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Ophthalmology > Gradual loss of vision > Flashcards

Gradual loss of vision Flashcards

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1
Q

causes of gradual loss of vision

A

cataract, macular degeneration, glaucoma, diabetic retinopathy, hypertension, optic atrophy, slow retinal detachment

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2
Q

what is the main cause of blindness

A

age related macular degeneration

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3
Q

what part of the vision is lost in age related macular degeneration

A

central vision (peripheral is maintained)

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4
Q

dry age related macular degeneration

A

mainly drusen and degenerative changes at macula. slow progression

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5
Q

wet age related macular degeneration

A

new vessels grow from choroid into retina and leak. deteriorates quickly

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6
Q

features age related macular degeneration

A

progressive gradual loss of central vision- difficulty reading and recognising distant objects. peripheral vision maintained so can navigate. pupil reactions normal

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7
Q

what can wet age related macular degeneration present like

A

vision deteriorates quickly. distorted images- straight lines wavy.

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8
Q

when are drusen usually first deposited

A

after age 45 years, but asymptomatic then

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9
Q

what investigation can be done age related macular degeneration if suspecting choroidal neovascularisation

A

fundus fluorescin angiogram. optical coherence tomography (OCT)

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10
Q

management age related macular degeneration

A

intravitreal VEGF inhibitors- bevacizumab and ranibizumab (wet); laser photocoagulation(wet); intravitrealsteroids; antioxidants and vitamins

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11
Q

pathogenesis open angle glaucoma

A

aqueous humour drains through trabecular meshwork in angle between cornea and iris. over time it undergoes morphological change. rise in IOP transmitted to optic disc where nerve fibre damage occurs

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12
Q

risk factors open angle glaucoma

A

genetic, increasing age, DM, myopia, black race, thin cornea

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13
Q

features open angle glaucoma

A

no symptoms until so advanced that central vision is threatened, no headache, eye pain, loss acuity

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14
Q

signs open angle glaucoma

A

increased IOP, optic disc cupping, peripheral visual field loss

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15
Q

optic disc exam open angle glaucoma

A

rim becomes pale and cup enlarges. cup:disc ratio

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16
Q

what cup:disc ratio suggests glaucoma

A

0.6. also asymmetry between the eyes of 0.2 is significant. (normal 0.4-0.7)

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17
Q

how to examine optic disc

A

stereoscopic viewing through a dilated pupil. OCT optical coherence tomography

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18
Q

visual field defect open angle glaucoma

A

central scotoma

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19
Q

treatment open angle glaucoma

A

prostaglandin analogues- latanoprost, travoprost- incr aqueous outflow through uveoscleral route rather than trabecular meshwork; B blockers to reduce production humour- timolol, betaxolol; alpha adrenergic agonists- brimonidine; carbonic anhydrase inhibitors; miotics- pilocarpine; sympathomimetics

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20
Q

surgery option in open angle glaucoma

Study These Flashcards
A

trabeculectomy

21
Q

which fields are lost first inopen angle glaucoma

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A

nasal and superior fields, temporal are lost last

22
Q

what is optic disc cupping

Study These Flashcards
A

loss of disc substance. if >0.9 cup:disc ratio then severe cupping

23
Q

what is a cataract

Study These Flashcards
A

opacity in the lens

24
Q

what happens to the red reflex in cataract

Study These Flashcards
A

still present in an immature cataract, but absent in dense cataract

25
what morphological variants can occur with cataract
nuclear sclerosis- common in old age, subcapsular- shallow opacification can be from steroid use; cortical; dot opacities
26
pre senile cataract causes
diabetes, corticosteroid therapy, atopy, galactosaemia, hypocalcaemia, dystrophia myotonica
27
causes of congenital cataract
1/3- autosomal dominant. 1/3- birth trauma or maternal infection- rubella, toxoplasmosis.
28
presentation cataract
blurred vision, unilateral often unnoticed but loss of stereopsis affects distance judgment. bilat causes loss of vision, dazzle, monocular diplopia
29
how may cataract present in children
squint, loss of binocular function, white pupil, nystagmus
30
treatment of cataract
prior to surgery- ocular biometry. surgery- lens extracted and another lens inserted- Perspex, acrylic, silicon. antibiotic and anti-inflammatory drops post op
31
post op complications after cataract
posterior capsule thickening, astigmatism, eye irritation, rare- VH, retinal detachment, glaucoma
32
prevention cataract
photoprotection- sunglasses. UV-B. decrease oxidative stress
33
signs in optic atrophy
discs are pale. may be from incr IOP or retinal damage (choroiditis, retinitis pigmentosa); or ischaemia
34
causative toxins optic atrophy
tobacco, methanol, lead, arsenic, quinine, carbon bisulfide
35
causes optic atrophy
toxins, lebers optic atrophy, MS, syphilis, tumours
36
what is visual loss usually due to in diabetic retinopathy
vitreous haemorrhage, maculopathy
37
what happens in diabetic retinopathy
accelerates formation age related cataract, causes ocular ischaemia-new blood vessels to form on iris leads to glaucoma if prevents drainage of the aqueous fluid
38
classification diabetic retinopathy
background, pre proliferative and proliferative
39
what does vascular occlusion lead to diabetic retinopathy
ischaemia and new vessels forming in retina, otic disc, iris- proliferative retinopathy
40
features of background retinopathy
microaneurysms, dot and blot haemorrhages, exudates
41
features pre proliferative
cotton wool spots, venous beading, exudates
42
features proliferative
new vessels at the disc, and elsewhere. cotton wool spots, flame shaped haemorrhages- ruptured microaneurysms
43
what do cotton wool spots show
ischaemic nerve fibres
44
what is maculopathy
leakage from vessels close to the macule cause oedema and threaten vision
45
treatment diabetic retinopathy
good control diabetes, keep BP
46
what can you treat diabetic macular oedema with
intravitreal triamcinolone and anti VEGF drugs
47
what can be a complication in diabetic retinopathy
vitreous haemorrhage
48
what factors can accelerate retinopathy
pregnancy, dylipidaemia, icr bp, renal disease, smoking, anaemia

Ophthalmology (6 decks)

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