Flashcards in Anterior Chamber Disorders Deck (38):
- Optic neuropathy results in progressive loss of retinal ganglion cell axons.
- Peripheral visual fields lost first, then central vision, then blindness
How does open angle glaucoma progress?
Peripheral fields ---> Central vision ---> Blindness
- Slowly progressive irreversible damage to the optic nerve.
- Loss of vision goes unnoticed until severe
Primary Open-angle Glaucoma (POAG) Symptoms
- Symptoms are rarely experienced
- No loss of visual acuity as long as central vision is preserved.
How is POAG diagnosed?
- Characteristic nerve damage on fundis exam and elevated intraocular pressures.
- 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.
- White, cup-like area in the center of the optic disc.
- Normal cup/disc ratio is 1/3
- There is some normal variation here
Do all patients with open angle glaucoma have elevated IOP?
No, not all patients with OAG have elevated IOP.
IOP > 40. what should you do?
IOP 30-40. what should you do?
Urgent referral within 24 hrs.
- 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.
Acute Angle-Closure Glaucoma (AACG)
Occurs only with closure of a pre-existing narrow anterior chamber angle.
What brings on AACG
Dark theatre, pharmacological Mydriasis, anticholinergenics,
- Rapid Onset
- Severe eye pain/HA
- Profound visual loss
- May have photophobia
Corneal edema or cloudiness
Shallow anterior chamber
Mid-dilated pupil not reactive to light
Is angle AACG an emergency?
If it will be greater than an hour before AACG pt can be seen, what should be given?
Acetazolamide, Mannitol, glycerol.
- Decrease IOP
AACG tx continued
One drop of each, one minute apart.
- Intraocular inflammation
- Is immunologic in most cases
- Associated with HLA B27
Causes of Uveitis
- CMV: Cytomegalovirus (immunocompromised)
- Cat scratch disease
- HSV and HZV
- 4 times more common than posterior.
- May be seen together with panuveitis
Anterior Uveitis Symptoms
- Eye pain
- May have visual loss
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
Infectious uveutis tx
- Antiviral or antibiotics
Noninfectious uveitis tx
Anterior: Topical glucocorticoids and dilating drop
Posterior: Periocular injection of triamcinolone or systemic corticosteroids.
- Usually idiopathic
- May be autoimmune associated
- Blunt trauma, corneal inflammation
Iritis is commonly associated with ______?
- Deep eye pain
- Redness, ciliary flush
- Pupillary constriction
- Synechiae can form
Which type of agent should be given to a patient with iritis?
A cycloplegic agent, but avoid atropine.
Complications of Iritis
- Calcifications of cornea
- A suspension of red blood cells in the aqueous humor.
- Due to direct trauma to the eyeball
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"
Is hyphema a medical emergency?
Yes. Refer to optho or ER immediately.
About 15-20% of people w/ hyphema have further bleeding in ____ to ____ days.
Three to five. Compliance is very important.
- 1% atropine may be used.
- Steroid drops
- Beta blockers if increased IOP.
- Cover eye with shield
Home instructions for hyphema
- Bedrest with head of bed elevated.
- No strenuous activity
- No bood thinners
- Tylenol can be taken
The presence of pus or puslike fluid in the anterior chamber of the eye.
Similar to hyphema, but puslike.