Download CMV Retinitis

Dr mahmood fauzi
ASSIST PROF OPHTHALMOLOGY
AL MAAREFA COLLEGE

To review the normal features of the human eye and the
ocular fundus.

To record the common systemic diseases affecting the eye.
To describe the ocular signs and symptoms associated
with selected systemic diseases and their serious ocular
squeal.


To compare and contrast the important features of diabetic
retinopathy types and the current screening guidelines.

To review the important ocular features of hypertension,
thyroid disease, sarcoidosis and inflammatory conditions,
malignancy and acquired immunodeficiency syndrome.
Hollenhorst Plaque
A Hollenhorst plaque appears as a bright, glistening, refractile plaque,
usually at the bifurcation of a retinal arteriole. These have the
propensity to break up and move, and may not be present at subsequent
visits.
Patient previously experiencing amaurosis fugax will not exhibit retinal
emboli, but may have arteriolar narrowing and sheathing.
PATHOPHYSIOLOGY
The Hollenhorst plaque is an embolus composed of cholesterol that forms
from an ulcerated ipsilateral carotid artery plaque. The patient frequently has
concurrent hypertension and elevated cholesterol levels. The stress on the
arteries induced by hypertension leads to reduced elasticity of the vessels.

BACK OF THE EYE
• Retinal Microvasculopathy
• CMV Retinitis
• Acute Retinal Necrosis
• Progressive Outer Retinal Necrosis
• Toxoplasmosis Retinochoroiditis
• Syphilis Retinitis
• Candida Albicans Endophthalmitis
 Most
common intraocular infection with AIDS
 Retinal necrosis, exudation, & hemorrhage
 Treatment:
 IV ganciclovir/foscarnet
 Intravitreal ganciclovir/foscarnet; Ganciclovir
intravitreal implant
CD4<100
Tertiary Syphilis
Need LP
Rx with IV PenicilinG
Uveitis
Choroidal granulomas
Periphlebitis
Granulomas = Choroidal Tubercules
An Ocular clue for Diagnosis of Tuberculosis
Cilio-retinal granuloma in TB
Fundus photography of a 40-year-old male with positive
Mantoux test with choroidal tuberculoma.
Acute central retinal artery occlusion in Adamantiades-Behçet disease
Fundus photography and fluorescein angiography. Note grossly impaired perfusion, retinal whitening
and relative cilioretinal sparing.
50% of patients with MS will
develop Optic Neuritis
 20-30% of time will be
presenting sign for MS


Most common intraocular
malignancy in adults

May be asymptomatic

May produce decreased or
distorted vision

Most common primary: Lung,
Breast

10% have unknown primary

No prior history of Cancer in 25%
Metastatic Lung Cancer.
Sturge-Weber Syndrome:
Choroidal Hemangioma
Nevus flammeus (Port Wine Stain)
 Benign
ocular conditions
Amiodarone – whorl keratopathy
 Toxic
Retinopathies
Thioridazine, chloroquine, hydroxychloroquine,
tamoxifen
 Toxic
Optic Neuropathies
Ethambutol, isoniazid




caused by the
drugs chloroquineor hydroxych
loroquine,
Used for rheumatoid arthritis,
SLE, etc
This eye toxicity limits longterm use of the drugs.
Both agents bind to melanin
pigment in the RPE, and this
may serve to concentrate the
drugs or to prolong their
adverse effects.
Bulls Eye Maculopathy
 salt
and pepper fundus is found in congenital
syphilis, choroideremia, Leber's congenital
amaurosis, rubeola, poliomyelitis, cmv retinitis.
 combination of RPE loss and migration produces
the "salt and pepper" fundus. The pepper may
be clumpy ("bone spicular"),
 Damaged RPE migrate into superficial retina.
The black pigment flecks are particularly
evident in the retinal mid-periphery.
A myopic crescent is white or grayish white moonshaped atrophic changes of choroid develop at
the temporal border of disc of myopic eyes.
 In myopia that is no longer progressing, the crescent
may be asymptomatic except for its presence
on ocular examination. However, in highdegree myopia, it may extend to the upper and lower
borders, or form a complete ring around the optic
disc and form a central scotoma.

 http://www.aao.org/theeyeshaveit/acquir
ed/
 http://www.aafp.org/afp/2002/0915/p99
1.html
 http://www.ncbi.nlm.nih.gov/pubmed/1
1926152
 http://ocularmanifestofsystemicdisease.wee
bly.com/quiz.html
 http://www.easynotecards.com/quiz/6222