BLOCK 104 U2
Terms in this set (63)
Hemorrhage within the anterior chamber of the eye; Blood in the anterior chamber, such as following blunt trauma to the eyeball
Accumulation of pus in the anterior chamber; Associated with an infectious disease of the cornea, iris or ciliary body; Associated with infectious and inflammatory diseases of the anterior segment, the posterior segment, and systemic diseases
Anterior Chamber Tumor
Tumor located on the iris; Must be observed for possibility of malignancy
Afferent Pupillary Defect (Marcus-Gunn pupil)
affects the pupillary fibers carrying light stimulus from the eye to the brain. Usually occurs in the fibers between the optic nerve and the optic chiasm: Causes include optic neuritis and diabetes; Diagnostic test is the swinging flashlight; o Size and shape can be normal; Reaction can be diminished; Consensual response intact in the affected eye; When light is shown in the affected eye, both eyes will dilate to ambient room lighting; When light is shown in the unaffected eye, both eyes will constrict (unaffected eye by direct response, affected eye by consensual response); Accommodation is intact.
CN III Palsy
is caused by damage to the oculomotor nerve usually by a tumor or aneurysm: Effects to EOMs, pupils, and lids:
Eye is positioned down and out; Dilated pupil; Ptosis of the lid; Size and shape of pupils is fixed and dilated; No constriction in dilated eye; No consensual response in dilated eye; Accommodation normal in unaffected eye
is referred to as the tonic pupil with unknown etiology (parasympathetic pathway involvement at ciliary ganglion behind orbit); Size and shape of pupils is unequal; affected pupil is larger and most pronounced under photopic conditions; Reaction is sluggish; Consensual response is delayed and slow; Accommodation is intact/slow; Long acting near response in later stages.
occurs from damage to the sympathetic pathway. The damage can occur anywhere in the brain or spinal cord;
Triad includes ptosis, miosis and facial anhydrosis; Size and shape of affected pupil smaller; Reaction is normal; Consensual response is normal; Accommodation is normal
Argyll Robertson Pupil
occurs from damage to the pupillary fibers in the idbrain: Causes include neurosyphilis, diabetes, and peripheral neuropathies; Size and shape of pupils unequal; affected pupil smaller and irregularly shaped; Consensual response is nonresponsive; Accommodation is intact, exhibits light-near dissociation - reacts poorly or not at all to light but constricts normally during convergence
Acute Narrow Angle Glaucoma
is an urgent situation that can easily change to an ocular emergency. There are symptoms of ocular pain and visual disturbances: Caused by blockage of aqueous draining from the anterior chamber; Size and shape of pupils unequal; affected pupil is mid-dilated; Reaction is fixed and no reaction; Consensual response is nonresponsive; Accommodation is nonreactive.
Opacification of the lens that can lead to reduced visual acuity, glare, and reduced color perception; Causes include trauma, age, systemic manifestations, and medications; Surgical removal of the lens may be necessary to restore functional vision
Dislocation (Ectopia Lentis)
Caused by broken or absent zonules; May cause a reduction in visual acuity and changes in a person's refractive status.
Diseases of the Uveal Tract
uvea or uveal tract includes the iris, ciliary body and choroid. Causes of disease include:Unknown; Trauma; Penetrating injury; Corneal ulcers; Surgery; Systemic disease; Autoimmune disease; Symptoms include: Pain;Headache;Photophobia;Lacrimation;Blurred vision;Ciliary flush;Sluggish pupil
Inflammation of the iris
Inflammation of the ciliary body
Inflammation of the choroid
Inflammation of the iris and ciliary body
Inflammation that affects any part of the uvea
Aqueous Cell - (uveal disease sign)
The accumulation of white blood cells (referred to as cells in the aqueous fluid of the anterior chamber) caused by an infection, trauma or other pathology of the cornea, iris, ciliary body, and/or systemically
Aqueous Flare - (uveal disease sign)
An inflammation of the iris or ciliary body causing aqueous flare or small protein particles to float in the aqueous fluid within the anterior chamber.
uveal disease sign - (undefined)
Ciliary Flush or circumlimbal injection; Keratic precipitates (KPs); Low IOP
Posterior Synechiae - (uveal disease sign)
The most common result of iritis is a posterior synechiae, or an adhesion of the iris to the lens. Adhesion of the iris to the corneal endothelium is called an anterior synechiae.
Sympathetic Ophthalmia - (uveal disease sign)
Uveitis is a serious disease and one of the most serious forms is sympathetic ophthalmia. The uninjured eye (sympathizing eye) develops a serious uveitis and eventually leads to blindness in both eyes unless the injured eye is surgically removed.
Diseases of the Vitreous (Vitreous Humor)
Occasionally, other disease processes can cause unwanted results in the vitreous. Opacities of the vitreous may result from uveitis, hemorrhage, systemic changes or aging
Vitreous Hemorrhage or Vitreous Bleed
Hemorrhage from the retina flowing into the vitreous reducing visual acuity; Blood in the vitreous may result from: Trauma; Neovascularization; Vitreous detachment; Retinal tears
Moving cells or tissue floating inside the vitreous (floaters); If there is a sudden appearance of many floaters, especially after trauma to the head or eyes, there may be retinal detachment present; Floaters are seen as spots, cobwebs or spiders; Causes include trauma, normal aging (fibrillar degeneration), vitreous detachments, retinal tears, intraocular inflammation, hemorrhages, and high myopia.
Retinal Detachment (RD)
results when the retina separates (detaches) from the
pigment epithelium. This disrupts the photoreceptor cell structure and dramatically affects vision. RDs often require urgent surgical repair depending on the severity of the detachment. There are 3 types of RDs: Rhegmatogenous-retinal tear, tractional (Non-Rhegmatogenous), exudative (Non-Rhegmatogenous
Retinal Detachment (main causes)
Shrinkage of the vitreous: can cause tear/or tractional RD;
Trauma: tear or tractional RD; Stretching of the scleral coats without stretching of the retina, as in high myopia: retinal tear; Fluid forming between the retina and pigment epithelium: exudative RD
Retinal Detachment (symptoms)
Loss of vision (sometimes seen as sector loss); Sudden onset of floaters; Flashes of light (sometimes seen as streaks or lightening streaks); Visual distortion/disturbances: a veil, shadow, or curtain covering central vision
is inflammation of the retina. Patient symptoms are few, except for some change in vision and slight discomfort:
As viewed with the ophthalmoscope: New lesions appear out of focus with fuzzy edges; Old healed retinitis appears clear with sharp edges and dark pigment throughout;
Acquired color vision deficiencies will be an early sign of retinitis, and only in the eye affected; Retinitis is usually a result of some other disease process within the body.
Central Retinal Artery Occlusion (CRAO)
is blockage of blood flow through the central retinal artery. Obstructions of the central retinal artery have a rapid complete loss of vision: Usually monocular; Arteries appear thinned; Opaque retinal layers; Macula has cherry red spots; Rapid action to correct the blockage of blood must be initiated to prevent permanent loss of vision; Central retinal artery obstruction produces a reduction of vision over a few hours
Central Retinal Vein Occlusion (CRVO)
is blockage of blood flow through the central retinal vein causing marked decrease in vision which may improve somewhat over many months: Dilated and engorged veins; Intraretinal and nerve fiber layer hemorrhages; Swollen optic disc margins; Retinal thickening; Secondary glaucoma results in most cases; Prognosis for vision is poor if the vein is blocked; Central vision may be spared if only a branch of the vein is affected
Age-Related Macular Degeneration (ARMD)
results in the loss of central vision from the UV induced photooxidative damage to the retinal pigment epithelium (RPE), Bruch's membrane and the choriocapillaris of the choroid. It is the leading cause of legal blindness in adults 60 years and over living in developed industrialized nations. ARMD presents in 2 forms: Dry (non-exudative) 80%-90% of cases; Wet (exudative) 10%-20% of cases (most visually compromising form of ARMD);
The most common retinal finding associated with ARMD; Drusen forms soft/or hard deposits within the macula. These deposits are the accumulation of extracellular metabolic waste from photoreceptors (primarily cones). The soft or hard yellow drusen deposits form between the RPE and Bruch's membrane of the choroid. This drusen build-up from oxidative damage blocks/or alters nutritional support from the choroid, and waste removal into the choroid.
Macular drusen; Gradual visual acuity (VA) changes and minor forms of visual distortion - metamorphopsia; Areas of geographic atrophy within macula - this finding increases risk of forming wet ARMD
VA compromise: poor acuity, decrease color vision and contrast sensitivity; Serious visual distortion - metamorphopsia and noticeable scotoma - blind spot; Numerous drusen; Subretinal hemorrhages; Choroidal Neovascularization (CNV or SRNVM)
Associated Risk factors of ARMD
Over exposure to UV light; Age; + FmHx of ARMD - genetic component; Race; Smoking
Treatments for ARMD
UV protection; Take multiple vitamins with anti-oxidants: Vit. C+E, zinc, lutein, lycopene, zeaxanthin, omega 3 fatty acids; Use Low vision aids: magnifiers
Photodynamic Therapy (PDT) with Verteporfin (Visudyne); Injections of anti-VEGF: Aventis, Lucentis, Macugen; Laser Photocoagulation
is macular damage from staring at the sun without protective filters. Those who view the sun or eclipses can permanently lose parts of their vision. Solar retinopathy causes: Central scarring, macular hole, vitreomacular traction; Central scotoma; Permanent/or partial loss of central vision
Almost always appears in children under the age of five;
Appears as a white reflection in the pupil known as a Luekocoria; There is a hereditary influence; It is extremely malignant; Treatment is enucleation as soon as possible
Choroidal melanoma (malignant)
Usually occurs in adults; Causes a retinal detachment
Secondary glaucoma may result if undetected; Enucleation is indicated as soon as a positive diagnosis is made
is a noninflammatory swelling of the nerve head or optic disc resulting from increased intracranial pressure: The condition is usually bilateral; Blurred optic disc margins; Flame hemorrhages; Enlarged blindspot; In early stages there is no reduction of visual acuity; Brain tumor is the most frequent cause
is an inflammation that can be mistaken for papilledema:Optic Neuritis; Usually acute; There is usually a great disturbance in vision; Pain around the eye; Pain usually present when eye is moved; Usually unilateral
is a gradual degeneration of the nerve fibers with a corresponding reduction of vision: Primary optic atrophy occurs during middle life, is slow in progression, and has a variable prognosis; Secondary optic atrophy can occur at any age and has a faster onset but a better prognosis if the causative agent is eliminated.
is a group of eye diseases that lead to damage of the optic nerve, resulting in progressive optic neuropathy with characteristic cupping, loss of visual field and potentially blindness; Usually associated with high IOP; Can occur in patients with "normal" IOP
Aqueous is the fluid that nourishes the cornea and is secreted by the ciliary processes. It is similar to plasma in composition; Flow of aqueous is from the posterior chamber to the anterior chamber, to the angle of the anterior chamber, and exits through the trabecular meshwork; Mechanism of outflow is unknown; From the trabecular meshwork, aqueous flows into Schlemm's canal and into the aqueous veins; Increased IOP results when aqueous is unable to flow out of the eye as fast as it is secreted; Balance between production and outflow; Outflow usually impaired, hypersecretion rare
Measuring the Cup to Disc ratio
The optic nerve is made up of about 1 million small individual thread-like nerve fibers that come from the retina. This is called the disc. There is a crater-like indentation in the center of the nerve called the cup. The enlargement of the cup in comparison to the disc is glaucoma
is one of several methods to measure the intraocular pressure. It can be done through applanation (pressing on the cornea with an instrument) or through non-contact methods. It is important to record to a baseline pressure reading for all patients, and monitor this pressure at each exam. Treatment of Glaucoma is always dependent on lowering ocular pressure
Corneal pachymetry (measuring)
is measuring the thickness of the cornea. Since ocular
pressure is measured by depressing the cornea, it is thought that the thickness of the cornea may impact our ability to accurately measure intraocular pressure.
With refractive surgery thinning the cornea, the ocular pressure readings may be affected
Visual Field Testing/perimetry (measuring)
Visual field testing is used to detect visual field loss and monitor the progression of the disease
Basic Types of Glaucoma
Primary open-angle glaucoma (POAG) and/or chronic open-angle glaucoma (COAG); Primary angle-closure (or primary closed-angle glaucoma); Secondary glaucoma;
Congenital glaucoma; Low tension glaucoma (LTG)/Normal tension glaucoma (NTG); Primary glaucoma exists without any preexisting ocular or systemic disease
comprises 60 to 90% of all adult glaucoma's;Trabecular meshwork dysfunction; IOP usually rises slowly over a long period of time; Relative lack of symptoms in early stages; Far advanced before noticed, progresses slowly effecting peripheral fields; Sometimes mild aching or ocular discomfort; Can detect with a routine eye exam A, ophthalmoscopy, tonometry, pachymetry, and visual fields; It is familial and affects both sexes; High incidence in diabetes, blacks, and in high myopia; Also called chronic open angle glaucoma (COAG); Treatment: the first line of TX is usually medication(s) to lower the IOP; If medications fail, laser or incisional surgery are available
Primary Angle-Closure Glaucoma
Caused by structural abnormalities of the uveoscleral angle - narrow angles; As the lens increases in size it may block the aqueous outflow channels; IOP rises rapidly when the angle is blocked; Usually occurs in pts over the age of 60; Accounts for 10% of all glaucoma's; 3X more prevalent in females; Eskimos higher incidence than average population; More rare in Blacks; Characterized by a shallow anterior chamber angle; A typical attack is unilateral, brought on by dark room conditions, emotional stress or pupillary dilating drugs; There are distinct symptoms such as severe pain in the eye and face, nausea, vomiting, reduced vision, halos around lights, cloudy cornea, mid-dilated pupil and red eye; all with a rapid onset; Requires emergency treatment with medications followed by a laser peripheral iridotomy
exists due to a systemic or ocular condition that causes an increase in IOP; Occurs secondary to another disease or disease process; Caused by reduced drainage of aqueous from inflammation, tumors, blood vessel blockage, trauma, diabetes, and some medications used to treat other diseases; Treat the primary disease and reduce IOP with medications
Developmental glaucoma is the third basic type of glaucoma; Congenital glaucoma is a rare disease in infants caused by a malformation of the anterior chamber angle; Affected patients often have other anatomical deformities; Surgical intervention is the primary treatment
Normal Tension Glaucoma
Low tension glaucoma (LTG), or normal tension glaucoma (NTG), is a progressive optic neuropathy with characteristic cupping and visual field defects; IOP is less than 21 mm Hg; LTG/NTG represents about one-sixth of all cases of primary open angle glaucoma (POAG); Age, family history, myopia are risk factors for LTG; Difficult to treat and the prognosis is poor; Reducing IOP is still believed to be beneficial so medications and surgical intervention are used for treatment
(Glaucoma Suspect)-IOP which is greater than accepted standard pressure but not elevated enough to cause any excavation of the optic disc or visual field loss. Some individuals eventually develop loss while others do not. This patient needs to be seen on a regular basis.
Treatment of Glaucoma
Medication is the initial treatment for Glaucoma. Conventional surgical treatment is used as a last resort;
Some of the reasons why surgical procedures are necessary: Failure of drops or laser treatment to control IOP; Allergy to drops-1 in 6 patients develop cataracts from using glaucoma medications; A type of glaucoma not controllable by medications; Closed angle glaucoma; Congenital or developmental glaucoma; Failure of patient to properly use medications
Types of Glaucoma microsurgery
Types of microsurgery used in the treatment of glaucoma. These surgeries are 80-85% successful, but many times medication still needs to be used.
Trabeculectomy - (Glaucoma microsurgery)
establishes a drain from the anterior chamber to the subconjunctival space; Most popular procedure for open angle glaucoma; Done in conjunction with a peripheral iridectomy; 80% successful
Iridectomy - (Glaucoma microsurgery)
complete removal of a small section of peripheral iris. This allows the aqueous to flow directly from the posterior chamber to the anterior chamber through the defect. This procedure has largely been replaced by the Laser.
Cyclocryotherapy - (Glaucoma microsurgery)
- this is a freezing procedure designed to decrease aqueous production by ablation of a portion of the ciliary body and its secretory epithelium.
Trabeculotomy - (Glaucoma microsurgery)
external procedure for opening up Schlemm's canal for increased flow of aqueous. Conjunctival and scleral flaps are raised and a cut is made into Schlemm's canal. A trabeculotome is introduced into the canal, which lacerates the meshwork. (primarily used in pediatric cases)
Goniotomy - (Glaucoma microsurgery)
same as a trabeculotomy but done through the cornea with a sharp instrument. This procedure is performed with a gonioscopy lens, and can be done only if the cornea is clear. (primarily used in pediatric cases)