Ophtho 4 Flashcards
(50 cards)
What is optic neuritis?
an inflammatory demyelinating condition that results in acute vision loss in one eye
What disease is optic neuritis strongly a/w? Occurs most commonly in?
MS
-may also occur w/ viral infections (measles, mumps, influenza)
Women ages 20-40
You are concerned your patient has optic neuritis based on their story. What are some of their presenting complaints?
- acute onset (hrs to days)
- monocular vision loss
- eye pain, worse with EOM’s
- visual field defect, usually central scotoma
In optic neuritis, what is the same of the most common visual field defect?
Central scotoma
What would you see on PE of a pt with optic neuritis?
- loss of color vision
- visual acuity decreased (variable)
- relative afferent pupillary defect (APD)
- optic nerve changes may be seen
2/3 of optic neuritis are ____, showing ______ in the fundus.
In 1/3, the optic nerve is ____ w/ ______ and occasionally has ____.
retro-bulbar
no changes
swollen w/ pallor
flame-shaped peri-papillary hemorrhages
How do you confirm diagnosis of optic neuritis?
MRI of brain and orbits
Tx of optic neuritis?
refer urgently to optho/neuro
IV methylprednisolone for 3 days, then oral taper to accelerate vision recovery
Visual acuity usually returns after tx of optic neuritis, how long?
If it doesn’t return, what do you need to rule-out?
2-3 weeks
compressive lesion or tumor
What is papilledema? Usually a/w what?
swelling of the optic nerve head
usually a/w elevated intracranial pressure
What would you see on PE of a pt with papilledema?
optic disc, margins, cup, venules
- optic disk is swollen, w/ blurred margins, cup may be obscured due to swelling
- venules are dilated and tortuous
- there may be flame hemorrhages and infarctions (white, indistinct “cotton wool spots) in the nerve finger layer, and edema in the surrounding retina
Pt’s with papilledema often 1st complain of other signs/symptoms of ______ before papilledema.
Like what?
increased intracranial pressure
HA
Transient vision changes
Ddx for papilledema
- intracranial mass/lesion (tumor)
- cerebral edema (encephalopathy, TBI)
- disorders of the CSF
- obstructive hydrocephalus
- idiopathic intracranial hypertension (aka pseudotumor cerebri)
What do you do if papilledema is found?
Urgent ophthalmology referral and complete workup
What is the leading cause of adult blindness in industrialized countries?
Age-related macular degeneration
What is age-related macular degeneration?
a degenerative dz of the macula (central retina) that results primarily in loss of central vision
What are risk factors for age-related macular degeneration?
- Age (over 50 increased incidence)
- female
- smoking hx
Symptoms of a pt with age-related macular degeneration?
What would you see on PE?
- gradual or acute painless vision loss
- metamorphopsia (wavy/distorted vision)
- central scotoma
PE:
+/- decreased vision
Amsler grid distortion
Characteristics of dry AMD
- retinal drusen (lipids) appear as discrete yellow deposits
- retinal pigment epithelium atrophies decreasing central vision
- Dry AMD has better prognosis than wet
Characteristics of wet AMD
- growth of abnormal vessel into the sub retinal space
- new vessels leak
Is wet or dry AMD more likely to cause blindness?
Wet AMD accounts for 80-90% of causes of blindness due to AMD
Tx of AMD
- ophthalmology referral
- vitamins (antioxidants/zinc)
- smoking cessation
- daily Amsler grid
- photocoagulation, photodynamic therapy, intravitreal steroid/anti-angigenic injections
- low vision aids
Most common cause of retinal detachment?
a tear in the retina- vitreous fluid can then work its way under the retina, causing detachment
Most common site of retinal detachment?
superior temporal retinal area
