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Egg Yolk in the Retina?

Nico Esterhuizen, B. Optom., Mark Lawrence, Optometrist Monday, 20 January 2014

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39 yo African American F

  - CC:  VISION BAD OD OVER ONE MONTH EVOLUTION
  - BEST CORRECTED ACUITY FC OD AND 20/20 OS.
  - IOP 13/14 mmHG
  - MED HX NO CONTRIBUTORY INFORMATION
  - MEDS: NONE

 

What is going on in OD?Slide4Slide5Slide6Slide7Slide8Slide9Slide10Slide11Slide12

IMPRESSION

 

  • SUPERFICIAL RETINAL MACULAR DEPOSITION OR SWELLING
  • EVIDENCE OF FEEDER VESSELS
  • NO EVIDENCE OF RNFL COMPROMISE
  • NO EVIDENCE OF GCC COMPROMISE RATHER SWELLING

LIKELY ASSOCIATION RETINAL HEMANGIOBLASTOMA

  • STIMULATED BY VEGF SECRETED BY STROMAL TUMOR CELLS
  • PRESENTS CHILDREN AND YOUNG ADULTS
  • IF TWO OR MORE RETINAL CAPILLARY HEMANGIOBLASTOMAS CLASSIFIED AS VON HIPPEL-LINDAU DISEASE

von Hippel-Lindau disease (VHL) is a rare, genetic multi-system disorder characterized by the abnormal growth of tumors in certain parts of the body. The tumors of the central nervous system (CNS) are benign and are comprised of a nest of blood vessels and are called hemangioblastomas. Hemangioblastomas may develop in the brain, the retina, and other areas of the nervous system. Other types of tumors develop in the adrenal glands, the kidneys, or the pancreas. Symptoms of VHL vary among patients and depend on the size and location of the tumors. Symptoms may include headaches, problems with balance and walking, dizziness, weakness of the limbs, vision problems, and high blood pressure. Cysts (fluid-filled sacs) and/or tumors (benign or cancerous) may develop around the hemangioblastomas and cause the symptoms listed above. Individuals with VHL are also at a higher risk than normal for certain types of cancer, especially kidney cancer. 

Caveat: When using any guidelines one must consider correlation with other patient characteristics and other clinical tests such as but not limited to: chief complaint, age, gender, ethnicity, refractive status, family history, associated medical conditions, current medications, pachymetry, visual field testing, angle assessment.

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