![]() In neuroretinitis (right image), the exudates tend to have a perivascular distribution, located surrounding blood vessel terminations. In other conditions, the exudate may be noted in the localized region of disease involvement, such as around aneurysms or along the involved vessels in a vein occlusion. For example, the two common conditions resulting in a so-called “macular star” exudate are hypertensive retinopathy and neuroretinitis. In each of these conditions, the pattern of exudate-or lipid deposits resulting from leakage-may be different. The etiology of the vascular breakdown is wide-ranging and potential mechanisms include vascular disorders, such as hypertension or diabetes, as well as inflammatory and infectious diseases (see “Possible Causes of Retinal Exudates,” below). The patient on the right has hypertensive retinopathy whereas patient on the left has neuroretinitis caused by seropositive Bartonella henselae (cat scratch disease).Įxudates appear in the intra- or subretinal space when the blood/retina barrier is interrupted within the retinal and/or choroidal circulation. Contact patient’s primary care provider.Ĭ. You determine that the patient on the left has not been compliant with his antihypertensive medications. Topical third-generation quinolone antibiotic.Ĥ. Assuming the patient on the right is a 10-year-old with no significant past medical history, what is the best course of action?Ĭ. What does not need to be included in the differential diagnosis for the patient on the right, who has no prior medical history and normal vital signs?ģ. Both patients have no systemic disease related to their ocular findings.Ģ. The patient on the left has a branch vein occlusion, while the patient on the right has increased intracranial pressure.ĭ. The patient on the left has poorly controlled diabetes, whereas the patient on the right has high blood pressure.Ĭ. The patient on the right may have a subclinical systemic infection.ī. The patient on the left has poorly controlled diabetes, hypertension or a mix of both. Which systemic processes may be involved in each patient presentation?Ī. The above fundus photographs depict two separate patients, each complaining of blurred vision for a short but indeterminate length of time.īoth are new to your practice and have never had an eye exam before.ġ. This article demonstrates a few examples of such cases and presents a series of self-test questions to sharpen your diagnostic skills. By familiarizing oneself with the differentiating nuances of these findings, we can overcome many of these clinical challenges. Masquerading features of various retinal and chorioretinal disorders can result in a diagnostic conundrum.
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