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Clinical Medicine II > Ophthalmology > Flashcards

Ophthalmology Flashcards

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1
Q

T or F

The Physiological cup in the eye sits inside of the Optic Disk ?

A
  • True
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2
Q

Hypertensive Retinopathy is caused by ?

A
  • Hypertension
  • Due to
    1) Vascular changes
    2) Damage to retina
    3) Choroid
    4) Optic nerve
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3
Q

Hypertensive Retinopathy depends on the degree/type of damage, what are the two types?

A

1) Acute hypertension: can cause Vasospasm

2) Chronic hypertension: leads to Arteriosclerosis

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4
Q

Hypertensive Retinopathy risk factors include?

A
  • Lipid levels
  • Smoking
  • Weight
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5
Q

What are the three visual signs of Hypertensive Retinopathy ?

A
  • AV Nicking
  • Copper Wiring
  • Silver Wiring
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6
Q

Mild retinopathy includes (1 or more) ?

A
  • Gen Arteriolar narrowing
  • Focal arteriolar narrowing
  • Arteriovenous nicking
  • Arteriolar wall opacity (silver wiring)
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7
Q

Moderate retinopathy includes (1 or more) ?

A
  • Microaneurysm
  • Cotton wool spot
  • Hard exudates
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8
Q

Malignant retinopathy includes?

A
  • Moderate retinopathy

plus

  • Optic disc swelling
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9
Q

Retinal Venous Occlusive Disease symptoms?

A
  • Acute
  • Painless loss of vision in one eye
  • Only part of vision decreased (Superior/inferior)
  • Branch retinal vein occlusion (BRVO)

or

  • Central retinal vein occlusion (CRVO)
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10
Q

Retinal Venous Occlusive Disease Fundus exam reveals?

A
  • Dilated, tortuous vein with retinal hemorrhages

- Cotton wool spots and retinal edema

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11
Q

Treatment of Retinal Venous Occlusive Disease ?

A
  • ASAP referral
  • Anti-VEGF injections (Bevacizumab)

1) Decreases macular edema
2) Improves long term prognosis

  • Younger patients without above risk factors: workup for hypercoagulable state = Systemic disease
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12
Q

Retinal Artery Occlusions ?

A
  • Branch retinal artery occlusion or Central artery occlusions (Cherry Spot)
  • Caused from an Emboli
  • Cholesterol
  • Calcific
  • Atherosclerotic plaque
  • Hollenhorst plaque
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13
Q

Retinal Artery Occlusions symptoms include?

A
  • Sudden painless vision loss in area affected

- Edematous opacification of the inner retina in distribution of affected vessel

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14
Q

Central artery occlusion will show ?

A

– Appearance of cherry red spot

  • Will show dull red color due to ischemia
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15
Q

If Retinal Artery Occlusions pt presents to ophtho within 4 hrs of vision loss what can you attempt?

A
  • Attempt measures to try to dislodge emboli

- Typically vision loss is permanent due to irreversible ischemia

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16
Q

Diabetic Retinopathy is the leading cause of vision loss for what ages?

A
  • 20 thru 74
  • Risk factors
    DM onset and Age
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17
Q

Pathogenesis of diabetic retinopathy ?

A
  • Hyperglycemia over time leads to
  • Microvascular endothelial cell damage
  • Capillary occlusion/retinal ischemia
  • Dysfunction of endothelial barrier
  • Leakage of serum and retinal edema
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18
Q

What causes the vision loss in Diabetic Retinopathy?

A
  • Macular edema (capillary leakage)
  • Macular ischemia (capillary occlusion)
  • Sequlae from ischemia-induced neovascularization
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19
Q

Two forms of Diabetic Retinopathy?

A

1) Non Proliferative

2) Proliferative

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20
Q

Non Proliferative diabetic retinopathy includes what signs during a visual exam?

A
  • Retinal microvascular changes
  • Microaneurysms
  • Cotton wool spots
  • Intraretinal hemorrhages
  • Hard exudate
  • Retinal edema
  • Arteriolar and venous abnormalities
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21
Q

Proliferative Diabetic Retinopathy has ?

A
  • Extraretinal neovascularization
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22
Q

Proliferative Diabetic Retinopathy Extraretinal neovascularization includes ?

A
  • Retinal ischemia
  • Neovascularization
    Vascular Endothelial Growth Factor (VEGF)
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23
Q

Complications of proliferative diabetic retinal neovascularization includes ?

A

1) Vitreous hemorrhage

2) Retinal detachment

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24
Q

Treatment of Diabetic proliferative retiopathy includes?

A
  • Panretinal photocoagulation to peripheral ischemic retina
  • Anti-VEGF intravitreal injections
  • Surgery
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25
What is the major cause of vision loss in both Proliferative and Non proliferative Diabetic Retinopathy vision loss?
- Vascular permeability (Macular Edema) - Cystic pockets of fluid build up in the central part of the Retina - Retinal detachment
26
Treatment for macular edema in both Proliferative and Non proliferative Diabetic Retinopathy ?
- Anti-VEGF intravitreal injections | - Laser therapy on leaking microaneurysms
27
Goal in treatment of diabetic retinopathy?
- Delay & Prevention of complications
28
T or F Pregnancy associated with worsening or Diabetic Retinopathy ?
- True | - Speeds up progression
29
Schedule for diabetic pts to have eye exams?
- DM I Within 5 years of Dx Annual check ups after - DM II Upon Dx Annual check ups after - Pregnancy Before conception / or Early 1st trimester Check ups 1 to 3 months during
30
Age-Related Macular Degeneration (ARMD) is the leading cause of what blindness? What age group?
- Severe central visual acuity loss | - > 50 y/o
31
What are the two categories of Age-Related Macular Degeneration (ARMD)?
1) Dry ARMD or 2) Wet ARMD
32
Risk factors for ARMD ?
1) Age & Cigarette MC 2) Caucasian 4) Family history 5) Female 6) Hyperopia 7) Light colored eyes
33
Dry Age-Related Macular Degeneration (ARMD) causes ?
- Slow | - Progressive central vision loss
34
Dry Age-Related Macular Degeneration (ARMD) findings?
- Drusen - large density of macular drusen increase risk of ARMD - Retinal atrophy - Retinal hyperpigmentation
35
T or F Small hard amount of Drusen may be associated with normal aging
- True
36
Treatment of Dry Age-Related Macular Degeneration (ARMD)?
- AREDS2 eye vitamins Vitamin E, C & Zinc - Decrease progression to late stage ARMD
37
Wet Age-Related Macular Degeneration (ARMD)
- Choridal neovascularization - Subretinal fluid or hemorrhage - Eventual fibrosis/scarring
38
Wet Age-Related Macular Degeneration (ARMD) causes ?
- Quick decrease in central acuity plus - Metamorphopsia Distorted vision in which a grid of straight lines appears wavy and/or - Central scotoma Grey, black or blind spot in the middle of one's vision
39
Wet Age-Related Macular Degeneration (ARMD) treatment includes?
- Anti-VEGF therapy can be effective if initiated BEFORE fibrotic changes
40
Age Related Macular Degeneration (AMD)
- Breakdown of light-sensitive cells of the macula - Progressive loss of central vision - Spares peripheral vision
41
Retinal Detachments classified as ?
1) Rhegmatogenous (most common) 2) Tractional (associated with neovascularization) 3) Exudative (associated with neoplasia or inflammation)
42
Rhegmatogenous Retinal Detachment causes?
- Full thickness retinal break - Secondary to posterior vitreous detachment (PVD) - Vitreoretinal traction can lead to retinal tears Horseshoe tears
43
Rhegmatogenous Retinal Detachment (MOST COMMON) symptoms?
- Sudden floater - Flashes - “curtain” across vision
44
Rhegmatogenous Retinal Detachment prognosis ?
- Depends if Macula was detached - Emergency - Catastrophic vision loss
45
Age related Cataract ?
- Pogressive clouding/opacification of crystalline lens - Due to proteins and lipids - Leading to decrease in vision
46
Age related Cataract symptoms ?
- Decrease in visual acuity - Decrease in contrast sensitivity - Glare (may have trouble driving at night) - Change in glasses prescription (myopic shift)
47
Age related Cataract can be caused by excessive steroid use ? T of F
- True
48
Age related Cataract treatment ?
- If interfering with ADLs = Surgery | - Phacoemulsification
49
Congenital Cataract
- @ birth or develop within first year - 33% associated with systemic syndrome - 33% inherited - 33% undetermined
50
Congenital Cataract may be unilateral or bilateral, but almost always bilateral in ?
- Systemic disease or - Familial
51
Congenital Cataract must be corrected within the first 3 months after birth? T or F
- True
52
Congenital Cataract workup includes?
Bilateral - If YES FH = No workup ``` - If NO FH = Systemic workup for TORCH infections - Toxoplasmosis - Other (syphilis, varicella-zoster, parvovirus B19) - Rubella - Cytomegalovirus (CMV) - Herpes infections ``` Unilateral - Typically not warranted
53
Congenital Cataract timing of surgery important because if Cataracts present prior to development of the fixation reflex (at 2-3 months) it increases the chances of more impact on child’s visual development ? T or F
- True - Bilateral cataracts sensory deprivation nystagmus develops at age 2-3 months, at which point visual potential decreases markedly
54
Congenital Cataract surgery timing?
- Between months 1-3 | - With 1 week interval if bilateral
55
Glaucoma
- Group of diseases with a characteristic optic neuropathy - IOP a risk factor BUT not a requirement - Progressing "Cupping" of the optic nerve, cup gets larger - Peripheral vision loss
56
Two types of glaucoma include?
- Open angle - Closed (Narrow) angle Acute or Chronic
57
Eye Aqueous is produced in the ciliary body and then drains where?
- Trabecular meshwork
58
What is the second leading causes of blindness?
- Glaucoma
59
Open angle glaucoma risk factors include?
- Most common - Age - Vision loss is irreversible - First periphery and progresses - Most patients do not appreciate vision loss until central vision is affected - Family history - Myopia (nearsightedness) - Race (African Caribbean)
60
Acute closed angle glaucoma risk factors include?
- Age - Female - Hyperopia (farsightedness) - Certain medications - Race (Asian)
61
Open angle glaucoma is associated with decreased ?
- Efficiency of the trabecular meshwork | - Clogged drain
62
Closed angle glaucoma is associated with decreased ?
- Access to the trabecular meshwork - Closed drain - Chronic form
63
Acute angle closure glaucoma ?
- Sudden extreme elevation of IOP - Acute blockage of trabecular meshwork by iris (anatomically predisposed eye) - Precipitated by dilation/low light conditions
64
Acute angle closure glaucoma symptoms include?
- Emergency !!! - Intense pain - Headache - Nausea/vomiting - Decreased vision - Halos - Emergent IOP lowering required to prevent permanent vision loss.
65
Acute angle closure glaucoma PE findings?
- Red Eye - Dilated Pupil - Cloudy cornea
66
Clinical Presentation of Acute Angle Closure Glaucoma includes?
- Rapidity and Degree of IOP determine the onset and severity of symptoms - Eye pain - Decreased vision - Nausea / vomiting - Halo around lights - Headache
67
Symptoms that suggest a rapid rise in IOP causing acute angle closure ?
- Conjunctiva redness - Corneal edema or Corneal cloudiness - Mild dilated pupil that reacts poorly to light
68
Why is the pupillary sidebar test important?
- Differentiates whether a patient is complaining of 1) Decreased vision from an ocular problem (Cataract) or 2) Defect of the optic nerve
69
The ‘swinging light test’ is used to detect ?
- Relative Afferent Pupil Defect (RAPD) - A means of detecting differences between the two eyes in how they respond to a light shone in one eye at a time. - The test can be very useful for detecting unilateral or asymmetrical disease of the retina or optic nerve
70
How do you evaluate for glaucoma ?
- Visual Acuity - Evaluation of the pupils - Measure IOP - Slit lamp examination of the anterior segments - Visual field testing
71
How do you evaluate for Specifically Angle-closure Glaucoma if you don't have a tonometer ?
- Test anterior chamber depth - By shining a light from the side of the eye - Darkness on the nasal side = decreased anterior chamber
72
Management for acute angle closure glaucoma < 1 hour from symptoms?
- Ophthalmologist referral if availability is within 1 hour
73
Management for acute angle closure glaucoma > 1 hour from symptoms?
- Emperic treatment if availability is greater than 1 hour - Laser or Surgical iridotomy (GOLD STANDARD) - IV acetazolamide (carbonic anhydrase inhibitor) - Topical B blocker - Mannitol for diuresis Ultimately
74
What is the only modifiable risk factor in glaucoma?
- Managing IOP - lowered via 1) Laser 2) Surgery 3) Medications
75
Papilledema
- (bilateral) optic disc swelling | - Results from increased intracranial pressure (ICP)
76
Papilledema causes?
- Tumors / Lesions in CNS - Idiopathic intracranial hypertension (aka pseudotumor cerebri) - Decreased CSF resorption (Venous sinus thrombosis, inflammatory processes, meningitis, subarachnoid hemorrhage) - Increased CSF production (tumors) - Cerebral edema/encephalitis - Medications 1) Tetracycline 2) Minocycline 3) Lithium 4) Accutane 5) Nalidixic acid 6) Corticosteroids (both use and withdrawal)
77
Papilledema symptoms include?
- Transient visual obscurations: “Grayouts” of vision (Orthostatic changes) - Pulsatile tinnitus - Diplopia from 6th nerve palsy - Decreased vision - Headache - Nausea, vomiting
78
Papilledema treatment includes?
- Treat underlining cause - Neuro and Ophtho consults - MRI/MRV brain/orbits - Visual acuity - Visual fields - Color vision - Possible LP with opening pressure
79
Amblyopia
- Diminished vision occurring during the years of cortical visual development (8 - 10y/o) - Secondary to abnormal visual stimulation - Unilateral MC
80
Amblyopia classifications?
1) Refractive 2) Deprivation 3) Strabismus
81
Amblyopia Dx can be difficult in children? T or F
- True | - Children do not complain about baseline vision
82
Amblyopia screening ?
- PreK visual acuity screening - Red reflex - Cover testing
83
Amblyopia management ?
- Prompt referral and treatment are critical - If not identified prior to completion of cortical visual development (8 to 10) - Vision will not improve with any treatment
84
Amblyopia treatment ?
1) Address underlying cause of amblyopia 2) Force fixation with amblyopic eye via - Patching or - Pharmacologic therapy
85
Strabismus
- Ocular misalignment - Due to eye muscle issues - Children or Adults
86
Strabismus causes?
- Trauma - Inflammation - Infection - Thyroid/Graves eye disease Autoimmune / Inflammation Hypertrophy - Myasthenia Gravis (Eye muscle neuromuscular junction) ``` - Dysfunction of cranial nerve 3, 4, or 6 Ischemic Compressive (tumor/aneurysm) Inflammatory Demyelinating (MS) ```
87
Strabismus Dx test ?
- Abnormal corneal light reflex | - Cover and Uncover test
88
Horizontal Strabismus include?
1) Esotropia (ET) “crossed inward eyes” 2) Exotropia (XT) “wandering/drifting outward eye”
89
Vertical strabismus include?
1) Left hypertropia (LHT) Describe the hypertropic eye 2) Right hypotropia
90
Child Strabismus treatment?
- Before the ages of 8 - 10 - Eye exercises with patch therapy or surgery - Patch good eye
91
Adult Strabismus
- Emergency - > 50 - F > M - 3rd nerve palsy - Giant cell arteritis (temporal arteritis)
92
Adult Strabismus presentation ?
- Limitation of Supraduction Infraduction and Adduction As well as 1) Ptosis and Pupillary dysfunction & 2) Dilated pupil (10% of pts)
93
Adult Strabismus can be partial or complete ?
- True
94
Complete adult strabismus presents?
- Upper Eye lid down | - Eye down and out
95
Causes of Adult strabismus ?
- Aneurysm MC - Microvascular disease - Infarct - Tumor - Inflammation - Infection - Infiltration - Trauma
96
T or F Adult strabismus - 3rd nerve palsy can be the first sign of expanding or rupturing aneurysm located at junction of posterior communicating artery and internal carotid artery?
- True | - Therefore, emergent consultation and imaging (MRA or CTA) are warranted
97
Giant cell arteritis (temporal arteritis) can be a cause of adult strabismus? T or F
- True - Transient or Constant binocular strabismus - Tender temporal artery = Bx
98
Adult Strabismus - Giant cell arteritis (temporal arteritis S&S?
- Emergency - Tender temporal artery - Malaise - Fever - Jaw claudication - HA - Anorexia - Wt loss - Joint/muscle pain
99
Adult Strabismus - Giant cell arteritis (temporal arteritis work up includes?
- ESR (elevated) - CRP (elevated) - CBC (thrombocytosis, normaochromic normocytic anemia) +/- temporal artery biopsy
100
Adult Strabismus - Giant cell arteritis (temporal arteritis treatment includes?
- High dose steroids | - Slow taper x 1-2 years
101
Adult Strabismus Dx includes?
- Abnormal corneal light reflex (Red Reflex) Test | - Cover and uncover test

Clinical Medicine II (9 decks)

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