Statistics and Associations

• Relatively low risk of melanoma; approximately 4 in 1000
• Suspicious lesions include growth (after puberty), significant elevation, underlying fluid, overlying orange pigment, close proximity to optic nerve and resultant visual symptoms

Management

• Photography for baseline
• Suspicious Nevi should be followed with serial photography to detect any changes

Statistics and Associations

• Separation of retina from underlying tissues
• Risk factors: lattice, nearsightedness, PVD, vitreous hemorrhage, retinal breaks (holes/tears), trauma
• 30% association with lattice degeneration

Management

• Surgical intervention
• If macula is attached, emergent treatment is indicated (within 24 hours)
• If macula is detached, urgent treatment is indicated (within 48 hours)

Statistics and Associations

• Thinning of peripheral retinal due to traction
• Present in 10% of population
• 25% develop holes in retina
• More common in nearsighted people
• 40% of retinal detachment patients also have lattice degeneration

Management

• Monitor as indicated
• Patient education regarding signs/symptoms of retinal detachment

Statistics and Associations

• Can be: traumatic, compressive (intraorbital/intracranial mass), hereditary (bilateral), toxic (bilateral), nutritional (bilateral), or secondary to various systemic situations/diseases
• Vision variable (20/20 – 20/400)

Management

• Consider neurology consultation

Statistics and Associations

• Two forms: arteritic (emergency) and non-arteritic
• Non-arteritic associated with high blood pressure (40%) and diabetes (20%)
• Occurs in people older than 55 (older than 60 for arteritic)
• Fellow eye involved in 25%-40% (non-arteritic)
• Vision loss usually permanent

Management

• Visual Field testing
• Consider STAT lab testing (ESR, CRP, CBC), check blood pressure
• Consider daily aspirin for non-arteritic AION

Statistics and Associations

• Buried material within the substance of the optic nerve
• 50% develop visual field defects
• Visual field defects can mimic glaucomatous defects
• Defects may change as the substance moves forward

Management

• No treatment necessary
• Monitor with routine visual fields to rule out glaucoma

Statistics and Associations

• Bilateral swelling of the optic nerve due to increased intracranial pressure
• Commonly associated with headaches, TVO’s, and pulsatile tinnitus
• Typically caused by an intracranial mass, malignant hypertension, or idiopathic intracranial hypertension

Management

• Visual field (enlarged blind spot), Optic nerve imaging (OCT)
• Emergent MRI of brain and orbit, lumbar puncture
• Check blood pressure

Statistics and Associations

• Necrotizing inflammation of the retina caused by a parasite
• Can be acquired (poorly cooked meat) or congenital

Management

• Amsler grid for daily monitoring
• No treatment necessary if inactive
• Consider referral to retinal specialist if active

Statistics and Associations

• Scarring in the retina secondary to a previous fungal infection
• Common in individuals raised on a farm (around chickens or other birds)
• Endemic in Ohio and Mississippi river valleys
• Fungus lies dormant with the potential to reactivate later
• Possibility of new blood vessel growth under the retina at scar location in macula.

Management

• No treatment necessary if inactive with no new blood vessel growth
• Refer new blood vessel growth for treatment with anti-VEGF injection

Statistics and Associations

• Cellular membrane growth/proliferation across retinal surface
• Common risk factors: idiopathic, trauma, ocular surgery/laser treatment
• Depending on location, can cause traction and wrinkling in macula (macular pucker) which can significantly decrease vision

Management

• Amsler grid for daily monitoring
• Surgical intervention if vision markedly reduced (20/60)
• 75% show improvement in vision after surgery