Diagnosis of Retinopathy of prematurity
Retinopathy of prematurity Diagnosis: Book Excerpts
Diagnostic Tests for Retinopathy of prematurity: Online Medical Books
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Retinal Hemorrhage:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
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It is critical to realize that hemorrhages do not progress but represent altered structure, and as such may affect acuity
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Nonaccidental trauma must be the first etiology considered
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Pigmented lesions of the retina including choroidal nevi, congenital hypertrophy of the retinal pigment epithelium, retinal pigment epithelial hyperplasia
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Diabetic retinopathy is characterized by dot/blot, flame, preretinal, vitreous hemorrhages
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Hypertensive retinopathy is typically accompanied by signs of hypoxia, e.g., cotton wool spots and optic disc swelling
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May be associated with any systemic vascular disease or collagen vascular disease (e.g., systemic lupus erythematosus)
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Vein occlusion
–Occlusion of a central vein may involve the entire retina, occlusion of one branch vein involves a section of the retina
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Peripheral retinal hemorrhaging may be associated with vascular insufficiency due to carotid stenosis
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May be associated with optic disc swelling
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Traumatic truncal injury may create intraretinal hemorrhages called Purtscher lesions
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Intracranial hemorrhage may dissect forward to surround optic nerve (Terson phenomenon)
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Blood dyscrasias, anemias, leukemias, sickle cell, ocular sarcoidosis, Behçet disease, Eales disease may cause retinopathy
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If sudden loss of vision is associated, wet macular degeneration, macular hemorrhage of histoplasmosis, preretinal hemorrhage, or vitreous hemorrhage may be the etiology
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Retinal vascular tumors, which may have an associated neurologic aneurysm
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HIV retinopathy presents with hemorrhage as first sign but may progress to involve and destroy vision
Workup and Diagnosis
- History
–Evaluate status of known systemic diseases; e.g., hypertension, diabetes
–Investigate for undiagnosed systemic disease: Hypertension, diabetes, carotid occlusion, cardiac anomalies, blood disorders, HIV
- Physical exam
–Visual acuity: Acuity is compromised if the hemorrhage lies within the foveal area
–Pupillary evaluation: Look for Marcus Gunn pupil
–Extraocular muscle evaluation for diplopia (may be
associated with diabetes)
–Confrontation visual fields are indicated in all cases
–Perform a dilated fundus evaluation - Labs
–CBC, differential, lipid profile, ANA, sickle cell, ACE, serum calcium
- Studies
–Ultrasonography, fluorescein angiography, ocular CT may be performed in conjunction with an ophthalmology consultation
–If secondary to a retinal vascular tumor, orbital and brain imaging with and without contrast is indicated with a neurologic consultation
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Retinal detachment:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Confirming diagnosis Diagnosis depends on ophthalmoscopy after full pupil dilation. Examination shows the usually transparent retina as gray and opaque; in severe detachment, it reveals folds in the retina and ballooning out of the area. Indirect ophthalmoscopy is used to search for retinal tears. Ultrasound is performed if the lens is opaque.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Vascular retinopathies:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Check visual acuity and then vital signs, including blood pressure. Diagnosis is made on fundal examination with an ophthalmoscope. Determine if female patients are pregnant; hypertensive retinopathy may be an early sign of preeclampsia. (See Diagnostic tests for vascular retinopathies.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Retinal Phenomena:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Hypertension
❑ Diabetic retinopathy
❑ Glaucoma
❑ Cholesterol emboli
❑ Papilledema
❑ Pigmented crescent
❑ Macular degeneration
❑ Retinal detachment
❑ Acute optic neuritis
❑ Optic atrophy
❑ Retinal hemorrhage
❑ Chorioretinal exudates
❑ Lipemia retinalis
❑ Central retinal artery occlusion
❑ Central retinal vein occlusion
❑ Angioid streaks
❑ Hyperviscosity
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Retinal detachment:
Diagnosis
(Handbook of Diseases)
Ophthalmoscopy after full pupil dilation allows diagnosis. Examination shows the usually transparent retina as gray and opaque; with severe detachment, it reveals folds in the retina and a ballooning out of the area. Indirect ophthalmoscopy is used to search for retinal tears. Ultrasonography is performed if the lens is opaque.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Vascular retinopathies:
Diagnosis
(Handbook of Diseases)
Appropriate diagnostic tests depend on the type of vascular retinopathy. (See Diagnosing of vascular retinopathies.) Always include determination of visual acuity and ophthalmoscopic examination.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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