PANCE Blueprint EENT (7%)

Retinal disorders (PEARLS)

NCCPA™ PANCE EENT Content Blueprint eye disorders ⇒ retinal disorders

Macular degeneration Gradual painless loss of central vision. The macula is responsible for central visual acuity which is why macular degeneration causes gradual central field loss.

  • Metamorphopsia (distortion on Amsler grid)
  • Dry macular degeneration (85% of cases): atrophic changes with age – a slow gradual breakdown of the macula (macular atrophy), with DRUSEN (DRY) = yellow retinal deposits.
  • Wet macular degeneration: an advanced form of dry age-related macular degeneration. New blood vessels growing beneath the retina (neovascularization) leak blood and fluid, damaging the retinal cells. These small hemorrhages usually result in rapid and severe vision loss

TX: Wet age-related macular degeneration

  • VEGF inhibitors (e.g., bevacizumab)
  • Photodynamic therapy
  • Zinc and antioxidant vitamins

Dry age-related macular degeneration

  • Zinc and antioxidant vitamin
Retinal detachment Separation of the retina from the pigmented epithelial layer causing the detached tissue to appear as a flap in the vitreous humor

  • Can occur spontaneously or secondary to trauma or extreme myopia
  • Vertical curtain coming down (curtain of darkness) across the field of vision may sense floaters or flashes at the onset, loss of vision over several hours (acute and painless)
  • Fundoscopic exam: asymmetric red reflex
  • Myopia (nearsightedness) is a risk factor for the development of retinal detachment
  • Retinal detachment usually presents with defects in the peripheral visual field

TX: Stay supine (lying face upward) with head turned towards the side of the detached retina

  • Consult ophthalmologist
  • Pneumatic retinopexy is a procedure for the management of retinal detachment that involves cryoretinopexy followed by injection of an air bubble in the vitreous
Retinopathy Caused by systemic disorders, including diabetes, hypertension, preeclampsia-eclampsia, blood dyscrasias, and HIV disease -may affect the retina

  • Diabetic retinopathy falls into two main classes: nonproliferative (early) and proliferative (late, advanced)
  • Prolonged hyperglycemia causes basement membrane thickening, decreased pericytes (hyperproliferation), microaneurysms, and neovascularization
  • Leading cause of blindness in adults

Nonproliferative type (an early form of the disease)

Proliferative type (most severe, abnormal blood vessel growth)

  • Proliferative diabetic retinopathy (PDR) is the more advanced form of the disease
  • At this stage, circulation problems deprive the retina of oxygen. As a result new, fragile blood vessels can begin to grow in the retina and into the vitreous. The new blood vessels may leak blood into the vitreous, clouding vision
  • Fundoscopic exam (abnormal growth of vessels) neovascularization

TX:  control of blood glucose and BP

  • Ocular treatments: retinal laser photocoagulation, intravitreal injection of antivascular endothelial growth factor drugs (eg, ranibizumab, bevacizumab), intraocular corticosteroids, vitrectomy, or a combination
  • If diabetic get yearly dilated ophthalmoscopic examination
Orbital cellulitis (ReelDx) (Prev Lesson)
(Next Lesson) Macular degeneration (Lecture)
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