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CMT > Inner Eye Disorders > Flashcards

Inner Eye Disorders Flashcards

1
Q

Thyroid Orbitopathy

occurs in who?

3 disorders

A
  1. Hyperthyroid (Graves)
  2. Euthryoid
  3. Hypothyroid
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2
Q

Thyroid Orbitopathy

presentation

A
  • bi or unilateral proptosis
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3
Q

Uveitis

describe

A

emergency inflammation of uveal tract

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4
Q

Uveitis

differentiate:
* anterior
* posterior
* intermediate
* panuveitis

A
  • anterior chamber structures
  • retina, choroid
  • vitreous body only
  • all structures involved
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5
Q

Uveitis

sx

6 components

A
  1. blindness, distorted/blurred vision
  2. painful
  3. redness
  4. photophobia
  5. uni or bi lateral
  6. acute, < 3 mo, sudden onset
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6
Q

Uveitis

PE Findings

6

A
  1. small/constricted pupil
  2. pupil reacts poorly to light
  3. iris becomes difficult to see
  4. redness
  5. WBCs settled in bottom of anterior chamber
  6. decreased IOP
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7
Q

Uveitis

tx

3 components

A
  • immediate referral to ophthalmology
  • steroids
  • exacerbated if give drugs for tx glaucoma
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8
Q

Uveitis

complications

4

A
  1. visual loss
  2. cyst-like formations on macula
  3. glaucoma
  4. cataracts
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9
Q

Episcleritis

describe

A

inflammation of the episclera which is the thin layer of vascular elastic tissue between the sclera and conjunctiva

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10
Q

Episcleritis

PE Findings

3 components

A
  • red, vascular injection of conjunctive w/ enlarged blood vessels beneath the conjunctiva
  • mild pain/discomfort
  • diffuse/nodular inflammation
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11
Q

Episcleritis

Tx

4 components

A
  1. refer to ophthalmology
  2. warm compress
  3. steroids (topical)
  4. NSAIDs (drops/PO)
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12
Q

Nystagmus

describe

2 components

A
  • involuntary rhythmic eye motion/oscillation
  • results from dysfunction in the vestibular system, brainstem, cerebellum
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13
Q

Nystagmus

describe vestibular nystagmus

A
  • results from dysfunction of the labryinth (Meinere’s disease), vestibular nerve, or vestibular nucleus in the brainstem
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14
Q

Nystagmus

signs/sx of vestibular nystagmus

5 components

A
  • nausea
  • vertigo
  • tinnitus
  • hearing loss
  • sudden head movements worsen sx
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15
Q

Nystagmus

describe jerk nystagmus

A
  • characterized by slow drifting off of a target followed by a quick corrective jerk
  • can be downbeat, upbeat, horizontal, or torsional
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16
Q

Nystagmus

signs/sx associated with jerk nystagmus

A
  • some pts are unaware they have it
  • others have: blurred vision, oscillopsia (environment oscillates)
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17
Q

Nystagmus

describe up and downbeat nystagmus

A
  • downbeat: occurs from lesions near the craniocervical junction (Chiari malformation, basilar invagination)
  • Upbeat: damage to the pontine tegmentum from troke, demyelination, or tumor.
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18
Q

Nystagmus

describe gaze evoked nystagmus

A
  • when the eyes are help eccentrically in the orbits, they tend to drift back to primary position
  • the pt will correct this, causing a quick oscillation to continue to target
  • normal in many pts in extreme vision fields
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19
Q

Nystagmus

what can exaggerate gaze-evoked nystagmus?

5 components

A
  1. drugs (sedatives, anti-convulsants, alcohol)
  2. muscle paresis
  3. myasthenia gravis
  4. demyelinating disease
  5. cerebellopontine angle, brainstem, cerebellar lesions
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20
Q

Strabismus

pathophys

A
  • problems w/ eye muscles, the nerves that transmit information to the muscles, or the control center in the brain that directs eye movements
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21
Q

Strabismus

describe the misalignment of the eyes

A
  • axis are not aligned
  • misaligned may be constant or intermittent
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22
Q

Strabismus

risk factors

3 components

A
  1. family hx
  2. refractive error (farsighted)
  3. medical conditions (down syndrome, stroke, cerebral palsy)
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23
Q

Strabismus

differentiate extropia and esotropia

A
  • extropia: deviating eye turns outward
  • esotropia: deviating eye turns inward
24
Q

Strabismus

differentiate hypotropia from hypertropia

A
  • hypotropia: deviating eye turns downward
  • hypertropia: deviating eye turns upward
25
Q

Strabismus

asssocaited sx

3

A
  • diplopia (double vision)
  • suppression (diminished sensitivity within visual field of deviating eye)
  • amblyopia (eyes not working together)
26
Q

Strabismus

describe accommodative esotropia

A
  • due to uncorrected farsightedness causing eye to turn inward
  • sx: double vision, closing/covering one eye when using nearsighted vision, tilting/turning head
27
Q

Strabismus

describe intermittent exotropia

A
  • person cannot coordinate both eyes together
  • sx: HA, difficulty reading, eye strain, closed eye w/ farsightedness/sunlight
28
Q

Strabismus

dx

5

A
  • corneal light reflex
  • cover/uncover test
  • retinal exam
  • ophthalmic exam
  • visual acuity
29
Q

Strabismus

emergent causes?

5

A
  1. orbital fractures
  2. cellulitis
  3. tumors
  4. meningitis
  5. increased IOP
30
Q

Strabismus

dx for emergent causes?

A
  • orbital CT (ocular infiltrative process, tumors, abscesses, cellulitis)
  • Brain MRI (evaulate CN roots + brainstem)
31
Q

Strabismus

tx

4 components

A
  • can spontaneously resolve as muscles strengthen
  • prism lenses (alter light enterance to eye to re-train them)
  • vision therapy
  • eye muscle surgery
32
Q

Amblyopia

describe generally

A
  • lack of development of clear vision in one/both eyes that cannot be fixed with glasses
33
Q

Amblyopia

pathophys

A
  • brain cannot combine the images from the eyes
34
Q

Amblyopia

this is a lazy eye

A

just FYI

35
Q

Amblyopia

causes

3

A
  1. early strabismus
  2. early myopia/presbyopia
  3. visual problems (ex: congenital cataracts)
36
Q

Amblyopia

tx

A
  • patching of “good eye” to force the lazy eye to work
  • vision therapy
37
Q

strabismus vs amblyopia

A
  • strab: cross eyed
  • ambl: lazy eye
38
Q

Glaucoma

generally describe

A

abnormal flow of fluid around lens that causes increases in IOP and then damages the optic nerve causing diminished vision and eye irritation

39
Q

Glaucoma

which type of glaucoma is usually asx?

A

chronic

40
Q

Glaucoma

epidemiology

age, race, common

A
  • increasing age
  • AAs at largest risk
  • family hx increases risk
  • chronic open angle is most common
41
Q

Open-Angle Glaucoma

what increases IOP in open angle?

A

IOP is elevated due to reduced drainage of aqueous fluid through the trabecular meshwork

42
Q

Open-Angle Glaucoma

goal for tx of open angle?

A

reduce the pressure by reducing the amount of fluid present in the eye

43
Q

Open-Angle Glaucoma

sx/signs

6 components

A
  • no sx in early stages
  • progressive bilateral loss of peripheral vision
  • tunel vision
  • preserved visual acuities until advanced disease
  • cupping of optic discs
  • elevated IOP
44
Q

Closed-Angle Glaucoma

predisposing factors

3

A
  1. shallow anterior chamber (farsightedness/short stature)
  2. Asian/Inuits
  3. enlarged lens
45
Q

Closed-Angle Glaucoma

what causes angle closure?

A

pupillary dilation

46
Q

Closed-Angle Glaucoma

associated sx

A
  • HA
  • red eye
  • pain in eye
47
Q

Closed-Angle Glaucoma

dx

A
  • measure IOP (elevated)
  • gonioscopy (allows you to observe narrow chamber angle)
48
Q

Closed-Angle Glaucoma

PE findings

5

A
  • red eye
  • cloudy cornea
  • pupil dilated, non-reactive to light
  • IOP > 50mmHg
  • globe firmness
49
Q

Closed-Angle Glaucoma

complication of acute

A

severe and permanent vision loss if not treated within 2-5 days of sx onset

50
Q

Closed-Angle Glaucoma

prophylaxis for acute

A

laser peripheral iridotomy to the unaffected eye

51
Q

Closed-Angle Glaucoma

Tx

4 components

A
  • goal: reduce IOP
  • Acetazolamide
  • osmotic diuretics (glycerin, urea, or mannitol) if no response to acetazolamide
  • Pilocarpine drops after IOP decreases
52
Q

Closed-Angle Glaucoma

surgical options

3

A
  • laser pepheral iridotomy
  • surgical peipheral iridectomy
  • cataract surgery
53
Q

Glaucoma

which BB can be used? describe what is does?

A
  • timolol
  • reduces aqueous humor which decreases IOP
54
Q

Glaucoma

which topical prostaglanding agonist can be used? how?

A
  • “prosts”
  • increases outflow of aqueous humor to decrease IOP
55
Q

Glaucoma

which alpha-2 adrenergic agonist can be used? describe?

A
  • brimonidine
  • dilates pupil to increase aqueous humor outflow and decrease IOP
56
Q

Glaucoma

which carbonic anhydrase inhibitor can be used? describe?

A
  • zolamides
  • decreases aqueous humor volume to decrease IOP
57
Q

Glaucoma

glaucoma screening guidelines

A
  • everyone at age 40
  • age 40-60 w/out risk factors: every 3-5 yrs
  • age 40-60 w/ risk factors: every 1-2 yrs
  • age > 60 y/o: every 1-2 yrs

CMT (72 decks)

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