Figure 2. Papillitis refers to disc edema secondary to inflammation of the optic nerve head, such as may occur with idiopathic demyelinating optic neuritis, whereas optic neuritis refers to inflammation of the optic nerve and may be proximal, papillitis (with disc edema) or distal, retrobulbar (without disc edema). Typical slow progression leads to a sharply demarcated, atrophic appearance involving only the posterior pole area, causing a central scotoma without night blindness. Stage 3: full-thickness hole (< 400 μm) often with yellow deposits at level of retinal pigment epithelium (Klein’s tags), operculum over the hole within the hyaloid face, cuff of subretinal fluid at hole edges, cystoid macular edema at hole edges, absence of a Weiss ring, and positive Watzke–Allen sign (subjective interruption of slit beam on biomicroscopy). The OCT shows the partial thickness opening of the hole. Essentially, the device takes a digital retinal photograph by recording the reflected light from a single, photographic flash. The retina is also normally transparent, allowing the choroid and retinal pigment epithelium (RPE) to be visible. 4–1). Cortical and cerebellar atrophy is commonly seen in cases with syndromic CPEO, in keeping with the higher burden of neurological disease in this specific patient population. 9.15), central progressive areolar choroidal dystrophy, central choroidal angiosclerosis]. The reflected light is then split by a beam splitter into distinct images of the same area of the retina, each filtered to a programmed wavelength (the amount of images and the bandwidths produced by the beam splitter depends on the proprietary system used). The risk is greater in myopic eyes. To make a correct diagnosis and establish an adequate treatment, one must combine a proper history of the patient’s symptoms with a detailed ocular examination. Depending on the patient history, a complete examination of both eyes, including intraocular pressure measurement and slit lamp evaluation to assess anterior chamber depth and inflammation, iris defects, and lens clarity, is necessary. Pigmentary changes in the macula of the right eye in an adolescent boy with a hereditary macular dystrophy. (2004, 2007).

[1] Once the pupil is dilated, examiners use ophthalmoscopy (funduscopy) to view the eye's interior, allowing assessment of the retina, optic nerve head, blood vessels, and other features. The disease progress is away from the optic disc, with new attacks occurring in areas previously uninvolved. 1990, Parisi et al. Your doctor will examine the back of your eye after your pupils are dilated. Your eye doctor can use ophthalmoscopy to screen for eye diseases and conditions that can affect blood vessels. 9.16). Many kinds of diseases can affect the posterior segment of the eyes.

Common causes of pseudoedema that may be mistaken for true disc edema include optic disc drusen, congenitally anomalous optic discs, tilted optic discs, and myelination of the nerve fiber layer at the optic disc head (Fig. Determination of the nature and duration of the visual symptoms, including past ocular and systemic history, should be the first step toward the correct diagnosis. The images were scanned by a FLIO (fluorescence lifetime ophthalmoscope) laser ophthalmoscope of Heidelberg Engineering, Heidelberg, Germany. Visual acuity is only affected if the central fovea is involved in an attack. The retinal map is the summary of the retinal examination, and the location and different kinds of lesions are standardized by colors (Table 4–1). By continuing you agree to the use of cookies. Then they will use a microscope to look at the back of your eye. Your eye doctor can look through the lenses to examine your eye. They include visual acuity, contrast sensitivity, color vision, visual field, dark adaptation, and retinal sensitivity profiles. Fig. The first is that a DFE increases the number of posterior pole anomalies detected (Siegel et al. Following the history, we proceed with measurement of the visual acuity, slit-lamp biomicroscopic examination, and the ophthalmoscopy, which always should be done with the patient’s pupils dilated to allow a wider view of the periphery of the ocular fundus.

Additional information can be obtained by determining how light diffuses through objects in the fundus using various ophthalmoscopic techniques. Mydriatic and cycloplegic agents can be used for diagnostic and therapeutic purposes. Finally, you should tell your eye doctor if you have glaucoma or a family history of glaucoma. FA may help by showing microaneurysms as hyperfluorescent dots; hemorrhages, on the other hand, are hypofluorescent lesions. Even if you think your eyes are healthy, getting a dilated eye exam is the only way to know for sure.

If the patient has subnormal vision, visual electrophysiology can be very useful as the electroretinogram (ERG) and visual evoked potentials (VEPs) can help pinpoint the anatomical location and extent of retinal dysfunction. However, many of the anomalies found in the peripheral retina are benign and do not need treatment (Siegel et al. Although one eye may have an obvious lesion, care must be taken to scrutinize the other eye, as the disease is bilateral in 20–40% of patients. Sometimes the vitreous may pull off an operculum, resulting in a round hole. The characteristics of an ERG that identify its relative normality are its waveform and its amplitude.

Stage 2: early, small, full-thickness hole either centrally within the ring or eccentrically at the ring’s margin.


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