Neuro: Eye Disorders Flashcards Preview

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Flashcards in Neuro: Eye Disorders Deck (60):

  • Impaired vision that improves with glasses

Refractive Error

  • Hyperopia
  • Myopia
  • Astigmatism
  • Presbyopia


  • Eye too short for Refractive Power of Cornea and Lens --> Light focused Behind Retina



  • Eye too long for Refractive Power of Cornea and Lens --> Light focused in Front of Retina



  • Abnormal Curvature of Cornea resulting in Different Refractive Power at Different Axis



  • Decrease in Focusing Ability during Accomoodation due to Sclerosis and Decreased Elasticity



  • Inflammation of Anterior Uvea and Iris w/ Hypopyon (sterile pus)
  • Accompanied by Conjunctival Redness
  • A/w Systemic Inflammatory disorders (e.g. Sarcoid, Rheumatoid arthritis, Juvenile idiopathic arthritis, TB,
    HLA-B27-associated conditions)



  • Retinal Edema and Necrosis leading to Scar
  • Often viral; CMV, HSV, HZV
  • A/w Immunosuppression




  • Acute, Painless monocular vision loss
  • Retina cloudy w/ attenuated vessels and "Cherry-red" spot at the fovea

Central Retinal Artery Occlusion


  • Blockage of Central or Branch retinal vein due to compression from nearby arterial Atherosclerosis
  • Retinal hemorrhage and edema in affected area

Retinal Vein Occlusion


  • Retinal damage due to Chronic Hyperglycemia
  • Formation of Capillary microaneurysms
  • Hemorrhages, Arteriolar Hyalinization, Cotton-wool spots, Neovascularization, and Fibroplasia
  • (2) Types:
    • Non-proliferative - damaged capillaries leak blood --> Lipids and Fluid seep into Retina --> Hemorrhages and Macular edema
    • Tx: Blood sugar control, Macular laser
    • Proliferative - Chronic hypoxia results in New blood vessel formation w/ resultant traction on Retina
    • Tx: Peripheral retinal photocoagulation, anti-VEGF injections

Diabetic Retinopathy


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CMV Retinitis


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Central Retinal Artery Occlusion


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Non-proliferative Diabetic Retinopathy


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Proliferative Diabetic Retinopathy


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Retinal Vein Occlusion


  • Optic disc atrophy w/ characteristic Cupping
  • Deepening of the Optic Cup --> decreasing Vision
  • Increased frequency of Headaches
  • Usually w/ Increased Intraocular Pressure (IOP) and Progressive Peripheral Visual field loss
  • (2) Classifications of Glaucoma
    1. Open Angle
      • Primary and Secondary
    2. Acute (Closed) Angle
      • ​Primary and Secondary



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  • A/w increase in Age, African-American race, Family History, Painless, more common in U.S.
  • Primary - Cause unclear, a/w GLC1A gene on Chromosome 1
  • Secondary - Blocked trabecular meshwork from WBCs (e.g., uvetis), RBCs (e.g. vitreous hemorrhage), Retinal elements (e.g. Retinal detachment)

Open Angle Glaucoma


  • Primary - enlargement or forward movement of lens against Central Iris (pupil margin) leads to obstruction of normal aqueous flow through Pupil --> Fluid builds up behind Iris --> Pushing peripheral Iris against Cornea and impeding flow through Trabecular meshwork
  • Secondary - Hyposcia from Retinal disease (e.g. Diabetes, Vein occlusion) induces Vasoproliferation in Iris that contracts angle
  • Chronic closure - Often asymptomatic w/ dmg to Optic nerve and Peripheral vision
  • Acute closure - True Ophthalmic emergency.  Increase IOP pushes Iris forward --> Angle closes abruptly --> Very painful, sudden vision loss, Halos around lights, Rock-hard eye, Frontal headache.  DO NOT GIVE Epinephrine because of its Mydriatic effect

Acute (Closed) Angle Glaucoma


  • Painless, often bilateral, opacification of Lens
  • Decrease in vision
  • A/w Systemic therapy w/ Glucocorticoids
  • A/w Age, Smoking, EtOH, Excessive Sunlight, Prolonged corticosteroid use, Classic galactosemia, Galactokinase deficiency, Diabetes (sorbitol), Trauma, Infection



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  • Optic disc swelling (usually bilateral) due to Increased Intracranial pressure (e.g. 2nd to mass effect)
  • Enlarged blind spot and elevated Optic disc w/ blurred margins seen on Fundoscopic exam
  • A/ increased Intra-cranial pressure is NOT Typically a/w Visual loss



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  • Degeneration of Macula (Cental area of Retina)
  • Causes Distortion (metamorphopsia) and eventual loss of Central Vision (Scotomas)
  • Dry (nonexudative, > 80%) - deposition of Yellowish extracellular material in and beneath Bruch membrane and Retinal pigment epithelium ("Drusen") w/ gradual Decrease in vision. Prevent progression w/ multivitamin and antioxidant supplements
  • Wet (exudative, 10 - 13%) - rapid loss of vision due to bleeding, 2nd to Choroidal neovascularization --> local production of VEGF
  • Tx: anti-vascular endothelial growth factor injections (anti-VEGF) or laser.

Age-related Macular Degeneration



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Dry Age-related Macular Degeneration


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Wet Age-related Macular Degeneration


  • Increase in orbit contents that push the eye forward
  • Results in chronic corneal exposure to the air --> Corneal Ulceration and Infection
  • Inferiorly medially: Lacrimal gland inflammation, lymphoma, Pleomorphic adenoma, Adenoid cystic carcinoma
  • Axial: Glioma, Meningioma



  • Proptosis caused by Exracellular matrix (ECM) accumulation and Rectus Muscle fibrosis
  • Severity is independent of Thyroid status

Thyroid Ophthalmopathy

(Graves Disease)


  • Most common eyelid malignancy
    • Predilection for Lower eyelids and Medial Canthus

Basal Cell Carcinoma


  • Second most common Eyelid malignancy
  • Metastisizes first to Parotid and Submandibular lymph nodes
  • May form a local mass that mimics Chalazion or may diffusely Thicken the Eyelid
  • May resemble inflammatory Blephitis or Ocular Cicatricial Pemphigoid due to intraepithelial spread
  • Exhibits Intraepithelial pagetoid spread into the Nasopharynx and Lacrimal glands
  • 22% Mortality rate

Sebaceous Carcinoma


  • Third most common Lesion
  • Melanomas are rare
  • Tend to follow an indolent course
  • A/w HPV type 16 and 18

Squamous Cell Carcinoma


  • Sebaceous drainage blocked by inflammation



  • Neoplasm, extravasated lipid provokes a Lipogranulomatous response



  • Nonkeratinizing stratified squamous epithelium
  • Responds to inflammation by forming minute Papillary folds

Palpebral Conjunctiva


  • Pseudostratified columnar epithelium rich in Goblet cells
  • A/w Lacrimal and Lympoid tissues and can be expanded in Viral conjunjuntivitis or Lympoid malignancy

Fornix Conjunctiva


  • Nonkeratinizing stratified squamous epithelium that covers the surface of the eye

Bulbar Conjunctiva


  • Common and typically benign
  • Rarely involve the Cornea, Fornix, or Palpebral conjunctiva (pigmented lesions)
  • Chornic inflammation can occur during adolescence (inflamed juvenile nevus) and involve Lymphocytes, Plasma cells, and Eosinophils
  • Contain subepithelial cysts lined w/ surface epithelia

Conjunctival Nevi


  • Unilateral
  • Middle-aged, Fair-complexioned patients
  • Have a Intraepithelial phase --> Primary acquired Melanosis w/ atypica --> spread through the lymphatics to Regional lymph nodes
  • Parotid and Submandibular lymph nodes are favored for Initial Metastatic sites
  • 25% Mortality rate

Conjunctival Melanomas


  • Calcific band keratopathy, a common complication of chronic uveitis
  • Calcium deposition in Bowman's layer
  • Actinic band keratopathy involves ultraviolet-induced corneal collagen degeneration

Band Keratopathies


  • Corneal thinning and Ectasia cause the Cornea to become Conical (rather than spherical)
  • Distored vision
  • Bowman's layer fractures are Hallmarks
  • Mtalloproteinase activation may be causal but Inflammation is absent



  • Primary loss of Corneal endothelial cells --> Stromal edema and Bullous Keratopathy (epithelial detachment from Bowman's layer, forming bullae)
  • Blurring and loss of Vision

Fuchs Endothelial Dystrophy


  • Deposits of various stromal proteins (resulting from mutations that affect folding) and form discrete opacities in the Cornea
  • Compromising vision
  • Deposits adjacent to Epithelium or Bowman's layer can also cause Painful Erosions and Scarring

Stromal Dystrophies


  • Most common form of Glaucoma
  • Intraocular pressures are elevated despite an Open angle and Normal-appearing structures
  • Some functional increases in Resistance to Aqueous Humor outflow
  • Familial MYOC mutations encoding for the protein Myocilin
  • Physical clogging of the Trabecular meshwork, Particulate matter (senescent erythrocytes after trauma, or iris pigment epithelial granules, etc.)

Open-angle Glaucoma


  • The Peripheral zone of the Iris (a/ tissue) adheres to the Trabecular Meshwork and Physically impedes the Aqueous Outflow from the eye
  • May occur as a Primary angle-closure Glaucoma in eyes w/ shallow anterior chambers (pts. are often Hyperopic) or can occur subsequent to Neovascular membrane formation (after trauma) or Ciliary Body tumors

Angle-closure Glaucoma


  • Non-infectious Uveitis limited to the Eye
  • A/w Penetrating eye injury, developing w/in 2 weeks (to many years) after the insult
  • Retinal antigens establish a delayed Hypersensitivity response that affects not only the injured eye but also the  Contralateral, Uninjured eye
  • Bilateral granulomatous inflammation affecting ALL Uveal Components

Sympathetic Ophthalmia


  • A/w Full-thickness retinal defect developing when Structural collapse of the Vitreous exerts traction on the Retinal Internal limiting membrane
  • Liquefied viteous humor then seeps through the tear and separates the neurosensory Retina and RPE

Rhegmatogenous Retinal Detachment


  • Exudates accumulate or Fluid leaks from the Choroidal circulation beneath the retina (e.g. w/ Choroidal tumors or malignant HTN)

Non-rhegmatogenous Retinal Detachment

(w/out a Retinal break)


  • HTN --> Retinal arteriosclerosis w/ Wall thickening
  • Malignant HTN --> damaged Choroidal vessles can cause Choroidal Infarcts (?) or Exudate accumulation between the Neurosensory retina and RPE --> detachment

Elschnig Pearls


  • Immature Retinal vessels respond to increased Oxygen tension (administered to premature infants) by constricting --> resulting in local Ischemia

Retinopathy of Prematurity

(Retrolental Fibroplasia)


  • Collection of fairly common inherited disorders that affect various aspects of Vision
  • Including Visual cascade and cycle, Structural genes, Transcription factors, Catabolic pathways, and Mitochondrial metabolism
  • Night blindness caused by loss of rod photoreceptors is an early symptom --> Eventual loss of Cones too
  • Branching reticulated pattern to the Retina
  • Optic disc may appear pale and waxy pallor
  • Attenuation of Retinal blood vessels
  • Both Rods and Cones are lost to Apoptosis and there is a/ Retinal Atrophy w/ Perivascular Retinal Pigment Accumulationkl;

Retinitis Pigmentosa


  • Blood supply to the Optic nerve can be interrupted by Vascular inflammation (e.g. Temporal arteritis) or by Embolism or Thrombosis

Anterior Ischemic Optic Neuropathy


Tay-Sachs Disease

"Cherry-red Spot"


  • Pupillary Light-near Dissociation
  • No Direct or Consensual Light reflex
  • Accommodation - Convergence Intact
  • A/w Neurosyphilis, Diabetes

Argyll Robertson Pupil


  • Lesion of Afferent Limb of Pupillary light reflex
  • Diagnosis made w/ swinging flashlight
  • Shine light in affected pupil --> pupils do not constrict fully
  • Shine light in normal eye --> pupils constrict fully
  • Shine light immediately again in affected eye --> apparent dilation of both eyes because of stimulus carried through that CN II is weaker
  • A/w Multiple Sclerosis

Marcus Gunn Pupil

(Relative afferent)


  • Caused by a lesion of the Oculosympathetic Pathway
  • Syndrome consists of Miosis, Pthosis, Apparent Enophthalmos, and Hemianhidrosis

Horner Syndrome


  • Dilated pupil that reacts sluggishly to light, but better to Accommodation
  • Seen in Women and a/w Loss of Knee Jerks
  • Ciliary ganglion lesion

Adie Pupil


  • Increased Intraocular pressure --> Leads to Uncal herniation --> CN III Compression --> Fixed and Dilated Pupil
  • "Down-and-Out" eye, ptosis

Uncal Herniation

Transtentorial Herniation


  • Most common cause of Corneal ulcers
  • Intranuclear inclusions
  • Perforate through the globe --> medical emergency
  • Chornic herpetic corneal infections --> Localized Opacity
  • Lymphocytes, Plasma cells, Viral inclusions in Corneal Epithelial cells are present

Herpes Simplex Virus


  • Most common malignant ocular neoplasm in children
  • Clusters of Cuboidal or Short Columnar cells around a Central lumen "Flexner-Winter-Steiner Rosettes"
  • Can spread to the Orbit or along the Optic Nerve