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Ophthalmology > Lecture III > Flashcards

Lecture III Flashcards

1
Q

What is the definition of acute visual loss?

A

Loss of vision within 72 hours

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2
Q

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

A

MS

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3
Q

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

A

Tear film

fairly significant

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4
Q

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

A 
Tear
Cornea
Aqueous humor
Lens
Vitreous humor
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5
Q

What are the common causes of corneal edema?

A
  • Increased IOP

- Closed angle glaucoma

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6
Q

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

A

True

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7
Q

What happens to the cornea with edema?

A

Crisp, clear cornea becomes dull, ground glass appearance

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8
Q

What is usual presentation of acute angle closure glaucoma?

A

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

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9
Q

What happens to the pupil with acute angle closure glaucoma?

A

Mid-dilated, fixed pupil

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10
Q

What happens to vision with acute angle closure glaucoma?

A

Blurred

Halos around light

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11
Q

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

A

HA

N/v

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12
Q

What, generally, happens with acute angle glaucoma?

A

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

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13
Q

What is hyphema?

A

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.

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14
Q

What generally causes hyphema? What other, lesser cause?

A

Trauma to the eye

Neovascularization of the eye

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15
Q

What are lenticular changes?

A

Cataracts (clouding of the lens)

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16
Q

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

A
  • DM retinopathy
  • Retinal break/detachment
  • Retinal detachment
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17
Q

How do you diagnose vitreous hemorrhage?

A

Dilate pupil and a fundoscopic exam

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18
Q

How fast do vitreous hemorrhages resolve relative to hyphema?

A

Much slower

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19
Q

What is vitreous detachment?

A

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

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20
Q

What are the common etiologies of vitreous detachment?

A
  • Myopia
  • Cataract surgery
  • Trauma
  • Inflammatory dz
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21
Q

What age range is commonly affected with vitreous detachment?

A

Over 45 yo

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22
Q

What are the hallmark s/sx of retinal detachment?

A

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

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23
Q

How does retinal detachment begin and spread?

A

Begins peripherally, and dissects posteriorly

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24
Q

How do you diagnose retinal detachment?

A

Through a dilated pupil, generally by an ophthalmologist

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25
Q

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

A
  1. DM
  2. Macular degeneration
  3. Glaucoma
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26
Q

What are the two forms of macular degeneration?

A

Dry and wet forms

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27
Q

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

A 
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
Q

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

A

Wet x2

29
Q

What is amaurosis fugax?

A

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

30
Q

Cholesterol plaque in the retina probably came from which vessels?

A

Carotid artery

31
Q

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

A
  • Cardio
  • Cerebrovascular
  • Ophthalmologic
32
Q

What is a common mimic of amaurosis fugax? Why?

A

Migraine–so much vasospasm causes occlusion of retinal

33
Q

What is the most common visual symptoms of migraines?

A

Scintillating scotoma

34
Q

What should always be evaluated with new onset migraines?

A

Ask about family h/o migraines

35
Q

What is CRAO?

A

central retinal artery occlusion

36
Q

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

A

Sudden, painless visual loss

37
Q

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

A

True

38
Q

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

A

-Opaque retina with cherry red spot

39
Q

What happens to vision with central retinal artery occlusion?

A

only light perception, or worse

40
Q

What happens to the pupil with central retinal artery occlusion?

A

Relative afferent defect

41
Q

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

A

Vascular stasis, boxcarring

42
Q

What is the immediate treatment for central retinal artery occlusion?

A

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

43
Q

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

A

Glaucoma meds–takes pressure down to 0

44
Q

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

A

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

45
Q

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

A

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
Q

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

A
  • Cardiac
  • Talc (drugs)
  • Fat
  • Vasculitis
47
Q

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

A

Size and location of the branch that is occluded

48
Q

What is the outcome of branch retinal artery occlusion?

A

Depends on the branch involved, but may be nothing

49
Q

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

A

Often severe vision loss, but onset is subacute

50
Q

What is the classic appearance of CRVO?

A

“Blood and thunder”

  • Disc swelling
  • Diffuse retinal hemorrhages
  • Venous engorgement
  • cotton wool spots
51
Q

Who generally gets CRVO?

A

Older patients with CVD

52
Q

What is the major late complication of CRVO?

A

Neovascular glaucoma

53
Q

What is optic neuritis? What can this lead to?

A

Idiopathic inflammation of the optic nerve

may be indicative of MS

54
Q

What is the prognosis of optic neuritis?

A

90% of vision comes back, especially if first attack

55
Q

What is the classic sign of optic neuritis?

A

RAPD

56
Q

How do you treat optic neuritis?

A

Parenteral corticosteroids

57
Q

How does glaucoma cause corneal edema?

A

Fluids overwhelms the Na/K pump

58
Q

What may happen as a result of a hyphema?

A

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

59
Q

What is the general MOA of cycloplegic agents?

A

Paralysis of the ciliary muscle

M3 receptor blocker (muscarinic antagonist)

60
Q

What happens when a person with a hyphema sits up?

A

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

61
Q

What are the general complaints that occur with vitreous hemorrhage?

A

Cobweb-like floaters in their visual field

62
Q

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

A
  • If blood vessels affected, then massive hemorrhage within the eye
  • If involves macula, will lead to blindness.
63
Q

What, generally, happens with retinal detachment?

A

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

64
Q

What may cause a sudden onset of macular degeneration?

A

neovascular membrane that grows beneath the retina causes distortion

65
Q

What are the two types of migraines?

A

Cephalic and acephalic

66
Q

What are the comorbidities that usually cause CRVO?

A
  • HTN
  • Arterosclerotic vascular disease
  • Glaucoma
  • DM

Ophthalmology (14 decks)

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