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1
Q

which layer is first to be affected by macular degeneration and react pathologically?

A

retinal epithelium cells react pathologically to waste products

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2
Q

Where does wave IV give information from?

A 
Lateral lemniscus (projects to midbrain) to Inferior collicus from superior olivary nucleus in pons
-dimished IV from an ear mean C/L lesion of LL
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3
Q

Where does wave IV give information from?

A

inferior colliculus located in caudal midbrain, if information does not get here then C/L hearing loss

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4
Q

sudden hearing loss with or without loud noise for over a few hours…

A

treat with steriods(prednisone) could be sudden hearing loss

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5
Q

Peripheral vestibular syndrome presents…

A

with improvement of nystagmus upon visual fixation

with improvement of dizziness upon visual fixation

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6
Q

what is produced in diabetic retinopathy that hurts the retina?

A

vascular endothelial growth factor VEGF

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7
Q

Pupillary sparing with partial third nerve palsy can be caused by…

A

vascular event in brainstem

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8
Q

What is the most common cause of untreatable vision loss?

A

cataracts

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9
Q

What is the most common cause of untreatable blindness in the elderly?

A

macular degeneration

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10
Q

What is the most common cause of blindness in the US?

A

diabetic retinopathy

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11
Q

what is the 2nd most common cause of blindness in the US?

A

glaucoma (primary open angle is most common)

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12
Q

besides macular degneration, what is another major source of aging vision loss?

A

cataracts

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13
Q

what is the patholoophys of primary open angle glaucoma?

A

genetic mutation causes decreased outflow through canal of schlemm of aqueous humor
increased intraocular pressure (can be high normal)

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14
Q

What is the presentation of primary open angle glaucoma?

A
  1. painless loss of visual fields
  2. slow progression (insidious)
  3. IOP is high normal
  4. cupping of optic disc
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15
Q

What is the presentation of close angle glaucoma?

A
  1. acute onset
  2. painful, steamy red cornea
  3. photophobia
  4. blurred vision-pupil fixed as dilated
    progresses
  5. progressive visual field loss
    periphery to fovea loss
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16
Q

What is the pathophysiology of closed angle glaucoma?

A

small anterior chamber due to…

  1. mydriatic agent (muscles slack and take up space)
  2. uveitis
  3. lens dislocation
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17
Q

What is the treatment for open angle glaucoma?

A

beta blocker to decreased aq humor outflow

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18
Q

What is the treatment for closed angle glaucoma?

A

pilocarpine to constrict the pupil

-contract pupillary sphincter muscle and cillary muscles

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19
Q

what are diagnostic tests for glaucoma?

A

cup to disc ratio
IOP measurement
visual field perimetry test

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20
Q

What is the treatment for glaucoma?

A

1.open angle-topical beta blocker (timolol)
2.closed angle-pilocarpine (topicl adrenergive cholinergic agonist)
3. other: prostaglandin analogue
carbonic annhydrase inhibitor topical or oral
4. surgery if pharmacy fails: laser trabeculoplasty

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21
Q

what are some complications to consider with glaucoma?

A

adverse effects of cholinergic agonists, B blockers

irreversible loss of sight (2nd MC cause blindness)

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22
Q

What is the best prevention for glaucoma?

A

regular screening

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23
Q

what is the general pathophysiology of glaucoma?

Study These Flashcards
A

increased IOP leads to optic neuropathy change in optic cup

seen as a change in visual fields

24
Q

what is the most common cause in US of visual decline that is not correctable?

25
What are some etiologies of cataracts?
1. MC age related 50% of people >65yo 2. trauma 3. immune mediated (corticosteriods supress immune system) 4. infection CMV, rubella 5. metabolic (diabetes mellitus-osmotic change) 6. nutritional defect 7. radiation
26
what is the pathophysiology of cataracts?
thickening of lens, opacity in crystalline structure of the lens - can lead to myopia increase" 2nd sight" - diplopia monocular due to irregular refractory - image blurr
27
What is the presentation of cataracts?
``` 1. painless progressive loss of vision (slowly progressive) 2. image blur 3. myopia increase 4. monocular diplopia ```
28
What is the treatment for cataracts?
surgery -cataract extraction
29
How are cataracts diagnosed?
visual actuity papillary response opthalmoscopy
30
What three conditions present with slow progressive loss of visual fields?
diabetic retinopathy and open angle glaucoma and macular degeneration cataracts also slow progressive but more image blur and change in focus
31
how can you distinguish glaucoma, diabetic retinopathy and macular degeneration?
- IOP in glaucoma high normal in open angle and optic disc cup - spots from microaneurysms seen in diabetic retinol - macular degeneration will be central vision distortion and blind spots
32
What is the treatment for diabetic retinopathy?
panretinal laser photocoagulation
33
how can you diagnose diabetic retinopathy?
opthamopathologic exam-regular surveillance with diabetes
34
what percentage of patients with diabetes for 15-25 years develop retinopathy?
60%
35
What is the pathophysiology of diabetic neuropathy and retinopathy?
aldose reductase turns glucose into sorbitol changes the osmotic potential tissue damage vascular insufficiency
36
What are the 2 types of diabetic retinopathy?
proliferative: new vessels(neovascular) form (VEGF) at risk for retinal detach and blindness photocoagulate microaneurysms nonproliferative: miscroaneurysms, flame hemmorhage, exudates
37
How does diabetic retinopathy present?
1. slow progression of visual field loss | 2. tiny dots on retina from ruptured micro aneurysms and retinal exudates
38
what is the treatment for diabetic retinopathy?
panretinal laser photocoagulation
39
What is the incidence of macular degeneration from age 50?
.05% | 11.8% after 80
40
What is the etiology of macular degeneration?
Drusen deposits on Brush's membrane due to degeneration of thin retina
41
what is the pathophysiology of macular degeneration?
1. Antioxidant damage 2. DRY thin retina membrane 3. hyaline nodule forms (yellow white)= Drusen deposits on layer of retina before the choroid - Brusch's membrane 2. WET vessels under retina hemmorage(subretinal neovascular change) 3. retinal cells die 4. pt. has blind spots or distorted central vision
42
how does the patient with macular degeneration present?
1. older 2. slow progressive painless loss of vision field - central vision, blindspots can be acute onset if retinal hemmorrage
43
what is the treatment for macular degeneration?
laser therapy
44
How is macular degeneration diagnosed?
angiography amsler grid testing opthalmoscopy
45
what increases the risk of closed angle glaucoma?
elderly on multiple drugs | drugs like bupriorion (wellbutrin), spiriva, advair, fluoxetine, albuterol
46
what can cause glaucoma idiopathically?
prescribing glucocorticoids -pt on them for 2-6 weeks can increase IOP and cause optic nerve damage "steriod glaucoma"
47
what distinguishes open angle from closed angle glaucoma?
closed angle will get relief from pilocarpine and minimal optic cupping seen in closed angle more cupping in open angle onset is usually acute in closed angle
48
what can cause open angle glaucoma?
progressive disc change
49
what is uvetitis?
cause of closed angle glaucoma | cilliary flushing with cells in anterior chamber
50
How does uvetitis present?
Head ache constant pressure and discomfort (pulsing) | blurry vision
51
What is the treatment for uveitis?
GOAL: create an environment of zero inflammation corticosteriods (side effects) topical cycllopeliga (atropine) topical or oral NSAID noncortocsteriod oral immunosuppressant (methotrexate) TNF alpha inhibitor
52
What are some side effects for the eye in using glucocorticoids?
keratitis (herpes simplex or fungal) due to immune suppression. Can cause perforation of the cornea steriod glacoma...increased IOP
53
in macular degeneration which are the first retinal cells to respond to degeneration (drusen build up)?
retinal pigmented epithelium cells (next cell layer anterior to Brushe's membrane-lamina vitae)
54
What causes bitemporal hemionopsia?
optic chiasm lesion (pit tumor if onset insidious)
55
An onset of 2 months (insidious) and lateral rectus palsy is most likely caused by...
meningeal tumor of ventral pons (if was infarct of pons would see other sensory, motor effects) (if was in cavernous sinus or superior orbital fissure would have complete opthalmopelgia)
56
What is the major factor in the retina pathology of diabetic retinopathy?
vascular endothelial growth factor
57
3rd nerve palsy with pupillary reflex intact is most likely due to what etiology?
vascular event in brainstem that spares medial fibers (not in 3rd nerve itself because by time it exits brainstem it carries both fibers)

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