Common Causes of Vision Loss Flashcards
(38 cards)
After a thorough history, what are the steps to an eye exam before calling a specialist?
- Visual acuity of each eye
- confrontation visual field testing
- extraocular motility
- pupillary reaction
- tonometry (pressure)
- ophthalmoscope
What are the 3 major categoty of causes of acute vision loss?
- media problems
- retinal problems
- neuroal visual pathway problems
What is the presentation of a patient with a corneal abrasion?
Causes?
How do you test for this?
Treatment?
- Presentation
- pain, redness, photophobia
- foreign body sensation
- cause - trauma or contacts
- Test
- fluorescein staining
- search for foreign body under the lid
- Treatment
- topical abx that cover pseudomonas (fluoroquinolone)
- cycloplegic drop cyclopentalate/atropie improves comfort
- NOT numbing drops
Why do you not send patient with a corneal abrasion home with numbing drops?
What are the numbing drops?
can erode cornea
proparacaine/tetracaine & topical NSAIDS
What does the fluorescein stain tell you?
intact epithelial cells do NOT take up the dye
it IS taken up by damaged epithelium
& you can visualize this with a cobalt blue light or Wood’s lamp
Who can prescribe topical steroids for an eye concern?
Why?
Eye doctor !
can cause infection to worsen
can cause elevated intraocular pressure & cataract
inhibit corneal epithelium
What is the key sign of allergic conjunctivitis?
itching
(usually bilateral)
Viral conjunctivitis shows what pattern of inflammation?
What lymph node is usually palpable?
follicular
preauricular
What is the presentation of a patient with viral conjunctivitis?
Treatment?
- Presentation
- watery or mucous discharge with swelling
- eye matted shut in the mornign
- starts in one eye & then “moves” to other
- recent cold symptoms
- Treatment
- WASH HANDS b/c very contagious
- typically self-limited (2-3 weeks)
- artificial tears, cool compress, OTC meds
- NO STEROIDS
What is the treatment for allergic conjunctivitis?
- Treatment
- OTC allergy medications
- artificial tears
- topical/oral antihistamines
- mast cell stabilizers
- cool compresses for swelling
What is the clinical presentation of a patient with bacterial conjunctivitis?
Treatment?
- Presentation
- copious mucopurulent discharge
- usually lack cold symptoms
- more likely to have papillary reaction
- Treatment
- topical antibiotics + referral to ophtho
- eye swab culture
- keep STI in mind - chlamydia & gonococcal need systemic treatment
Bacterial conjunctivitis shows what pattern of inflammation?
papillary
What is the clinical presentation of herpes keratitis?
- Presentation
- pain, redness, photophobia
- foreign body sensation
- recurrent
- dendritic staining
- follicular conjunctival reaction
- decreased corneal sensation
- Treatment
- refer to ophthalmologist
- topical / oral antivirals
- close monitoring
Herpes keratitis shows what pattern of inflammation?
How does it stain with fluorescein?
follicular
dendritic staining
What is Hutchinson Sign?
Treatment?
crusted blisters on the nose
implies herpatic involvement of nasociliary nerve & raises concerns about serious ophthalamic complications
- Treatment
- oral antivirals (most beneficial within 72 hrs)
- supportive treatment for complications by eye doctor
- systemic treatment by PCP for postherpetic neuralgia
What are the most common causes of infectious keratitis corneal ulcer?
Treatment?
bacterial (MC) - herpes/fungal/acanthamoeba
- Treatment
- history contact lens wear or eye trauma
- fluorescein staining
- urgent ophtho referral with cultures
- topical broad spectrum antibiotics, usully fortified
-
NO STEROIDS
- makes fungal & acanthamoeba worse
What is presbyopia?
cause?
what is the name of this theory?
age related farsigntedness
hardening of the lense - no longer able to change shape & thus focal point
Helmholtz Accomodation Theory
What percent of accomodation is present at age 40 compared to peak ability?
By 60?
- By 40- 50%
- by 60- 90%
What is Amblyopia?
“lazy eye”
brain fails to process inputs from one eye & over time favors the other eye
- Causes
- stabismus (MCC)- poo ocular alignment
- refractive error- ned glasses to better focus image
- Deprivational- ptosis, congenital catarac
What is the screening test for abnormal alignment?
Cover and Cover-uncover tests
What is a positive result on bruckner screening test?
Treatment?
deviated eye will have whiter/brighter reflex
glasses; eyepatch to force the use of the “lazy” ambylopic eye or penlalize the “good” eye
If visual pathway connections are not made by what age, vision will never be regained?
7-10yrs
What screening tests should be performed at a well-child visit?
- external inspection, pupil reflex, ocular motility
- corneal light reflex
- cover & cover/uncover testing
- bruckners
- visual acuity as soon as child able to cooperate
Myopia?
Hyperopia?
Astigmatism?
- Myopia - nearsightedness
- eye too long or cornea too steep
- concave lenses (-)
- Hyperopia - farsightedness
- eye too small or cornea too flat
- convex lenses (+)
- Astigmatism - abnormal cornea curvature
