Vision Changes: Retinal Pathology

Pathology	Description	Onset	B/L or U/L	Etiology	Other Sx	Method of Dx
Retina
Normal Retina		.
Glaucoma:		Mostly gradual			Pt classically described as halos around lights and pain, but most are asymptomatic
Retinal Detachment: Retina appears elevated, sometimes w/ folds & the choroidal background is indistinct		Sudden (vision loss if extensive detachment)		Retinal tears with secondary retinal detachment	Flashing lights then many floaters then a shade over the vision

Pathology	Description		B/L or U/L	Etiology	Dx
[Branch] Retinal Artery Occlusion:
	Sudden, painless vision loss. If transient (several minutes), called "amaurosis fugax" Later, after vascular stasis, can see "boxcarring" (rows of corpuscles separated). Later still, the retinal inner layer becomes opalescent, esp around the fovea, resulting in a cherry-red-spot.	This an ophthalmic emergency - refer to an ophthalmologist. If the vision loss is still present, as an emergency measure, a primary care physician could compress the eye for 10 seconds and release for 10 seconds for a total of 5 minutes. The sudden rise/fall in intraocular pressure could dislodge a small embolus and restore circulation	U/L	Emboli, sometimes from atheroma of carotid stenosis (especially for a Branch of the Retinal Artery.)
Central Retinal Vein Occlusion:			.
	venous engorgement, cotton-wool spots , diffuse retinal hemorrhages. Can be so severe that described as "blood and thunder"	Severe, but subacute onset.			General medical evaluation to detect a possible etiology, followed by a ophthalmologist followup (who may perform laser photocoagulation surgery)

Pathology	Description	Onset	B/L or U/L
Diabetic Macular Edema with severe exudates, microaneurysms, hemorrhage and retinal thickening. [SH Goldberg, 1997 #1]		Tends to be slow onset	Either
Diabetic Neovascularization: 1/4 to 1/3 disc area, which increases risk of severe visual loss [SH Goldberg, 1997 #1]
Diabetic Venous Beading:
HTN: Exudates and Cotton Wool Spots -- also Copper and Silver Wiring, AV Nicking, sometimes Papilledema, Hemorrhage
Astrocytoma -- also Copper and Silver Wiring, AV Nicking, sometimes Papilledema, Hemorrhage

Retina-Related/Signs of Ophthalmologic Pathology