Pathologic appearance by color
1. Normal retinal color
- Light reflex is from a healthy internal limiting membrane
- Macula does not have a ganglion cell or nerve fiber layer
- Tay-Sachs diseases is accumulation in ganglion cells so cherry
macula
- Normal blood vessel walls are clear
- Optic nerve pinkness due to vasculature
- Outer plexiform layer is superficial so no flame hemorrhages in
macula
- Retina is transparent
- Retinal color a result of melanin, carotene and choroidal blood
flow.
2. Dark retinal color changes
Atrophic holes
Choroidal neovascularization
- Net leakage results in RPE and or sensory retina elevation
- Gray green net develops up through compromised area of RPE-Bruchs
- If fluid spreads between bruchs and RPE it looks gray - green
If fluid gets past RPE it looks red
- Metamorphopsia and or reduced acuity
- Exudates possible at any stage (Coats disease)
Angoid streaks
- Post-photocoagulation scars 60%+ of Laser treatment diabetics
may develop a net in 5 yrs.
Choroidal rupture
- May develop a net 5 yrs later As fibrosis progresses it
becomes yellow
Pseudoxanthoma elasticum
Piagets disease
Sickle cell
Calcified Bruchs membrane
- Vascular nets lead to macular degeneration
Choroidal nevi
Congenital melanosis oculi
RPE hyperplasia
- RPE resonses to injury
- Congenital hypertrophy of RPE are jet black
- Seen with red free filter as black (Sub-RPE lesions disappear)
- Bear tracks Correlation of binocular bear tracks and genetic
form of colon cancer
Black demarcation lines
- Retinal detachment's an adhesion between RPE and choroid
- Chorioretinal scars are white sclera surrounded by RPE hyperplasia
- Melanin may accumulate around vessels in RP, blunt trauma and
late syphilis
RPE hypoplasia
- Attenuation of RPE above drusen reveals drusen
- Congenital rubella creates salt and pepper patches
Melanoma
Pavingstone degeneration
- Cobblestone degeneration
- Well demarcated concave areas of depigmentation in outer retinal
layers with pigmented borders
- Posterior to ora
- No problem
Reticular cystoid degeneration
- Disruption at nerve fiber layer
- Behind regular cystoid
- Often has fine blood vessel's overlying
3. Red retinal color changes
Bright red boat shape
- Fresh sub-internal limiting membrane hemorrhage
Bright red with feathery edges
- Fresh nerve-fiber layer hemorrhage
- Nerves tightly packed at pole so flame shaped hemorrhage
- Nerves less tight in periphery so dot-blot hemorrhage
Brown-black with sharp borders
- Fresh Sub RPE hemorrhage
- RPE and bruches membrane normally adherent
Microaneurysms
Neovascularization
- Vessels between hyaloid face and internal limiting membrane. If
vitreous shrinks they leak.
Early PVD hemorrhage
- Red and later red blood cells seen as tan ghost cells.
- If anterior hyaloid ruptured, may clog trabecula
Brownish hemisiderosis of clear retina
4. White retinal color changes
Degeneration's
Cotton wool spots
- Focal infarcts at the level of the nerve fiber layer from ischemia
induced transection and build up transported material
Cystoid degeneration
- Cyst-like spaces in outer plexiform layer
- Everyone has them and get more with age
- Coalescence produces senile retinoschisis
- Beaten metal appearance with white dots
- May have holes in both inner and outer layer which may lead
to a rhegmatogenous retinal detachment
Diabetic maculopathy
- Extracellular edema from leaking vessel's
- Acute ischemia of artery occlusion leads to intracellular edema
and later necrosis
Drusen
- Multiple extramacular drusen = 80% chance of macular degeneration
- No extramacular drusen = 2% chance of macular degeneration
- Bilateral macular drusen = 10% chance of wet in 4 yrs
- Hyaline deposits between RPE and choroid
Hard drusen
- Autolysis of RPE cells and later calcification
- RPE Drusen whiten when calcify
- Sick RPE
- If lots of hard drusen less chance of neovascularization
Lattice
- Thinning of inner retinal layers
- Loss of internal limiting membrane
- Liquefaction of overlying vitreous
- Strong vitroretinal adhesions at margins may lead to a retinal
detachment post PVD Overlying vessel walls are hyalinized
Soft drusen
- Localized areas of RPE detachment
- Refer for Fluroscein angiopathy
- Watch for metamorphopsia
String of pearls
- Peripheral fundus
- Linear row of drusen at ora
- May break free and float in vitreous
White with pressure
White without pressure
- Retinal atrophy and overlying vitroretinal adhesion in elderly
myopes
Emboli
- Calcium is white
- Lipids are yellow
- Platelets are gray - white
Errors of retinal structure
Drusen of optic nerve
- Calcified concretions
- Episcleral in-growth through scleral opening
- Doesn't scar over
Myelinated nerve fibers
- Retinochoroidal coloboma
- Temporal myopic crescent
Inflammation
Retinal edema
Commotio retinae
- Berlins edema
- Gray - white opacification of macula following blunt injury
- May subside if slight damage If more sever leads to macular
cyst
Diabetes
Hypertension
Occlusive disease
Retinal fibrosis
- Fibrous growths through bruches membrane into RPE in disciform
macular degeneration
- Arteriosclerotic vessel wall thickening
- Fibrotic vascularized membranes in diabetic retinopathy
- Organization of old vitreous hemorrhage
Retinal gliosis
- Non-glaucoma optic atrophy gliosis of nerve and reduced blood
supply cause nerve whitening
- Gliosis forms preretinal membranes in response to retinal
damage
- Snowbanking of inferior retina in chronic pars planitis is
inflammatory cells, gliosis and fibrosis
Retinal necrosis
- Viral CMV looks like a pizza (Red and white)
- Fungal White abscesses
- Protozoal
- Early toxoplasmosis is choroidal inflammatory response
- Late toxoplasmosis is a result of retinal and choroidal destruction
allowing sclera to be seen
Sarcoid
- Sheathing around vessel's
- "Candle wax drippings"
- Accumulations of inflammatory cells
Regressed retinoblastoma
- Necrotic Looks like cottage cheese
Roth spots
- Hemorrhages with necrotic centers in bacterial endocarditis
5. Yellow changes of retinal color
Lipids
- Usually in outer plexiform layer
- Outer plexiform layer is oblique in macula so see in profile
as spokes of wheel.
- Peripherally seen looking down on so appear round (End of a
cylinder)
Transudation
- Leakage due to osmolarity allowing smaller molecules out
Exudation
- Damage allowing all molecules out
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