1.

The neurosensory
retina is
embryologically
derived from ____;
and injury causes
____
-the DIENCEPHALON
-GLIOSIS
2. The adult vitreous -is AVASCULAR, but it can be
opacified by hemorrhage from trauma
or retinal neovascularization
-age related liquefaction and collapse
of the vitreous gives rise to "floaters"
in the visual field
3. Retinal detachment -separation of the neurosensory retina
from the retinal pigmented epithelium
(RPE) is classified based on the
presence or absence of a break in the
retina
1) Rhegmatogenous retinal
detachment - associated with a full-
thickness retinal defect developing
when structural collapse of the
vitreous exerts traction on the retinal
internal limiting membrane; liquefied
vitreous humor then seeps through
the tear and separates the
neurosensory retina and RPE
2) Non-rhegmatogenous retinal
detachment (without a retinal break) -
occurs when exudates accumulate or
fluid leaks from the choroidal
circulation beneath the retina (e.g.,
with choroidal tumors or malignant
HT)
4. Retinal Vascular
disease
(neovascularization)
-a common end-point of numerous
insults
-it can occur secondary to vessel
occlusion, hypoxia, or primary
angiogenic factor production
*RETINAL HYPOXIA - causes
growth factor production (e.g.,
vascular endothelial growth factor
[VEGF]), --->angiogenesis;
**bleeding, increased vascular
permeability, or subsequent
contraction of the neovascular
membrane can cause retinal
detachment
5. Hypertension -results in retinal arteriosclerosis with wall
thickening
-In malignant HT, damaged choroidal vessels
can cause choroidal infarcts (ELSCHING
PEARLS) or exudate accumulation b/w the
neurosensory retina and RPE (causing
detachment)
-Occlusion of retinal arteries causes infarcts of
the retinal nerve fiber layer, and exudates from
damaged retinal vessels accumulate in the
outer plexiform layer
6. Diabetes
Mellitus
-Causes MICROVASCULAR INJURY with
thickened basement membrane (and
physiologic breakdown of the blood-retina
barrier with edema and hemorrhage), as well
as pericyte loss leading to characteristic
microaneurysms
1) Background (pre-proliferative) diabetic
retinopathy
-constitutes a spectrum of structural and
functional abnormalities of angiogenesis
restricted to the retina (i.e. beneath the
internal limiting membrane)
2) Proliferative diabetic retinopathy
-reflects new vessels (retinal
neovascularization) that breach the retinal
internal limiting membrane
-retinal neovascularization can be
accompanied by a neovascular membrane on
the iris secondary to elevated aqueous humor
VEGF levels; contraction of this membrane -->
adhesions that occlude aqueous outflow and
precipitate glaucoma
7. Retinopathy
of
prematurity
*immature retinal vessels respond to increased
oxygen tension (administered to premature
infants) by constricting, resulting in local
ischemia
8. Sickle
Retinopathy,
Retinal
Vasculitis,
Radiation
Retinopathy
*reduced oxygen tension leads to erythrocyte
sickling and microvascular occlusions
*Vasculitis and ocular radiation both damage
vessels, producing zones of retinal ischemia
1357-1365
Study online at quizlet.com/_8is3s
9. Retinal
artery and
vein
occlusions
*arterial occlusions due to atherosclerosis or
to atheroembolism cause retinal infarction
-since this onset is TYPICALLY SUDDEN,
there is no prolonged ischemia, and hence no
significant neovascularization
*retinal VEIN occlusion (e.g. due to arteriolar
thickening in hypertension that compromises
the venous lumen where the vessels cross)
typically leads to ischemia and subsequent
neovascularization
10. Age related
macular
degeneration
(ARMD)
**The most common cause of IRREVERSIBLE
visual loss in the U.S.
-more than 70% of cases are hereditary
-onset is influenced by env. exposures (e.g.
smoking)
-any disruption of RPE, its basement
membrane (Bruch membrane), or the
associated choroidal vasculature affects the
overlying photoreceptors and causes visual
loss
1) ATROPHIC (dry) ARMD - most common
(80-90%)
-associated with geographic atrophy of the
retinal pigment epithelium and deposits
(drusen) in the Bruch membrane
2) EXUDATIVE (wet) ARMD - (10-20%) is
associated with OVERALL GREATER VISION
LOSS
-it is caused by leaky choroidal neovascular
membranes
-therapy involves VEGF antagonists to block
the vessel formation
11. Retinitis
Pigmentosa
-collection of fairly common inherited
disorders that affect various aspects of vision,
including visual cascade and cycle, structural
genes, transcription factors, catabolic
pathways, and mitochondrial metabolism
*NOT primarily inflammatory
-both rods and cones are lost to apoptosis and
there is retinal atrophy, with perivascular
retinal pigment accumulation
12. Retinoblastoma *most common primary intraocular
malignancy of CHILDREN
-prognosis is worsened with extraocular
extension or optic nerve or choroidal
invasion
-in 40% of cases, retinoblastoma is
associated with a germ-line RB mutation;
such cases are often bilateral and are
associated with pinealblastoma with a
dismal outcome
-retinoblastoma tends to spread to brain
and marrow, with rare dissemination to
the lung
*Morphology
-tumors contain UNDIFFERENTIATED
(i.e. small, round cells) and differentiated
elements encircling blood vessels with
zones of necrosis and dystrophic
calcification
-well-differentiated tumors exhibit
FLEXNER-WINTERSTEINER ROSETTES,
reflecting abortive photoreceptor
development
-degree of diff. does not influence
prognosis
13. Anterior
Ischemic Optic
Neuropathy
-the optic nerve supply can be interrupted
by vascular inflammation (e.g. temporal
arteritis) or by embolism or thrombosis
14. Papilledema -optic nerve edema can be caused by
COMPRESSION (e.g. by neoplasm) or by
elevated CSF pressure; the latter is typically
bilateral (papilledema)
-Papilledema associated with increased
intra-cranial pressure is not typically
associated with visual loss
15. Glaucomatous
Optic Nerve
Damage
-characterized by atrophy (due to increased
intraocular pressures)
-accompanied by optic nerve head cupping
*In NORMAL-TENSION GLAUCOMA, the
same changes are seen WITHOUT
INCREASED INTRA-OCULAR
PRESSURES
*mutations in the OPTINEURIN GENE are
implicated
16. Other Optic
Neuropathies
1) inherited - e.g. Leber hereditary optic
neuropathy = due to MITOCHONDRIAL
GENE MUTATIONS
2) Toxins - e.g. methanol
3) nutritional deficiency
17. Optic
Neuritis
-common feature = visual loss secondary to OPTIC NERVE DEMYELINIZATION
-not all are inflammatory
** MULTIPLE SCLEROSIS = most important cause of optic neuritis
18. Phthisis
Bulbi
*The End-Stage Eye
-Trauma, intraocular inflammation, chronic retinal detachment, and many other conditions give rise to a small (atrophic)
and internally disorganized eye: PHTHISIS BULBI