Lecture III Flashcards Preview

Ophthalmology > Lecture III > Flashcards

Flashcards in Lecture III Deck (66):
1

What is the definition of *acute* visual loss?

Loss of vision within 72 hours

2

What is the major cause of optic nerve dysfunction in young patients?

MS

3

What is the first media that light has to pass through to get to the retina? How significant is pathology in this area?

Tear film
fairly significant

4

What are the refractive media that light passes through to get to the retina?

Tear
Cornea
Aqueous humor
Lens
Vitreous humor

5

What are the common causes of corneal edema?

-Increased IOP
-*Closed angle glaucoma*

6

True or false: any infx/inflammation of the eye may mimic corneal edema

True

7

What happens to the cornea with edema?

Crisp, clear cornea becomes dull, ground glass appearance

8

What is usual presentation of acute angle closure glaucoma?

Acute onset of severe ocular pain, with a rock hard eye

9

What happens to the pupil with acute angle closure glaucoma?

Mid-dilated, fixed pupil

10

What happens to vision with acute angle closure glaucoma?

Blurred
Halos around light

11

What are the extraocular s/sx of acute angle closure glaucoma?

HA
N/v

12

What, generally, happens with acute angle glaucoma?

Iris closes the canal of schlemm, causing a buildup of pressure in the eye

13

What is hyphema?

a collection of blood anterior chamber The blood may cover part or all of the iris and the pupil, and may partly or totally block vision in that eye.

14

What generally causes hyphema? What other, lesser cause?

Trauma to the eye

Neovascularization of the eye

15

What are lenticular changes?

Cataracts (clouding of the lens)

16

What are the common etiologies of vitreous hemorrhage? (3)

-DM retinopathy
-Retinal break/detachment
-Retinal detachment

17

How do you diagnose vitreous hemorrhage?

Dilate pupil and a fundoscopic exam

18

How fast do vitreous hemorrhages resolve relative to hyphema?

Much slower

19

What is vitreous detachment?

Vitreous separates from the retina, causing the vitreous humor to liquefy, shrinks, and forms opacifications that can be visualized within the visual field

20

What are the common etiologies of vitreous detachment?

-Myopia
-Cataract surgery
-Trauma
-Inflammatory dz

21

What age range is commonly affected with vitreous detachment?

Over 45 yo

22

What are the hallmark s/sx of retinal detachment?

Flashes of light and floaters, followed by a shade in the visual field

23

How does retinal detachment begin and spread?

Begins peripherally, and dissects posteriorly

24

How do you diagnose retinal detachment?

Through a dilated pupil, generally by an ophthalmologist

25

What are the three leading causes of blindness in the US?

1. DM
2. Macular degeneration
3. Glaucoma

26

What are the two forms of macular degeneration?

Dry and wet forms

27

What is the difference between dry and wet forms of macular disease?

Wet = neovascularization behind the retina which can leak exudate and fluid and also cause hemorrhaging
Dry = cellular debris called drusen accumulates between the retina and the choroid, causing atrophy and scarring to the retina

28

Which form of macular degeneration causes a sudden loss of vision: dry or wet? Which is usually worse?

Wet x2

29

What is amaurosis fugax?

Sudden occlusion of the temporal artery, causing a sudden (total) and transient visual loss

30

Cholesterol plaque in the retina probably came from which vessels?

Carotid artery

31

What are the three major organ systems that should be evaluated with amaurosis fugax?

-Cardio
-Cerebrovascular
-Ophthalmologic

32

What is a common mimic of amaurosis fugax? Why?

Migraine--so much vasospasm causes occlusion of retinal

33

What is the most common visual symptoms of migraines?

Scintillating scotoma

34

What should always be evaluated with new onset migraines?

Ask about family h/o migraines

35

What is CRAO?

central retinal artery occlusion

36

What are the s/sx of central retinal artery occlusion?

Sudden, painless visual loss

37

True or false: central retinal artery occlusion is an ocular emergency

True

38

What is the appearance of the eye with central retinal artery occlusion after hours of occlusion?

-Opaque retina with *cherry red spot*

39

What happens to vision with central retinal artery occlusion?

only light perception, or worse

40

What happens to the pupil with central retinal artery occlusion?

Relative afferent defect

41

What are the retinal changes with central retinal artery occlusion in the first minutes to hours?

Vascular stasis, boxcarring

42

What is the immediate treatment for central retinal artery occlusion?

Digital massage compress eye with heel of hand firmly for 10 seconds, then release to 10 seconds to attempt to relieve occlusion

43

What are the medications that can be used in central retinal artery occlusion?

Glaucoma meds--takes pressure down to 0

44

What are the characteristics of the eye in the months following central retinal artery occlusion?

Blind eye with a pale optic disc, but the vessels will recannulate

45

What is BRAO? What usually causes it? What are the usual results?

branch retinal artery occlusion, usually caused by an embolus

Only a branch of the central retinal artery involved--may just cause peripheral vision loss

46

What are the common sources of branch retinal artery emboli? (4)

-Cardiac
-Talc (drugs)
-Fat
-Vasculitis

47

The scotoma seen with branch retinal artery occlusion depends on what?

Size and location of the branch that is occluded

48

What is the outcome of branch retinal artery occlusion?

Depends on the branch involved, but may be nothing

49

What are the general s/sx of central retinal vein occlusions?

Often severe vision loss, but onset is subacute

50

What is the classic appearance of CRVO?

"Blood and thunder"
-Disc swelling
-Diffuse retinal hemorrhages
-Venous engorgement
-cotton wool spots

51

Who generally gets CRVO?

Older patients with CVD

52

What is the major late complication of CRVO?

Neovascular glaucoma

53

What is optic neuritis? What can this lead to?

Idiopathic inflammation of the optic nerve

may be indicative of MS

54

What is the prognosis of optic neuritis?

90% of vision comes back, especially if first attack

55

What is the classic sign of optic neuritis?

RAPD

56

How do you treat optic neuritis?

Parenteral corticosteroids

57

How does glaucoma cause corneal edema?

Fluids overwhelms the Na/K pump

58

What may happen as a result of a hyphema?

Clogging of the trabecular meshwork, which can causes increased IOP days later

59

What is the general MOA of cycloplegic agents?

Paralysis of the ciliary muscle

M3 receptor blocker (muscarinic antagonist)

60

What happens when a person with a hyphema sits up?

The blood in the anterior chamber will settle inferiorly, clearing the vision

61

What are the general complaints that occur with vitreous hemorrhage?

Cobweb-like floaters in their visual field

62

What are the major consequences that can occur with retinal detachment? (2)

-If blood vessels affected, then massive hemorrhage within the eye
-If involves macula, will lead to blindness.

63

What, generally, happens with retinal detachment?

Retina detaches, and causes the vitreous humor to fill in behind it, further detaching the retina

64

What may cause a sudden onset of macular degeneration?

neovascular membrane that grows beneath the retina causes distortion

65

What are the two types of migraines?

Cephalic and acephalic

66

What are the comorbidities that usually cause CRVO?

-HTN
-Arterosclerotic vascular disease
-Glaucoma
-DM