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Flashcards in Lecture IV Deck (89):
1

What are the two subgroups of optic neuritis?

-Papillitis
-Retrobulbar neuritis

2

How do you diagnose papillitis? (2)

Relative afferent pupillary defect
Disc edema

3

What is papillitis?

Subgroup of optic neuritis involving optic nerve, therefore swollen optic nerve

4

Who usually gets retrobulbar neuritis?

Young adult with a progressive loss of vision over hours to days

5

What are the s/sx of retrobulbar neuritis? Why?

Progressive loss of vision and Pain on ocular movement d/t movement of the optic nerve

6

What is the difference between papillitis and retrobulbar neuritis?

Papillitis is inflammation of the head of the optic nerve

Retrobulbar neuritis is when the posterior part of the optic nerve is inflamed

7

What cause optic neuritis?

Anything that causes inflammation of the optic nerve--(e.g. viral or MS)

8

What differentiates optic neuritis and retrobulbar neuritis on fundoscopic exam?

Papillitis will reveal disc swelling, whilst optic neuritis will not

9

Are there vision problems or pupillary reflex abnormalities with acute papilledema? Chronic?

No, but if left untreated may progress to vision loss

10

Compare papillitis and papilledema in terms of the presence of hemorrhages.

Both have

11

Compare papillitis and papilledema in terms of etiology.

Papillitis is 2/2 inflammation

Papilledema is 2/2 increased ICP

12

Compare papillitis and papilledema in terms of optic nerve swelling

Both have

13

Compare papillitis and papilledema in terms of vision

Reduced with papillitis but normal with papilledema

14

Compare papillitis and papilledema in terms of pupillary responses.

RAPD in papillitis

Normal with papilledema

15

What is ischemic optic neuropathy?

Infarction of the optic disk, which may be 2/2

16

Who usually gets ischemic neuropathy (age)? Is it more commonly unilateral or bilateral?

Over age 55, usually unilateral

17

What are the s/sx of ischemic optic neuropathy? (4)

-rapid vision loss
-Cephalalgia/scalp TTP
-jaw claudication
-Arthralgias

18

What is the prognosis for ischemic neuropathy?

There is no effective treatment for the arteritic variety, and most lost vision is not recovered

19

What is giant cell arteritis?

vasculitis of large arteries, usually involving the aorta or its branches (e.g. ophthalmic artery). May result in blindness if the ophthalmic artery is occluded

20

What are the s/sx of giant cell arteritis? (3)

-HA
-TTP over the temporal artery
-Polymyalgia rheumatica

21

What is polymyalgia rheumatica?

Diffuse muscle pain that usually appears in the morning, and is caused by idiopathic diffuse inflammation, and WBCs affecting the joints.

22

What are the labs that are sensitive for giant cell arteritis (but not specific)?

CRP and ESR

23

What is the treatment for giant cell arteritis?

ASA and high dose corticosteroids

24

What age group usually gets giant cell arteritis?

Around age 70

25

What is the only way to definitively diagnose giant cell arteritis? What is the problem with this test?

Bx of the artery--if do not bx the correct part, may not diagnose it

26

What are the exam findings of anterior ischemic optic neuropathy?

-RAPD
-Pale, swollen optic nerve and altitudinal VF defect

27

What level of ESR is suggestive of anterior ischemic optic neuropathy?

More than 60 mm/hr

28

What is the common exam finding of a avulsion of the optic nerve?

RAPD

29

What is the usual defect with vascular occlusion of the CNS?

Homonymous hemianopia or quadrantanopia

30

Cherry red spot = ?

CRAO

31

In which ethnicity is glaucoma particularly prevalent in?

African Americans

32

What is the insidious symptom of glaucoma?

Slow, progressive loss of peripheral vision

33

What is the normal range of pressure in the eye?

10-21 mmHg

34

What causes the increased pressure with glaucoma?

Continuous production and drainage of aqueous fluid

35

What are the primary and secondary causes of open angle glaucoma?

Primary = unclear
Secondary =Blocked trabecular meshwork from WBCs, RBCs, or retinal elements

36

What causes primary closed angle glaucoma?

Enlargement or forward movement of lens against the central iris leading to obstruction or normal aqueous flow through pupil

37

What causes secondary closed angle glaucoma?

hypoxia from retinal disease induces vasoproliferation in iris that contracts angle

38

What are the s/sx of acute angle glaucoma?

Red, painful eye with decreased vision and markedly increased intraocular pressure

39

What causes the cupping of the optic disc with glaucoma?

Increased ocular pressure is exerted through the vitreous humor back onto the optic disc

40

A cup to disc ratio greater than what is concerning?

0.5

41

What fraction of all glaucoma cases are primary open angle glaucoma?

2/3

42

True or false: primary open angle glaucoma tends to be familial

True

43

Is primary open angle glaucoma usually bilateral or unilateral? Symmetric or asymmetric?

Bilateral, but can be asymmetric

44

What are the risk factors for primary open angle glaucoma?

-greater than 50 yo
-FH
-AA
-Myopic

45

What is the most common and effective drug for glaucoma?

Prostaglandin analogs

46

What is the major cholinergic compound that is used to treat glaucoma?

Pilocarpine

47

What are the adrenergic compounds that are used to treat glaucoma?

Propine
Iodine
Alphagan

48

Which is common: angle closure or open angle glaucoma?

Open angle

49

Which has an acute nd which has a chronic onset: angle closure or open angle glaucoma?

Acute = angle closure
Open angle = chronic

50

Which has severe ocular pain: angle closure or open angle glaucoma?

Pain = acute angle closure

51

What are the pupil characteristics of angle closure and open angle glaucoma?

Closed = Mid-dilated fixed pupil
Open = normal

52

What happens to vision with angle closure and open angle glaucoma?

Acute= blurred vision, halos around lights

Chronic = insidious loss of vision, without halos

53

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

Open = HA, n/v
Closed = none

54

What can cause acute angle closure glaucoma? (3)

Dilating drops
Stress
Sympathomimetic drugs

55

What type of glaucoma is a contraindication to sympathomimetics or other drugs that dilate the eyes?

Closed angle

56

What are the 4 drugs that should be started immediately for acute, closed angle glaucoma?

Pilocarpine
acetazolamide
Oral glycerine
Mannitol

57

What is the MOA of pilocarpine?

Cholinergic drug that causes ciliary muscle contraction and mydriasis

58

What is an iridotomy?

Hole punch through the iris to allow flow through the iris and into the trabecular meshwork

59

True or false: miotics are a substitute for an iridotomy

False

60

Child with a clouded eye = ?

Glaucoma until proven otherwise

61

Increase IOP greater than what is an indication for referral to an ophthalmologist?

21 mmHg

62

If there is a greater than (__) difference in pressure between eyes, you should refer them to an ophthalmologist.

5 mmHg

63

If there is a cup:disc ratio of what value is an indication to refer to an ophthalmologist?

0.5

64

If there is a difference in cup:disc ratio between eyes is an indication to refer to an ophthalmologist?

0.2

65

True or false: cataracts are a normal part of the aging process

True

66

What is the most successful operation in all of surgery

Cataract correction

67

What is the second sight that patients with cataracts can get?

Increased myopia causes an increased ability to read close up

68

What are the first few s/sx of cataracts? (3)

slight blur
Decreased colors
Diplopia

69

True or false: there is NEVER a RAPD with cataracts

True

70

What is the first step in assessing cataracts?

Visual acuity test

71

What type of device should be used to assess the eye with cataracts?

Slit-lamp

72

What causes the halos around lights with cataracts?

Scattering of lights from the cataract

73

When should you refer a patient for cataracts?

If interferes with ADLs or causes falls/MVAs

74

What are the early complications that can arise from cataract surgery?

Hemorrhage
Infection

75

What are the late complications that can arise from cataract surgery?

Corneal/retinal problems
retinal detachment

76

true or false: you have to control DM or other relevant comorbidities prior to treating cataracts

True

77

What is the leading cause of blindness in patients over 50?

Macular degeneration

78

What is the possible treatment for macular degeneration?

laser surgery

79

True or false: often, there is not effective treatment for macular degeneration

True

80

What is the natural h/o macular degeneration?

Progressive deterioration of vision

81

What is the hallmark finding of macular degeneration?

Drusen--hyaline nodules in Bruch's membrane

82

Which type of macular degeneration is there an effective treatment for: wet or dry

Wet

83

What is metamorphopsia?

a type of distorted vision in which a grid of straight lines appears wavy and parts of the grid may appear blank

84

What are the s/sx of macular degeneration?

-Sudden loss of vision
-metamorphopsia
-Central blind spot if advanced

85

True or false: the amount of drusen correlates well with the vision changes

False

86

What is the geographic form of macular degeneration?

Progressive loss of pigmentation of the retina

87

What causes the metamorphopsia with macular degeneration?

Usually caused by neovascularization beneath the retina, which lifts it up and distorts vision

88

True or false: the peripheral vision is usually greatly affected with macular degeneration?

False--Usually remains good

89

What are the risk factors for macular degeneration? (5)

-Age
-Smoking
-hyperopia
-Blue eyes
-FH