Ophthalmology 2

Terms in this set (66)

Opacities can affect various media of the eye, such as:
cornea, anterior chamber, lens, or vitreous
True or false, opacities can cause a reduction in visual acuity and the pupillary reflexes can be affected revealing an abnormal red pupillary reflex?
true
Corneal edema
normally crystal-clear, takes on a ground-glass appearance when tissue swells
Causes of corneal edema (2):
-endothelial dysfunction (single layer of hexagonal cells that do not regenerate*)
-increased intra-ocular pressure
Examples of cornea trauma
burn, abrasion, foreign body, and laceration
Contact lens-related media opacities
abrasion and keratitis
Infectious keratitis can be caused by _____ agents.
bacterial, viral, and parasitic/fungal
True or false, after a chemical burn it is better for the eye to appear white than red?
false, white is worse because it means blood vessels have been obliterated
When hear "dendrite" we should think ______ on the cornea.
HSV
Hyphema*
presence of blood in the anterior chamber
Causes of hyphema (2):
-trauma
-pre-existing abnormal vessels from tumors, diabetes, surgery, and chronic inflammation
Will cause patients to come into ER with stomach pain and will mimic a GI issue with blurry vision
acute angle closure glaucoma
Vitreous hemorrhage
bleeding in the vitreous cavity
Causes of vitreous hemorrhage (8):
-retinal breaks
-posterior vitreous detachment (PVD)
-retinopathy of blood disorders
-valsava retinopathy
-neovascularization from various disorders (diabetes)
-hypertensive retinopathy
-ruptured macroaneurysm
-trauma
Four retinal diseases
-retinal detachment
-macular disease
-vascular occlusions
-retinal inflammatory conditions
Two types of retinal detachment
Rhegmatogenous and non-rhegmatogenous
Symptoms of retinal detachment
-floaters, flashes, shadow over the vision
-sometimes completely asymptomatic
Rhegmatogenous retinal detachment:
due to full thickness break
Non-rhegmatogenous retinal detachment:
serous (subretinal accumulation of fluid) or tractional (contraction of scar tissue pulling the retina)
Retinal detachment causes*
-rhegmatogenous
-serous
-tractional
Examples of rhegmatogenous causes of retinal disease
lattice degeneration, PVD, elevated myopia, trauma, and surgery
Examples of serous causes of retinal disease
tumors, inflammatory disease, or degenerative lesion
Examples of tractional causes of retinal disease
diabetic retinopathy, proliferative vitreoretinopathy from ocular ischemic event
Central serous retinopathy
-idiopathic subretinal leakage of fluid
-occurs more in males, Type-A personality, and with stress
-usually resolves on own in weeks-months
Macular hole
can be partial thickness (lamella) or full-thickness (severe vision loss)
Macular dystrophies*
usually progressive but vision loss can be sudden in atypical cases
True or false, vision loss secondary to vascular occlusion is always transient?
false, can be transient or permanent
Transient monocular vision loss is referred to as _______ and indicates arterial insufficiency.
amaurosis fugax*
Mononuclear vision loss in patients >50 should be investigated with which 3 things?
-carotid doppler looking for emboki interrupting blood flow to retina
-auscultate carotids for bruit
-cardiac echo
Central retinal artery occlusion (CRAO)
-sudden, painless often complete vision loss
-w/i minutes to hours: narrowing of arterial blood columns and interrupting in venous blood columns (box-car)
-hours after: whitening of retina except for macular "cherry-red spot' (underlying choroidal circulation)
For CRAO, is the optic nerve head (ONH) usually swollen?
no, because the blood supply comes from other branches of the ophthalmic artery
True or false, the ONH eventually demonstrates pallor from ganglion cell death in CRAO?
true
True or false, someone with CRAO has a limited field of vision, but he or she can still see 20/20?
true
Is a central retinal artery occlusion a true ocular emergency?
yes, within 24 hours a digital ocular massage may help restore blood flow but poor prognosis for visual recovery
Branched retinal artery occlusion (BRAO)
-partial loss of vision secondary to occlusion of a branch of the central retinal artery
-cholesterol, calcific, platelet-fibrin emboli
-digital ocular massage may be beneficial
-good prognosis
Central retinal vascular occlusion (CRVO)
-ischemic or non-ischemic
-onset not as sudden as CRAO (vission loss may be severe but painless)
-optic disc swelling, venous engorgement, cotton-wool spots, diffuse retinal hemorrhages
-associated with HTN, DM, peripheral vascular disease, coronary artery disease, and glaucoma
True or false, with arteries get swelling of the discs, but not with veins?
false, we don't see swelling of discs with arteries (only with veins)
With CRVO, does ischemic or non-ischemic have better prognosis?
non-ischemic
CRVO is seen mostly in elderly patients older than _____.
50
With CRVO, treatment of underlying _____ disease is essential and have to rule out ______.
-CV
-DM, CGA
Branch retinal vein occlusion (BRVO)
-painless visual field defect
-limited to 1 quadrant of the retina
-good prognosis
-management similar to CRVO
The pupillary response is abnormal is ________ optic nerve disease.
unilateral
Occurs when conduction of one optic nerve is reduced compared to that of the fellow optic nerve
afferent pupillary defect (APD)
Optic neuritis
inflammation of optic nerve
Two forms of optic neuritis
-papillitis (optic disk swelling)
-retrobublar (normal disc, inflammation behind globe)
Greater than 50% of patients with _______ develop optic neuritis but it can also be a presenting sign.
50
True or false, optic neuritis affects men and women of all ages equally?
false, women>men and young patients
In children, optic neuritis is usually:
post-viral and bilateral
Papillitis
unilateral, hyperemic disc, DDx papilledema (look in other eye)
Retrobulbar
unilateral, pain on eye movements, Ddx compressive optic neuropathy
True or false, in both cases of optic neuritis, there is a relative afferent pupillary defect (RAPD) and vision loss may progress before it stabilizes and improves
true
Treatment of choice for optic neuritis
steroids (IV steroids followed by oral steroids)
Pt with optic neuritis must be sent for neuro-imaging of orbits and brain to rule out what?
compressive lesion
In older patients, disc swelling is more commonly associated with a ________ than inflammation.
vascular event
Ischemic optic neuropathy can be caused by:
giant-cell arteritis, HTN, DM, or atherosclerotic changes
Ischemic optic neuropathy
infarction right behind optic nerve leading to swollen optic disc, sudden unilateral decrease in vision, and color vision, RAPD, altitudinal vision field loss (respects horizontal meridian)
Does ischemic optic neuropathy usually effect one or both eyes?
unilateral but fellow eye involvement common
After 6-8 weeks, tend to see ______ with ischemic optic neuropathy.
residual optic nerve pallor
Giant-cell arteritis
-common cause of ischemic optic neuropathy in pts >55-60
-"arteritic AION"
-presents with associated tender temporal artery (scalp tenderness), jaw claudication, malaise, fever, recent weight loss, muscle/joint pain
-double vision can occur (CN 6 palsy)
What should be obtained if suspect giant-cell arteritis?
-ESR and/or C-reactive protein
-temporal artery biopsy can confirm diagnosis
Treatment of choice for CGA
steroids
When trauma damages vascular supply to eye, what may help?
IV steroids or surgical decompression
Functional vision loss definition
decreased vision in absence of any organic disease (non-physiologic)
Malingering vision loss
voluntary faking of vision loss, usually for secondary gain (legal action or $$ compensation)
Hysteria visual loss
subconscious faking of loss, usually secondary to other issues
Management of functional visual loss
reassurance and psychological consult
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