Anterior Chamber Disorders Flashcards Preview

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Flashcards in Anterior Chamber Disorders Deck (38):
1

Open-angle Glaucoma

- Optic neuropathy results in progressive loss of retinal ganglion cell axons.
- Peripheral visual fields lost first, then central vision, then blindness

2

How does open angle glaucoma progress?

Peripheral fields ---> Central vision ---> Blindness

3

Glaucoma Sequelae

- Slowly progressive irreversible damage to the optic nerve.
- Loss of vision goes unnoticed until severe

4

Primary Open-angle Glaucoma (POAG) Symptoms

- Symptoms are rarely experienced
- No loss of visual acuity as long as central vision is preserved.
- Irreversible

5

How is POAG diagnosed?

- Characteristic nerve damage on fundis exam and elevated intraocular pressures.
- Cupping

6

Cupping

- A cup that is greater than 50% of the vertical disc diameter.
- Glaucoma can cause the cup to enlarge
- Cup gets bigger in a vertical oval type pattern.

7

Optic Cup

- White, cup-like area in the center of the optic disc.
- Normal cup/disc ratio is 1/3
- There is some normal variation here

8

Do all patients with open angle glaucoma have elevated IOP?

No, not all patients with OAG have elevated IOP.

9

IOP > 40. what should you do?

Emergency Referral.

10

IOP 30-40. what should you do?

Urgent referral within 24 hrs.

11

Screening recommendations

- 40-60 yrs w/o risk factors: ever 3-5 yrs.
- Every 1-2 yrs w/ risk factors
- Periodic exams for black men and women btw ages 20-39.

12

Acute Angle-Closure Glaucoma (AACG)

Occurs only with closure of a pre-existing narrow anterior chamber angle.

13

What brings on AACG

Dark theatre, pharmacological Mydriasis, anticholinergenics,

14

AACG symptoms

- Rapid Onset
- Severe eye pain/HA
- Profound visual loss
- May have photophobia
- N/V

15

AACG signs

Conjunctival redness
Corneal edema or cloudiness
Shallow anterior chamber
Mid-dilated pupil not reactive to light

16

Is angle AACG an emergency?

Absolutely.

17

If it will be greater than an hour before AACG pt can be seen, what should be given?

Acetazolamide, Mannitol, glycerol.
- Decrease IOP

18

AACG tx continued

Timolol (Timoptic)
Apraclonidine (Ioponide)
Pilocarpine (Isopo)
One drop of each, one minute apart.

19

Uveitis

- Intraocular inflammation
- Is immunologic in most cases
- Associated with HLA B27

20

Causes of Uveitis

- CMV: Cytomegalovirus (immunocompromised)
- Toxoplasmosis
- Syphillis
- Cat scratch disease
- HSV and HZV

21

Anterior Uveitis

- 4 times more common than posterior.
- May be seen together with panuveitis

22

Anterior Uveitis Symptoms

- Eye pain
- Redness
- May have visual loss

23

Posterior Uveitis S/S

- Usually painless
- Cells seen in vitreous
- Inflammatory lesions on retina and choroid
- Gradual vision loss
- Often Bilateral
- Yellow or pigmented lesions

24

Infectious uveutis tx

- Antiviral or antibiotics
- Glucocorticoids

25

Noninfectious uveitis tx

Anterior: Topical glucocorticoids and dilating drop
Posterior: Periocular injection of triamcinolone or systemic corticosteroids.

26

Iritis

- Usually idiopathic
- May be autoimmune associated
- Blunt trauma, corneal inflammation

27

Iritis is commonly associated with ______?

Uveitis

28

Iritis Presentation

- Deep eye pain
- Photophobia
- Redness, ciliary flush
- Pupillary constriction
- Synechiae can form

29

Which type of agent should be given to a patient with iritis?

A cycloplegic agent, but avoid atropine.

30

Complications of Iritis

- Cataracts
- Calcifications of cornea
- Glaucoma
- Uveitis
- Blindness

31

Hyphema

- A suspension of red blood cells in the aqueous humor.
- Due to direct trauma to the eyeball

32

grades of hyphema

Grade 1: Less than 1/3 of the chamber
Grade 2: 1/3 to 1/2 of the chamber
Grade 3: 1/2 to total chamber
Grade 4: Total clotted blood "8-ball hyphema"

33

Is hyphema a medical emergency?

Yes. Refer to optho or ER immediately.

34

About 15-20% of people w/ hyphema have further bleeding in ____ to ____ days.

Three to five. Compliance is very important.

35

Hyphema Meds

- 1% atropine may be used.
- Steroid drops
- Beta blockers if increased IOP.
- Cover eye with shield

36

Home instructions for hyphema

- Bedrest with head of bed elevated.
- No strenuous activity
- No bood thinners
- Tylenol can be taken

37

Hypopion

The presence of pus or puslike fluid in the anterior chamber of the eye.
Similar to hyphema, but puslike.

38

Cataracts

Opacity of the lens
Leading causes of blindness in the world.
Easily cured by surgery
Complex pathophysiology