Atlas oftalmologia version 2.pdf
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Transcript of Atlas oftalmologia version 2.pdf
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FONDO DE OJO NORMAL
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CRISTALINO LUXADO VISTO POR RETROILUMINACION
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Degeneración de la retina, Pepe
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Perdida de visión brusca, mono lateral e indolora
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MIOPíA MAGNA se aprecia atrofia coroidea en placas bien delimitadas y pequeña hemorragia macular.
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Corrección de la miopía mediante lente intraocular de cámara anterior anclada en iris.
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Corrección de la miopía mediante lente intraocular de cámara anterior cuyos hápticosse apoyan en el ángulo.
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Enfoque de un eje en retina y otro eje detrás de retina (astigmatismo miópico). La colocación de un cilindro corrige el astigmatismo.
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anillo de succión alrededor del ojo. El microqueratomo girará alrededor del eje situado en el lado temporal y se deslizará por las ruedas que se sitúan en el lado nasal del anillo.
CIRUGíA REFRACTIVA. LASIK
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HIPERMETROPíA
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MIOPíA
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MIOPíA MAGNA Fondo de ojo en el que se aprecia atrofia coroidea, hemorragia macular, fondo atigrado.
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MIOPíA MAGNA atrofia coroidea, estrías en barniz en la mácula.
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CATARATA NUCLEAR la pupila está dilatada
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CATARATA NUCLEAR : vista con lámpara de hendidura
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CATARATA SUBCAPSULAR POSTERIOR con lámpara de hendidura
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CATARATA SUBCAPSULAR POSTERIOR
zona del eje visual que afecta mucho la visión. Aspecto con retroiluminación.
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CATARATA SUBCAPSULAR POSTERIOR
paciente diabético. Aspecto con lámpara de hendidura.
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paciente diabético. Aspecto con retroiluminación. CATARATA SUBCAPSULAR POSTERIOR
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CATARATA CORTICAL Estas opacidades en ocasiones producen mucha fotofobia.
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CATARATA PULVERULENTA
Estas opacidades en muchos casos afectan poco a la visión pues son periféricas.
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CATARATA SUBCAPSULAR POSTERIOR
specto estrellado de una catarata subcapsular posterior secundaria a tratamiento con corticoides.
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CATARATA INICIAL O INCIPIENTE
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CATARATA MADURA
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blanca con sinequias posteriores.
CATARATA TRAUMáTICA
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CATARATA TRAUMáTICAetroiluminación de una catarata algo subluxada de causa traumática.
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CATARATA SUBLUXADA
madura y subluxada con pupila dilatada.
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CATARATA SUBLUXADA
blanca y totalmente desplazada. Pueden verse restos de vítreo en pupila.
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CATARATA SUBLUXADA
subluxación con la pupila dilatada con la lámpara de hendidura. Catarata brunescente.
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CATARATA SUBLUXADA
subluxación con la pupila dilatada por retroiluminación. Catarata brunescente.
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CIRUGíA DE CATARATAS
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Técnica de facoemulsificación. El mago del facoemulsificador se muestra a la derecha partiendo un fragmento del núcleo del cristalino. Se ayuda mediante una espátula que el cirujano maneja con la mano izquierda.
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Limpieza de masas cristalinianas una vez acabada la facoemulsificación. La cápsula posterior se ve transparente y se aprecia la capsulorrexis.
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Introducción de la lente intraocular plegable mediante pinza.
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Aspecto de un ojo normal en el postoperatorio de una cirugía de catarata. Se aprecia la lente intraocular bien centrada y la capsulorrexisrodeando la zona óptica de la lente.
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Lente intraocular desplazada, como complicación de una cirugía de cataratas.
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HEMORRAGIA PRERETINIANA (SUBHIALOIDEA)
Las hemorragias vítreas se pueden almacenar en un espacio habitualmente virtual localizado entre la hialoides posterior y la superficie de la retina (hemorragia subhialoidea). Debido a que la haloides separa la hemorragia del resto del gel vítreo este no se enturbia. Habitualmente se forma con el reposo un nivel característico entre la sangre y suero. Al tratarse de una hemorragia de localización preretiniana oculta los vasos sanguíneos.
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HEMORRAGIA PRERETINIANA
Hemorragias preretinianas que ocultan los vasos sanguíneos. Son frecuentes en las alteraciones hematológicas. En este caso se deben a una leucemia.
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DESPRENDIMIENTO POSTERIOR DE VíTREO.
El vítreo se halla fuertemente unido al nervio óptico. Cuando se separa el vítreo de la retina (desprendimiento posterior de vítreo) se puede, en ocasiones, observar esta zona de unión como un anillo flotando por delante de la retina, denominado anillo de Weiss.
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HIALOSIS ASTEROIDE
En la hialosis asteroide se observan múltiples puntos brillantes flotando en el interior de la cavidad vítrea. Con frecuencia suele ser asintomático.
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HEMORRAGIA VíTREA
En esta ocasión no es que la diapositiva sea mala y no se vea nada. Cuando hay una hemorragia masiva en el vítreo este se enturbia y no se alcanza a distinguir los detalles del fondo de ojo.
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HEMORRAGIA PRERETINIANA (SUBHIALOIDEA) Y VíTREA
1.Hemorragia subhialoidea 2.Hemorragia preretiniana
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Neovascularización subretiniana DMAE
La neovascularización subretiniana suele presentar gran tendencia a producir hemorragias que al igual que la membrana que las origina son subretinianas por lo que se puede observar el trayecto de los vasos retinianos pasando por encima de ellas sin ser ocultados (al contrario de lo que sucede en las hemorragias preretinianas o vítreas).
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FONDO DE OJO NORMAL (ATIGRADO)
El fondo de ojo atigrado se caracteriza por presentar unas estriaciones oblicuas más oscuras debidas al acúmulo de pigmento en la coroides. Es una variante de la normalidad y es más frecuente en personas de ojos oscuros.
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RETINOSIS PIGMENTARIA
1.Acúmulos de pigmento periférico en forma de osteoclastos2.Arterias estrechas 3.Palidez del nervio óptico
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RETINOSIS PIGMENTARIA
1.Acúmulos de pigmento periférico en forma de osteoclastos2.Arterias estrechas 3.Palidez del nervio óptico
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RETINOSIS PIGMENTARIA
Acúmulos de pigmento periférico en forma de osteoclastos
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COROIDOSIS MIóPICA
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FOTOCOAGULACIóN NEOVASCULARIZACIóN SUBRETINIANA
a NVSR se fotocoagula en su totalidad y de manera directa hasta provocar una lesión blanquecina y homogénea
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DMAE. Forma seca
•Drusas •Area de atrofia centra l
Un truco para diferenciar las drusas de los exudados es que estos últimos tienen su origen en una anomalía vascular (hemorragia microaneurismas etc...) que ocupa el centro de la lesión. En este caso en el centro no existe lesión vascular sino una zona de atrofia a través de la cual se ve la coroides (de aspecto atigrado) por lo que deduciremos que se trata de drusas.
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DMAE. Forma húmeda
1.Exudados lipídicos 2.Area de neovalarización central
Un truco para diferenciar las drusas de los exudados es que estos últimos tienen su origen en una anomalía vascular (hemorragia microaneurismas etc...) que ocupa el centro de la lesión. En este caso en el centro existe lesión vascular (membrana neovascular subretiniana por DMAE) por lo que deduciremos que pese a ser una DMAE se tratan de exudados
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DMAE. Cicatriz disciforme I
•Hemorragia subretiniana•Cicatriz disciforme (fibrosa
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CICATRIZ POR NEOVASCULARIZACIóN SUBRETINIANA
Las estrías angioides son alteraciones de la membrana de Bruch que se observan con líneas irregulares alrededor del nervio óptico por lo que pueden pasar desapercibidas o ser confundidas con vasos. Predisponen a la aparición de membranas neovasculares subretinianas que pueden ser confundidas con una DMAE.
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Miopía magna (mancha de Fuchs)
CICATRIZ POR NEOVASCULARIZACIóN SUBRETINIANA 1.NVSR (mancha de Fuchs) 2.Atrofia peripapilar3.Se ven vasos coroideos
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DMAE. FORMA SECA. DRUSAS BLANDAS
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DMAE. FORMA SECA. DRUSAS DURAS
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ENFERMEDAD DE BEST
En la enfermedad de Best se observa un acúmulo central de lipofucsina (el mismo material que las drusas) que aparece normalmente en niños o personas jóvenes (Imagen de yema de huevo frito). En este estadio la agudeza visual es buena. Es de carácter hereditario.
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ENFERMEDAD DE STARGARDT
La enfermedad de Stargardt se caracteriza por la presencia de acúmulos de lipofucsina y atrofia en el área central acompañada en ocasiones de fundusflavimaculatus (acúmulos periféricos de lipofucsina amarilla). La visión central se ve muy afectada. La edad de aparición es juvenil lo que la diferencia de la DMAE. La diferencia con la enfermedad de Best es que en esta última sólo aparece un acúmulo de lipofucsina (en yema de huevo frito) y la visión se afecta menos.
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OCLUSIóN DE ARTERIA CENTRAL DE LA RETINA
La mancha rojo cereza solo se ve en las fases iniciales del proceso.
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RETINOSIS PIGMENTARIA
Acúmulo de pigmento en forma de espículas u osteoclastos
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DMAE. DRUSAS
Drusas blandas confluentes
En ocasiones pueden aparecer con un aspecto similar en pacientes jóvenes tratándose en eses caso de un proceso de herencia autosómica dominante.
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DMAE. CICATRIZ DISCIFORME
En las fases avanzadas del proceso la sangre y la exudación se reabsorben quedando sólo la cicatriz disciforme de la DMAE.
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ENFERMEDAD DE STARGARDT
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DMAE
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RETINOSIS PIGMENTARIA
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OCLUSIóN DE LA ARTERIA CENTRAL DE LA RETINA
Mancha rojo cereza
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OCLUSIóN DE LA VENA CENTRAL DE LA RETINA (fotocoagulación con laser)
Hemorragias en astilla
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OCLUSIóN DE LA VENA CENTRAL DE LA RETINA
En ocasiones tras un oclusión venosa puede aparecer isquemia retiniana con riesgo de desarrollo de neovasos o edema. En la imagen se observan impactos recientes de láser en la zona isquémica donde sucedió la oclusión venosa a fin de evitar la aparición de neovasos. Las hemorragias en astilla desaparecen al cabo de algunos meses de evolución.
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OCLUSIóN VENOSA DE RAMA DE LA RETINA
Hemorragias en astilla en una zona de oclusión venosa de la rama temporal superior. A diferencia de cuando ocurre una oclusión de la vena central de la retina en la que todo el fondo de ojo se llena de hemorragias en astilla aquí solo aparecen en la zona de la vena ocluida. La diferencia entre una hemorragia por una oclusión de rama y la provocada por una DMAE es que en la oclusión las hemorragias siguen el trayecto de la capa de fibras (en llama o en astilla). En la DMAE son anárquicas y subretinianas (por debajo de los vasos sanguíneos).
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OCLUSIóN VENOSA DE RAMA TEMPORAL INFERIOR
La oclusión venosa de la rama temporal inferior es menos frecuente.
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TROMBOSIS VENOSA
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DESPRENDIMIENTO DE COROIDES
La diferencia entre un desprendimiento de coroides y un desprendimiento de retina es que en el primera el líquido está a tensión con un aspecto liso y compacto en cambio en el desprendimiento de retina se observan arrugas en su superficie adquiriendo un color más blanquecino.
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DESPRENDIMIENTO DE RETINA
La diferencia entre un desprendimiento de coroides y un desprendimiento de retina es que en el primera el líquido está a tensión con un aspecto liso y compacto en cambio en el desprendimiento de retina se observan arrugas en su superficie adquiriendo un color más blanquecino. La parte de la izquierda se ve desenfocada porque al estar la retina desprendida se encuentra en un plano de enfoque distinto al del resto del fondo de ojo.
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MEMBRANA EPIRETINIANA
La membrana epiretiniana puede aparecer de forma idiopática asociada a la edad tras la cirugía de desprendimiento de retina o tras un desprendimiento de retina traumático. Consiste en una fina membrana avascular que se localiza por encima de la retina. Al contraerse arruga la retina como si fuese papel de celofán (por eso se la ha llamado también maculopatía en celofán) distorsionando los vasos sanguíneos.
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Obsérvese la distorsión de los vasos provocada por la tracción de la membrana situada sobre la retina.
MEMBRANA EPIRETINIANA
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DESPRENDIMIENTO DE RETINA
La retina desprendida tiene un color más blanquecino y un aspecto elevado y arrugado.
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La retina desprendida tiene un color más blanquecino y un aspecto elevado y arrugado.
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DESGARRO RETINIANO FOTOCOAGULADO
En el centro se observa un desgarro retiniano. Tiene forma de herradura aunque la lengüeta de retina desgarrada lo tapa parcialmente. Las zonas no ocultadas por la lengüeta retiniana tienen un color rojo más intenso. El desgarro está rodeado por múltiples puntos blancos que corresponden a impactos recientes de láser (pocos minutos después de la aplicación.
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DESGARRO RETINIANO FOTOCOAGULADO
Cuando cicatrizan los impactos de láser estos adquieren un aspecto moteado con zonas claras y oscuras de borde nítidos.
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UVEITIS POSTERIOR. FOCO DE COROIDITIS
Los focos activos de coroiditis se observan como zonas de bordes poco nítidos de aspecto blanquecino y situadas en profundidad por debajo de la retina. Se observa un vaso sanguíneo que pasa por encima de la lesión. Normalmente son planas aunque en ocasiones pueden ser algo elevadas como en este caso correspondiente a una tuberculosis.
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UVEITIS POSTERIOR. FOCOS DE COROIDITIS
Focos múltiples de coroiditis. Similares a estos se pueden observar en la oftalmía simpática
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GRANULOMA POR TOXOCARA
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UVEITIS POSTERIOR. VITRITIS. (SARCOIDOSIS)
En ocasiones debido a la inflamación de la uvea posterior se produce el paso de celulas inflamatorias al vitreo (vitritis) como en este caso de sarcoidosis. La turbidez vítrea produce miodesopsias y es difícil ver detalles del fondo de ojo.
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UVEITIS POSTERIOR.
Los focos de coroiditis al cicatrizar producen zonas de atrofia del epitelio pigmentado (claras) junto con otras de hipertrofia reactiva. Los bordes son nítidos. En este caso se trata de una coroiditis serpinginosa denominada así por su progresión serpenteante.
Cicatriz corioretiniana
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UVEITIS POSTERIOR Desprendimiento exudativo I
Asociada a la uveitis posterior de pueden producir desprendimientos serosos de la retina (sin presencia de desgarros retinianos). La retina adquiere un color blanquecino y se pueden distinguir como pequeñas elevaciones quísticas de la retina. Esta imagen corresponde a un proceso denominado síndrome de Vogt-Koyonagi-Harada (poco frecuente).
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UVEITIS POSTERIOR Desprendimiento exudativo II
Asociada a la uveitis posterior de pueden producir desprendimientos serosos de la retina (sin presencia de desgarros retinianos). La retina adquiere un color blanquecino y se pueden distinguir como pequeñas elevaciones quísticas de la retina. Esta imagen corresponde a un proceso denominado síndrome de Vogt-Koyonagi-Harada (poco frecuente).
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TOXOPLASMOSIS (AGUDA Y CICATRICIAL)
Los focos recientes de coroiditis por toxoplasma tiene una aspecto blanquecino y de bordes poco nítidos. Las cicatrices antiguas tienen un contorno nítido y un color claro-oscuro.
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ENDOFTALMITIS POSTQUIRúRGICA
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TOXOPLASMOSIS CICATRICIAL
En presencia de una cicatriz coroidea (zonas claras y oscuras) con lesiones satelites en la zona macular hay que pensar siempre en una toxoplasmosis congénita hasta que se demuestre lo contrario ( y después también).
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UVEITIS (Uveítis intermedias, posteriores y panuveítis)
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a) Uveítis posteriores y panuveítis
• SIGNOS Y SINTOMAS:- Opacidades y exudados vítreos- Coroiditis
(foco o focos blanquecinos o amarillo-grisáceos de localización coroides, con edema de retina adyacente. A veces cursa con áreas blanquecinas cicatrizadas; otras con hemorragias retinianas)- Retinitis
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Eb) Uveítis intermedias
• Inflamación preferentemente en el vítreo (vitritis) y en úvea intermedia o zona de la pars plana.
• VITRITIS: acúmulos blanquecinos en parte inferior de la retina (bancos de nieve) –turbidez vítrea.
Además, existe edema macular quistico.
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SíNDROME PSEUDO FOSTER-KENNEDY. NOIA BILATERAL
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NEURITIS
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Papilitis y estrella macular OD
NEURORETINITIS
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NEUROPATíA óPTICA ISQUéMICA EN FASE AGUDA Noia
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NEUROPATíA óPTICA ISQUéMICA FASE CRóNICA-ATRóFICA
Síndrome de Pseudofoster-Kennedy
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NEUROPATíA óPTICA ISQUéMICA FASE CRóNICA-ATRóFICA
Síndrome de Pseudofoster-Kennedy
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NEUROPATíA óPTICA ISQUéMICA FASE CRóNICA-ATRóFICA
Síndrome de Pseudofoster-Kennedy
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PAPILA INCLINADA
Atrofia parapapilar inferior
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PAPILA INCLINADA
Atrofia parapapilar inferior
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DISVERSIóN PAPILAR LATERAL OI
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COLOBOMA Y DRUSAS
Coloboma parcial y drusas papilares OD
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PAPILEDEMA
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PAPILEDEMA
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a). Neuropatías ópticas anteriores(papilitis)
•Edema de la cabeza del nervio óptico con:
-alteración de la visión moderada o intensa
-defecto pupilar aferente
☼¡¡¡OJO!!!☼
No confundirlo con papiledema (edema de papila por HT intracraneal), ya que este último no tiene ni defecto pupilar aferente ni disminución de la agudeza visual.
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Papila edematosa: borrosa e hiperfluorescente en AGF
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Fondo de ojo: contorno del nervio óptico desdibujado, hiperémico.
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b) Neuropatías ópticas posteriores
• “Ni el enfermo ni el médico ve nada”
• Sintomatología igual q la NOA pero NO EDEMA DE PAPILA!!
• El fondo de ojo suele ser normal durante el periodo de crisis, aunque posteriormente puede instaurarse una ATROFIA ÓPTICA.
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Acuerdate que aquí es eso que explicó en clase el Dr Moreno
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Uveítis aguda con pequeños precipitados retrocorneales en endotelio
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Tras una uveítis pueden apreciarse sinequias iris-cristalino. Al dilatar la pupila pueden romperse estas sinequias y dejan la huella de pigmento en la superficie anterior del cristalino. En la parte superior persiste una sinequia
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En una uveitis curada a veces se pueden visualizar acúmulos de fibrina en pupila
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Al dilatar la pupila del paciente anterior se aprecia que esta fibrina ha producido unas sinequias posteriores (iris-cristalino)
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ESCLERITIS
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Escleritis difusa
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Escleritis necrotizante
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Escleritis difusa
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Escleritis nodular
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Escleritis posterior
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Fondo de ojo normal
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EPIESCLERITIS
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epiescleritis
escleritis
Escleritis necrotizante
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Epiescleritis difusa
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Epiescleritis nodular
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Sin vasoconstricción
Con vasoconstricción
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UVEITIS ANTERIORES
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INYECCIÓN PERIQUERÁTICA
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Nodulos de Busacca
HIPEREMIA Y EDEMA DEL IRIS
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Iridociclitis heterocrómica de Fuchs
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EXUDADOS Fenómeno Tyndall
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Precipitados retrocorneales
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Hipopion
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Malla de fibrina en pupila
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SINEQUIAS POSTERIORES
Sinequia rota
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Iris bombé
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SINEQUIAS ANTERIORES
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ATAQUE AGUDO DE GLAUCOMA
(Glaucoma de ángulo cerrado)
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SÍNTOMAS:
1.Visión borrosa: por edema de cornea
2.Dolor ocular tipo clavo
3.Blefarospasmo y lagrímeo
4.Síntomas vegetativos
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SIGNOS:
1.Hiperemia periquerática y conjuntival (fig 5.2 y 5.1)
2.Edema de córnea. Se ve turbia y opalescente y no se distingue el iris (fig 5.26)
3.Midriasis media hiporreactiva (pupila se ve con asopecto ovalado)
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1.HIPEREMIA PERIQUERATICA Y CONJUNTIVAL
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2. EDEMA DE CORNEA
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3. MIDRIASIS MEDIA HIPORREACTIVA (forma ovalada)
Midriasismedia
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Todos estos signos nos llevan a: Glaucoma agudo
13
2
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2
3
1
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Ver las imágines del libro:
fig 5.56
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DISTROFIA ENDOTELIAL DE FUCHS
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GERONTOXON
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MANIFESTACIONES CORNEALES DE ENFERMEDADES SISTÉMICAS
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Enf wilson
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QUERATOCONO
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Estrías
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Estrías
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QUERATOPATÍA EN BANDA
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erosiones
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temprana
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QUEMOSIS CONJUNTIVAS Y EQUIMOSIS PALPEBRAL
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IRIDODIÁLISIS SECUNDARIA. TRAUMATISMO
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CAUSTICACIóN ALCALIS ULCERACORNEAL
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CAUSTICACIóN ALCALIS ULCERACORNEAL
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TRAUMATISMO PERFORANTE OCULAR
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HIFEMA
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ROTURA DE LA RAIZ DEL IRIS POR TRAUMATISMO CONTUSO
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RECESIóN ANGULAR POR TRAUMATISMO CONTUSO
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HERIDA PERFORANTE EN CóRNEASe aprecia el fenómeno de Seidel con salida del humor acuoso a través de la herida
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HERIDA PERFORANTE EN CóRNEAe aprecia el fenómeno de Seidel con salida del humor acuoso a través de la herida
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ABERTURA TRAUMáTICA DE INCISIóN QUIRúRGICA
aciente operada de queratoplastia que sufre una caida: se abre la herida en la zona izquiera con salida del iris e hifema.
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HERIDA CORNEAL SUTURADA
Se aprecia herida corneal suturada con hifema.
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HERIDA CORNEAL SUTURADA Se aprecia herida corneal suturada con neovascularización de la herida
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Se aprecia una herida superior en córnea suturada y con presencia de masas cristalinianas en cámara anterior
HERIDA CORNEAL Y CRISTALINIANA
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CUERPO EXTRAñO METáLICO
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CUERPO EXTRAñO METáLICO
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CUERPO EXTRAñO INTRAOCULAR
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CAUSTICACIóN CORNEAL
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CAUSTICACIóN CORNEAL
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CAUSTICACIóN CORNEAL por cal
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RUPTURA DE COROIDES TRAUMáTICALas roturas coroideas postraumáticas tienen forma de media luna paralela al borde del nervio óptico. Si afecta la zona foveal produce una pérdida severa de visión. Tienen un mayor riesgo de desarrollar neovascularización subretiniana.
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DESPRENDIMIENTO DE RETINA POSTRAUMáTICO
Los desprendimientos de retina postraumáticos tienen peor pronóstico ya que la reacción inflamatoria es mayor, lo que provoca la aparición de un proceso de cicatrización exagerado con la aparición de membranas cuya contracción provoca que la retina se vuelva a desprender.
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AGUJERO MACULAR Los agujeros maculares pueden ser idiopáticos (asociados a la edad) o bien postraumáticos. La causa es una tracción del vítreo que se encuentra especialmente unido a la mácula lo que poduce el desgarro de la retina.
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CUERPO EXTRAñO INTRAOCULAR con desprendimiento de retina
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CUERPO EXTRAñO INTRAOCULAR
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EDEMA MACULAR POST-TRAUMáTICO edema de Berlin
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ENFERMEDADES DE LOS PÁRPADOS
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Se pueden producir por:
1- Alt. Cutáneas
2- Inflamaciones
3- Anomalías de la posición
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ALT. CUTÁNEAS
- Alt. por enfermedades exantemáticas(varicela…)
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ALT. CUTÁNEAS
- Lesiones por VHS y Virus Zoster
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ALT. CUTÁNEAS
- Xantelasmas: Son depósitos grasos, se sitúan en el canto interno normalmente. Son un signo de hiperlipidemia II y III
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ALT. CUTÁNEAS
- Dermatocalosis: caida del párpado
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INFLAMACIONES
• Difusas
• Localizadas
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INFLAMCIONES: Difusas
- Blefaritis estafilococica o ulcerosa:producida normalmente por S. Aureus o Epidermidis
ver fig 5.35 y 5.43
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INFLAMCIONES: Difusas
- Blefaritis post: Inflam gland Meibonio. Produce perdida pestañas (madarosis) y triquiasis
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INFLAMCIONES: Difusas
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INFLAMCIONES: Difusas
madarosis
no pestañas
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INFLAMCIONES: Localizadas
- Orzuelo: Infección estafilococica focal y aguada de las glandulas de Zeiss, Möll o Meibonio
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INFLAMCIONES: Localizadas
- Chalazión: Inflamación granulomatosa de una gland. de Meibonio con retención de la secreción, no deslizable ni dolorosa a la presión
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INFLAMCIONES: Localizadas
fig 5.46
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ANOMALÍAS DE LA POSICIÓN
- Estáticas
- Dinámicas
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ANOMALÍAS DE LA POSICIÓN: Estáticas
- Ectropión:
Fig 5.47
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ANOMALÍAS DE LA POSICIÓN: Estáticas
- Entropión: se asocia frecuentemente con ulceras corneales lagrimeo y epífora
fig 5.48
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ANOMALÍAS DE LA POSICIÓN: Dinámicas
- Alt elevador párpado superior
- por defecto: Ptosis
Fig 5.49
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ANOMALÍAS DE LA POSICIÓN: Dinámicas
- por exceso: Retracción párpado sup
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ANOMALÍAS DE LA POSICIÓN: Dinámicas
- Alt. Orbicular
- Lagoftalmos: paralisis VII pc, no pueden cerrar los ojos Queratitis exposición.
Fig 5.51
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ANOMALÍAS DE LA POSICIÓN: Dinámicas
- Blefarospasmo: contracción espásmódica del musc. Orbicular
- Blefarotic o Miokimia:fasciculaciones del musc.Orbicular, por fatiga o incorrecta correción óptica
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GONIOSCOPIA NORMALÁngulo abierto se aprecian las estructuras del
ángulo sin ninguna patología.
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GONIOSCOPIA CON NEOVASOSSe aprecian neovasos en el ángulo característicos del glaucoma neovascular.
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GONIOSCOPIA CON PIGMENTO
Se observa un gran depósito de pigmento en la malla trabecular que parece marrón.
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PAPILA GLAUCOMATOSA Excavación vertical de 8/10. En la parte superior la excavación llega hasta el borde papilar.
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ASIMETRíA EN LA EXCAVACIóN
Excavación de los 2 ojos de un mismo paciente. La excavación de la papila izquierda es de 6/10 y la derecha es de 3/10.
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PAPILA GLAUCOMATOSA
Se aprecia un rechazo de los vasos y en la zona inferior una excavación que llega al norte papilar
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PAPILA GLAUCOMATOSA
Papila glaucomatosa con excavación de 7/10 que posteriormente desarrolla una hemaorragia en astilla (fotografía inferior).
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CAMPIMETRíA GLAUCOMATOSA
e aprecia en el campo de la derecha un empeoramiento campimétrico con aumento de la mancha ciega y escotoma absoluto en el campo nasal.
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CAMPIMETRíA GLAUCOMATOSA
Aumento del escomota absoluto nasal e incicio de escotoma arciforme inferior en el campo de la derecha.
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CAMPIMETRíA GLAUCOMATOSA
Escotoma arciforme superior absoluto muy cerca del punto de fijación.
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TRABECULECTOMíA
Colgajo escleral cuadrangular.
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TRABECULECTOMíA Una vez levantado el colgajo escleral se realiza la trabeculectomía y posteriormente la iridotomía.
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TRABECULECTOMíA
Sutura del colgajo escleral.
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TRABECULECTOMíA
Sutura conjuntival final.
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TRABECULECTOMíA Aspecto postoperatorio: se observa una cámara formada, la iridectomía y la ampolla por donde sale el acuoso.
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TRABECULECTOMíA Ampolla en el postoperatorio muy grande y de forma quística.
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Aspecto en el postoperatorio de un paciente reintervenido. A la derecha trabeculectomía antigua que se ha cerrado y a la izquierda la segunda intervención de trabeculectomía que es funcionante.
TRABECULECTOMíA
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Trabeculectomía visible mediante gonioscopia.
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COLOCACIóN DE IMPLANTE VALVULAR Se aprecia la entrada del tubo en la cámara anterior.
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GONOSCOPIA Diálisis de la raiz del iris en un glaucoma traumático.
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SíNDROME DE STURGE-WEBER Se aprecian hemangiomas en la cara. Glaucoma por aumento de presión venosa epiescleral en el ojo derecho de la paciente.
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hiperpigmentación en el ángulo camerularGLAUCOMA PIGMENTARIO
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Huso de Krukenberg DISPERSIóN PIGMENTARIA
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PSEUDOEXFOLIACIóN EN ANILLO PUPILAR
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Papila glaucomatosa
GLAUCOMA DE BAJA TENSIóN
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GLAUCOMA TERMINAL
Gran excavación, atrofia papilar y parapapilar.
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ATALAMIA
Ausencia de cámara anterior tras cirugía filtrante de glaucoma.
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SíNDROME DUANE. OJO DERECHO
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SíNDROME DUANE. OJO DERECHO
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SíNDROME DUANE. OJO DERECHO
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ENDOTROPíA
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EXOTROPíA
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ENDOTROPíA
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ESTRABISMO Horizontal infantil endotropia
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ESTRABISMO VERTICAL
Parálisis del recto superior del OD
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EXOTROPIA
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ENDOTROPIA
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NISTAGMO/NISTAGMUS
Atrofia esencial de iris, nistagmo horizontal y albinismo.
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ANGIOMA DE PAPILA
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NEVUS COROIDES
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METáSTASIS COROIDEA
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METáSTASIS COROIDEA
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MELANOMA DE COROIDES
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HEMANGIOMA COROIDEO
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ASTROCITOMA RETINIANO AGF
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ASTROCITOMA RETINIANO AGF
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NEVUS IRIS
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RETINOBLASTOMA HEMORRAGIA
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MELANOMA COROIDEO EXUDATIVO
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HEMANGIOMA DE COROIDES
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HIPERPLASIA DEL EPITELIO PIGMENTADO DE LA RETINA
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NEVUS COROIDES. DRUSAS
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NEVUS COROIDEO
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NEVUS COROIDEO
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OSTEOMA COROIDEO
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OSTEOMA COROIDEO (TAC)
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MELANOMA COROIDEO ENDOFíTICO
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MELANOMA COROIDEO (RMN)
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ECOGRAFíA MELANOMA COROIDEO
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NEVUS DE OTA
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NEVUS IRIS
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HEMANGIOMA PALPEBRAL
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CARCINOMA BASOCELULAR. CANTO INTERNO
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MELANOMA PALPEBRAL. RNM
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CARCINOMA BASOCELULAR óRBITA TAC
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PAPILOMA
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NEVUS CARúNCULA
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PAPILOMA PALPEBRAL
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CARCINOMA BASOCELULAR INFILTRACIóN ORBITARIA
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NEVUS INTRADéRMICO
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NEVUS CONJUNTIVAL
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HEMANGIOPERICITOMA. TAC
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QUERATOSIS SEBORRéICA
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DERMOLIPOMA OCULAR Y ORBITARIO
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NEVUS PALPEBRAL
![Page 631: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/631.jpg)
MELANOSIS CONJUNTIVAL RACIAL
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MELANOSIS CARúNCULA Y CONJUNTIVA ADQUIRIDA
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HEMANGIOMA ORBITARIO. TAC
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NEVUS CONJUNTIVAL
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HEMANGIOMA ORBITARIO
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QUISTE COLOBOMATOSO DERECHO. RNM
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GLIOMA NERVIO óPTICO. PROPTOSIS DERECHA
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GLIOMA NERVIO óPTICO.TAC
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HEMANGIOMA PALPEBRAL
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ADENOCARCINOMA GLáNDULA LAGRIMAL
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CARCINOMA BASOCELULAR
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PAPILOMA CARúNCULA
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RETINOPATIA DIABéTICA SIMPLE
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SIGNOS DE CRUCE
![Page 646: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/646.jpg)
Los exudados duros o lipídicos se distribuyen alrededor de una lesión vascular que en el caso de la retinopatía diabética suelen ser microaneurismas.
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RUBEOSIS IRIS
Cuando la isquemia retiniana es muy severa los factores de crecimiento que estimulan la aparición de los neovasos pueden llegar al segmento anterior del ojo y provocar la rubeosis del iris. Se trata de pequeños vasos difíciles de detectar que se localizan en el borde pupilar y en el ángulo iridocorenal lo que provoca su cierre y el aumento de la presión intraocular. En esta imagen se puede observar también una catarata.
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RETINOPATíA DIABéTICA PROLIFERANTE
La retinopatía diabética proliferante se caracteriza por la presencia de neovasos que dejados evolucionar se acompañan de un proceso fibroso. De esta manera se forman mebranas fibrovasculares que se enclavan en la retina y se introducen en la cavidad vítrea. Su posterior contracción da lugar a desprendimientos de retina traccionales. En esta imagen se ven además impactos antiguos de láser y restos de una hemorragia retrohialoidea (preretiniana)
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RETINOPATíA DIABéTICA PROLIFERANTE
La hemorragia vítrea deja ver por la parte superior la presencia de membranas fibrovasculares que son el origen del sangrado
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RETINOPATíA DIABéTICA PROLIFERANTE Penacho de neovasos en retinopatía diabética proliferante.
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RETINOPATíA DIABéTICA PROLIFERANTE
Impactos de láser antiguos Hemorragias en llama Hemorragia preretiniana
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RETINOPATíA HIPERTENSIVA
1.Exudados algodonosos 2.Hemorragias en llama 3.Hemorragias puntiformes 4.Venas tortuosas5.Papila de bordes difusos (edema de papila)
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OFTALMOPATíA TIROIDEA. ENGROSAMIENTO MUSCULAR. TAC
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EXUDADOS ALGODONOSOS Los exudados algodonosos son áreas de infarto en la capa de fibras del nervio óptico. No son patognomónicos de ningún proceso y pueden aparecer en la retinopatía diabética, en la retinopatía hipertensiva, en la microangiopatía asociada al SIDA, tras embolismos grasos, en enfermedades hematológicas, tras oclusiones de vena retiniana, etc...
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RETINITIS POR CITOMEGALOVIRUS
La retintis por citomegalovirus es la principal causa de ceguera en pacientes con SIDA. Su incidencia ha descendido tras la administración de las nuevas terapias anti-HIV (terapia HAART). En la foto se observan zonas de necrosis retiniana (blancas) junto con hemorragias. Es típica la distribución perivascular. La imagen del fondo de ojo se ha denominado en 'queso con tomate'.
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RETINITIS POR CITOMEGALOVIRUS
1.Areas de necrosis 2.Areas de hemorragias 3.Afectación perivascular 4.Aspecto de 'queso con tomate' (blanco-rojo)
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RETINOPATíA ASOCIADA AL SIDA Exudados algodonosos en retinopatía asociada al SIDA
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RETINITIS NECROTIZANTE POR VIRUS HERPES Area de necrosis inferior sin hemorragias. La causa más frecuente es la infección por virus de la familia herpes. (Síndrome de necrosis retiniana aguda). Su incidencia aumenta en inmunodepresiones como en el SIDA.
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RETINITIS NECROTIZANTE POR VIRUS HERPES
El síndrome de necrosis retiniana aguda provocada por un herpes-virus deja como secuela una zona de retina atrófica, con vasos esclerosados y exangües. En la zona superior se observan fibras de mielina que no están relacionadas con el proceso y son un hallazgo casual.
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RETINITIS POR CITOMEGALOVIRUS
En la retinopatía asociada al SIDA se pueden ver exudados algodonosos, una estrella macular por depósitos lipídicos (sin anomalía vascular central) y hemorragias en llama. Todos estos hallazgos no son patognomónicos y se pueden ver en otros procesos.
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RETINITIS POR CITOMEGALOVIRUS
1.Retinitis por citomegalovirus 2.Exudados algodonosos 3.Estrella macular de exudados lipídicos
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Cuerno cutáneo
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Papiloma
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Queratosis seborreica
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Queratoacantoma
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Pecas y nevus
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Xantelasma
![Page 672: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/672.jpg)
Hemangioma palpebral
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Queratosis actínica, solar o senil
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Carcinoma in situ(enfermedad de Bowen)
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Dermatitis por radiación
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Xeroderma pigmentosum
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Carcinoma basocelular(Basalioma)
![Page 680: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/680.jpg)
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Carcinoma escamoso (epitelioma)
![Page 685: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/685.jpg)
Carcinoma Sebáceo
![Page 686: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/686.jpg)
Melanoma
![Page 687: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/687.jpg)
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Dermoide del limbo(quiste dermoide)
![Page 690: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/690.jpg)
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Papilomas(solo de carúncula, sorry)
![Page 693: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/693.jpg)
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Nevus
![Page 695: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/695.jpg)
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Pinguécula
![Page 697: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/697.jpg)
• También Fig.5-23 Pag 167
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Neoplasias intraepiteliales
![Page 701: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/701.jpg)
Melanosis adquirida primaria
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o escamoso
![Page 704: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/704.jpg)
Melanoma
![Page 705: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/705.jpg)
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Linfomas
![Page 707: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/707.jpg)
No es la misma que la anterior??
![Page 708: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/708.jpg)
Sarcoma de Kaposi
![Page 709: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/709.jpg)
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Retinoblastoma
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Metástasis intraoculares
![Page 714: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/714.jpg)
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Melanoma de úvea
![Page 718: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/718.jpg)
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Quistes dermoides y epidermoides
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Hemangioma capilar
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Rabdomiosarcoma
• Fig. 7-22 Pag. 210
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Glioma del nervio óptico(astrocitoma pilocítico juvenil)
![Page 726: Atlas oftalmologia version 2.pdf](https://reader038.fdocuments.ec/reader038/viewer/2022102421/55cf9846550346d03396ac1b/html5/thumbnails/726.jpg)
Proptosis derecha
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Sarcoma granulocítico(en leucemia)
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Hemangioma cavernoso
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Meningioma del nervio óptico
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Linfomas
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Tumores de la glándula lagrimal(adenocarcinoma de la glándula lacrimal)
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RETINOPATIA DIABéTICA SIMPLE
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SIGNOS DE CRUCE
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Los exudados duros o lipídicos se distribuyen alrededor de una lesión vascular que en el caso de la retinopatía diabética suelen ser microaneurismas.
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RUBEOSIS IRIS
Cuando la isquemia retiniana es muy severa los factores de crecimiento que estimulan la aparición de los neovasos pueden llegar al segmento anterior del ojo y provocar la rubeosis del iris. Se trata de pequeños vasos difíciles de detectar que se localizan en el borde pupilar y en el ángulo iridocorenal lo que provoca su cierre y el aumento de la presión intraocular. En esta imagen se puede observar también una catarata.
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RETINOPATíA DIABéTICA PROLIFERANTE
La retinopatía diabética proliferante se caracteriza por la presencia de neovasos que dejados evolucionar se acompañan de un proceso fibroso. De esta manera se forman mebranas fibrovasculares que se enclavan en la retina y se introducen en la cavidad vítrea. Su posterior contracción da lugar a desprendimientos de retina traccionales. En esta imagen se ven además impactos antiguos de láser y restos de una hemorragia retrohialoidea (preretiniana)
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RETINOPATíA DIABéTICA PROLIFERANTE
La hemorragia vítrea deja ver por la parte superior la presencia de membranas fibrovasculares que son el origen del sangrado
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RETINOPATíA DIABéTICA PROLIFERANTE Penacho de neovasos en retinopatía diabética proliferante.
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RETINOPATíA DIABéTICA PROLIFERANTE
Impactos de láser antiguos Hemorragias en llama Hemorragia preretiniana
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RETINOPATíA HIPERTENSIVA
1.Exudados algodonosos 2.Hemorragias en llama 3.Hemorragias puntiformes 4.Venas tortuosas5.Papila de bordes difusos (edema de papila)
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OFTALMOPATíA TIROIDEA. ENGROSAMIENTO MUSCULAR. TAC
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EXUDADOS ALGODONOSOS Los exudados algodonosos son áreas de infarto en la capa de fibras del nervio óptico. No son patognomónicos de ningún proceso y pueden aparecer en la retinopatía diabética, en la retinopatía hipertensiva, en la microangiopatía asociada al SIDA, tras embolismos grasos, en enfermedades hematológicas, tras oclusiones de vena retiniana, etc...
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RETINITIS POR CITOMEGALOVIRUS
La retintis por citomegalovirus es la principal causa de ceguera en pacientes con SIDA. Su incidencia ha descendido tras la administración de las nuevas terapias anti-HIV (terapia HAART). En la foto se observan zonas de necrosis retiniana (blancas) junto con hemorragias. Es típica la distribución perivascular. La imagen del fondo de ojo se ha denominado en 'queso con tomate'.
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RETINITIS POR CITOMEGALOVIRUS
1.Areas de necrosis 2.Areas de hemorragias 3.Afectación perivascular 4.Aspecto de 'queso con tomate' (blanco-rojo)
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RETINOPATíA ASOCIADA AL SIDA Exudados algodonosos en retinopatía asociada al SIDA
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RETINITIS NECROTIZANTE POR VIRUS HERPES Area de necrosis inferior sin hemorragias. La causa más frecuente es la infección por virus de la familia herpes. (Síndrome de necrosis retiniana aguda). Su incidencia aumenta en inmunodepresiones como en el SIDA.
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RETINITIS NECROTIZANTE POR VIRUS HERPES
El síndrome de necrosis retiniana aguda provocada por un herpes-virus deja como secuela una zona de retina atrófica, con vasos esclerosados y exangües. En la zona superior se observan fibras de mielina que no están relacionadas con el proceso y son un hallazgo casual.
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RETINITIS POR CITOMEGALOVIRUS
En la retinopatía asociada al SIDA se pueden ver exudados algodonosos, una estrella macular por depósitos lipídicos (sin anomalía vascular central) y hemorragias en llama. Todos estos hallazgos no son patognomónicos y se pueden ver en otros procesos.
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RETINITIS POR CITOMEGALOVIRUS
1.Retinitis por citomegalovirus 2.Exudados algodonosos 3.Estrella macular de exudados lipídicos
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COLOBOMA DE NERVIO óPTICO Y COROIDES
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COLOBOMA DE IRIS
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COLOBOMA NERVIO óPTICO Y COROIDO-RETINIANO
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SíNDROME AXENFIEL-RIEGER
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CATARATA CONGéNITA
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Catarata congénita sutural y cerúlea
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Catarata congénita polar posterior
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HEMANGIOMA COROIDEO
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GLAUCOMA CONGÉNITO
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LEUCOCORIA
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