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HEENT Clin Med > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

What happens when light hits the retina

A

photoreceptors turn the light into electrical signals

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2
Q

What does the top number on the snelling chart refer to

A

the distance in feet you stand to the chart

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3
Q

What does the bottom number on the snelling chart refer to

A

the distance in which a person with normal eyesight can read the same line

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4
Q

What type of equipment is used for refractive testing

A

phoropter

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5
Q

What equipment is used for glaucoma evaluation

A

gonioscopy

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6
Q

What is the normal eye pressure range

A

10-21 mmHg

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7
Q

What is the leading cause of blindness / low vision in the US due to

A

aging

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8
Q

What are some age related vision changes

A

cataracts
diabetic retinopathy
glaucoma
macular degeneration

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9
Q

What is the most frequent eye problem in the US

A

Refractive errors

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10
Q

What are refractive errors

A

myopia
hyperopia
astigmatism
presbyopia

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11
Q

What is near sightedness known as

A

myopia

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12
Q

What is farsightedness

A

hyperopia

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13
Q

What causes distorted vision at all distances

A

astigmatism

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14
Q

What is the loss of ability to focus up close and when does it generally occur

A

presbyopia
40-50y/o

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15
Q

What is the cause of myopia

A

cornea is too steeply curved
axial eye length too long

*point of focus is in front of retina

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16
Q

How do you correct myopia

A

concave lens

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17
Q

What causes hyperopia

A

cornea too flat
axial length too short

*point of focus is behind retina

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18
Q

How do you correct hyperopia

A

convex lens

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19
Q

What causes astigmatism

A

variable curve of the cornea / lens causing light to focus at different points

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20
Q

hat type of lens is used to correct astigmatism

A

cylindrical lens

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21
Q

What causes presbyopia

A

loss of the lens’ ability to change shape to focus on near objects from aging

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22
Q

What is anisometropia

A

Significant difference between refractive errors of the 2 eyes

*>3 diopters

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23
Q

What is aniseikonia

A

Different image sizes

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24
Q

What are common s/sx of refractive errors in patients

A

blurred vision
headaches
perceived imbalance
Ocular surface desiccation

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25
Q

What do refractive errors cause headaches

A

excessive colliery muscle tone
Prolonged squinting/frowning

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26
Q

What are the signs of ocular surface desiccation from excessive staring

A

eye irritation
itching
visual fatigue
foreign body sensation
redness

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27
Q

What are symptoms of refractive errors in children

A

frowning / squinting when reading
excessive blinking
rubbing of eyes

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28
Q

How do you workup refractive errors

A

visual acuity testing
refraction
comprehensive eye exam

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29
Q

How often should visual acuity and refraction testing be done

A

every 1-2 years

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30
Q

Who preforms comprehensive eye exams

A

ophthalmologists
optometrist

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31
Q

How can you treat refractive errors

A

glasses
contacts
surgery

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32
Q

What are the three numbers that are included with corrective lens prescriptions

A

spherical correction
cylindrical correction
axis

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33
Q

What is the power of spherical corrections used for

A
  • (myopia)
    + (Hyperopia)
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34
Q

What is amblyopia

A

lazy eye

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35
Q

When can severe loss of vision occur with amblyopia

A

if the affected eye is not detected and treated before 8 years old

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36
Q

What occurs amblyopia

A

visual cortex suppress image from affected eye

if suppression persists long enough - vision loss can be permanent

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37
Q

What is strabismus

A

misalignment of the eye resulting in different retinal images being sent to visual cortex

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38
Q

What is anisometropia

A

different focus of retinal images with image from eye with greater refractive error being less well focused

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39
Q

What causes obstruction of the visual axis

A

some point between surface of eye and retina, something interferes with or completely prevents formation of retinal image of affected eye

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40
Q

How can strabismus be confirmed

A

with alternate cover test or cover to uncover test

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41
Q

How can anisometropia be confirmed

A

refraction of each eye

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42
Q

How can obstruction of visual axis be confirmed

A

ophthalmoscope or sit-lamp exam

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43
Q

How do you treat amblyopia

A

glasses / contacts
patching (Common in kids)
Atropine drops
tx of strabismus if present

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44
Q

What is the most common cause of IRREVERSIBLE central vision loss in older patients

A

AMD (macular degeneration)

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45
Q

What is the diagnostic test for AMD

A

Dilated fundoycopic findings

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46
Q

What tests can be done for AMD

A

Color photographs
fluorescein angiography
optical coherence tomography

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47
Q

How do you treat AMD

A

Dietary supplements
intra-vitreal injection
laser photocoagulation
low vision devices
photodynamic therapy

48
Q

What are the different forms of AMD

A

Dry (all AMD starts here)
Wet

49
Q

What does dry AMD do to the eye

A

Change in retinal pigment epithelium (dark pinpoint areas)

50
Q

What occurs in the eye with dry AMD

A

Accumulation of waste products from rods and cones (drusen) will look like yellow spots

51
Q

What causes dry AMD to turn wet

A

New abnormal blood vessels develop under the retina (choroidal neovascularization)

52
Q

What is physically different with wet AMD compared to dry

A

Localized macular edema or hemorrhage may elevate an area of the macula or cause pigment epithelial detachment

53
Q

What does untreated neovascularization cause

A

disciform scar under the macula

54
Q

What is the clinical presentation of dry AMD

A

Loss of central vision that occurs over years and is generally painless

central blind spots (scotomas)

usually bilateral

Fundoscopic changes

55
Q

What fundoycopic changes occur with dry AMD

A

Drusen
changes in retinal pigment epithelium

chorio-retinal atrophy

56
Q

What is the clinical presentation of wet AMD

A

Rapid vision loss usually over days to weeks

legally blind in affected eye if not treated

often unilateral

57
Q

What is the first sx of wet AMD

A

visual distortion (scotoma or metaporphopsia)

58
Q

What is metaporphopsia

A

Curving of straight lines

59
Q

What are some fundoscopic changes with wet AMD

A

Subretinal fluid (elevation)
Retinal edema
gray-green discoloration
exudates in/around macula
sub retinal hemorrhage
detachment of retinal epithelium

60
Q

What test is better for wet AMD

A

color fundus photography
fluorescein angiography

61
Q

What is optical coherence tomography help identify

A

Aids in identifying intraretinal / sub retinal fluid

assess response to treatment

62
Q

What does Amsler grid help detect

A

visual changes

63
Q

What supplements can help manage dry AMD

A

Zinc
Copper
Vitamin C/E
Lutein

64
Q

What can help manage wet AMD

A

VEGF infections
thermal laser photocoagulation
Photodynamic therapy
injected corticosteroids

65
Q

What supportive measures can be used for patient with lost central vision (AMD)

A

Low vision devices
large print on electronics
low vision counseling

66
Q

if someone feels like they are looking through a steamed up window.. what do they most likely have

A

cataracts

67
Q

What is the leading cause of blindness and vision loss in the US

A

Cataracts

68
Q

Is cataracts age related

A

No, can be congenital or degenerative

69
Q

Where in the eye can cataracts occur

A

central lens nucleus (nuclear)
beneath posterior lens capsule
On side of the lens (Cortical)

70
Q

Which form of cataracts does not interfere with central vision

A

cortical

71
Q

What are main symptoms of cataracts

A

painless vision blurring
gradual

72
Q

How do you diagnose cataracts

A

ophthalmoscope and slit-lamp exam

73
Q

How do you treat cataracts

A

surgical removal and placement of intraocular lens

74
Q

What are early symptoms of cataracts

A

loss of contrast, glare, needing more light to see well, problems distinguishing dark blue from black

75
Q

What are rare symptoms that can occur with cataracts

A

swelling pushing iris over trabecular drainage meshwork, causing occlusion and secondary closed angle glaucoma

76
Q

What is nuclear cataract

A

Distance vision worsens, near vision may improve in early stages temporarily

presbyopic patients may be able to temporarily read without glasses (second sight)

77
Q

What is posterior sub scapular cataracts

A

Reduced visual acuity when the pupil constricts

more likely to cause loss of contrast and glare

disproportionally affects vision because opacity is located at crossing point of incoming light rays

78
Q

How do you workup cataracts

A

ophthalmoscope followed by slit-lamp
*best with pupils dilated

Exam of red reflex through dilated pupil (30cm away)

79
Q

What will cataracts look like

A

gray/white/yellow-brown opacities in lens

80
Q

What test is definitive for cataracts

A

slit-lamp because it provides more detail about character, location, and extent of opacity

81
Q

How do you treat cataracts

A

frequent refractions and corrective lens prescription changes

long term pupillary dilation for small centrally located cataracts

Indirect lights while reading to minimize pupillary constriction

82
Q

What are the indications for surgery with cataracts

A

best vision obtained with glasses is worse that 20/40

bothersome halos or starburst

vision is limiting

83
Q

What are the different types of cataracts surgery

A

intracapsular
extracapsular
phacoemulsification

84
Q

What is intracapsular cataract extraction

A

cataract and lens are used in one piece

85
Q

What is extra capsular cataract extraction

A

hard central nucleus is removed in one piece and then soft cortex is removed in multiple pieces

86
Q

What is phacoemulsification

A

Type of extracapusular
**Gold standard cataract surgery

87
Q

What do patients have to avoid for several weeks after cataracts surgery

A

valsalva maneuver
heavy lifting
excessive forward bending
eye rubbing

88
Q

What is the second most common cause of blindness worldwide

A

Glaucoma

89
Q

What is the leading cause of blindness for hispanics and African Americans in the US

A

glaucoma

90
Q

What is the most common type of glaucoma in the US

A

primary open angle glaucoma

91
Q

What causes glaucoma

A

progressive optic nerve damage with a relative increase in IOP

92
Q

What is glaucoma

A

acquired loss of retinal ganglion cells and axons within the optic nerve that results in a characteristic optic nerve head appearance and peripheral vision loss

93
Q

What occurs with open angle glaucoma

A

> 98% of aqueous humor exits the eye via either trabecular meshwork and canal of schlemm

94
Q

What are the divisions of glaucoma

A

primary (cause of outflow resistance or angle closure is unknown)

Secondary (outflow resistance results from a known disorder

95
Q

What are symptoms of closed angle glaucoma

A

severe ocular pain and redness decreased vision
colored halos around lights
H/A
N/V
Increased IOP

96
Q

What is definitive treatment of closed angle glaucoma

A

iridotomy

97
Q

What are risk factors for closed angle glaucoma

A

Fhx
advanced age
ethnicity (asians at most risk)

98
Q

What type of glaucoma is an ophthalmic emergency

A

primary acute closed angle

99
Q

what IOP is indicative of closed angle glaucoma

A

> 40mmHg

100
Q

What is intermittent closed angle glaucoma

A

an episode of pupillary block that resolves spontaneously after several hours -> generally after sleeping supine

101
Q

What is chronic closed angle glaucoma

A

angle narrows slowly, which allows for scarring between peripheral iris and trabecular meshwork

IOP elevation is slow

102
Q

What can cause secondary closed angle glaucoma

A

proliferative diabetic retinopathy
ischemic central vein occlusion
uveitis epithelial down-growth

103
Q

Why is acute closed angle glaucoma misdiagnosed

A

systemic complaints being so severe

104
Q

What will be seen on exam with acute closed angle glaucoma

A

conjunctive hyperemia
hazy cornea
fixed mid-dilated pupil
anterior chamber inflammation
IOP 40-80

105
Q

What is seen on exam with chronic closed angle glaucoma

A

gonioscopy showing peripheral anterior synechiae

optic nerve/visual field abnormalities

106
Q

How do you treat acute closed angle glaucoma

A

Timolol
pilocarpine
Brinonidine
Acetazolamide
osmotic agent

107
Q

What is definitely treatment of acute closed angle glaucoma

A

laser peripheral iridotomy

*done as soon as cornea is clear and inflammation has subsided

108
Q

What are risk factors for open angle glaucoma

A

older age
positive family history
African Ethnicity
Hypertension
Diabetes
Myopia

109
Q

What is occurring with open angle glaucoma

A

aqueous humor drainage is inadequate but production by ciliary body is normal

110
Q

What is found on physical exam with open angle glaucoma in asians

A

IOP with average range but optic nerve damage and visual field loss typical of glaucoma are present

*Have higher risk of intravascular disease

111
Q

How will the optic nerve look with open angle glaucoma

A

increased cup to disc ration
pitting / notching of rim
splinter hemorrhage
vertical cup elongation
bayoneting

112
Q

What is bayoneting in the eye

A

quick angulations in course of exiting blood vessels

113
Q

What is diagnostic of glaucoma regardless of IOP

A

thinning of neurosensory rim
Visual field change

114
Q

What is the clinical presentation of open angle glaucoma

A

Visual field defects
arcuate scotoma extending nasally
temporal wedge defect
paracentral scotoma

115
Q

What is the initial treatment for open angle glaucoma

A

drug therapy

then laser and last option is surgery

116
Q

Which medications can be used to manage open angle glaucoma

A

prostaglandin analogs
beta blockers (timolol)

HEENT Clin Med (7 decks)

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