g. laser scars

Page 27: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Degeneration/dystrophy signs

• Drusen• Atrophy• Pigmentation• Scarring

Result of diseaseor Iatrogenic e.g. laser scars

Page 28: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Degeneration/dystrophy signs

• Drusen• Atrophy• Pigmentation• Scarring

Result of diseaseor Iatrogenic e.g. laser scars

Page 29: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Elevations of the Retina

sub

Total RetDet.

• by fluid – retinal detachment• by solid mass - tumours• Choroidal neovascularisation

Choroidal melanoma

Page 30: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Choroidal neovascularisation (CNV) – with subretinal haemorrhage

Fluorescein angiogram – showing large CNV at macula

Page 31: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

The Macula

• Oedema

• Drusen

• Atrophy

• Scarring

• Pigmentation

Page 32: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Cystoid macular oedema – (CMO/CME) petalloid appearance on FFA

Page 33: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Drusen and atrophy Atrophy and pigmentation

Page 34: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Signs of Inflammation-Posterior uveitis

• Vitreous opacities, cells, snowballs• Choroiditis – deep yellow or grey lesions• Retinitis – white cloudy lesion with obscuration of

retinal vessels• Vasculitis – periphlebitis (veins) or periarteritis –

fluffy haziness around blood column• Granlomas – choroidal or preretinal

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Vitritis

Page 36: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Multifocal choroiditis

Retinitis

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Granulomas

Page 38: Signs of Retinal Diseases - Auckland · Signs of Retinal Vascular Disease. Lens • Vascular changes – arteriolosclerosis, AV crossing changes, ... • on the iris NVI / rubeosis

Self-Assessment:retinal diseases

(All diagnoses covered in preceding PPt)

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The EndMaterial contained in this lecture presentation is

copyright of The Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, and should not be reproduced without first obtaining

written permission