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Clin Med Exam II > Opthalmic disorders > Flashcards

Opthalmic disorders Flashcards

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1
Q

Retinal detachment

A

separation of the sensory retina from the pigment epithelium and underlying choroid

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2
Q

What is the result of a retinal detachment

A

ischemia and rapid progressive photoreceptor degeneration

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3
Q

What is the retina

A

mutilayer or neurons that line the back of the eye

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4
Q

Risk factors of retinal detachment

A 
MYOPIA
PREVIOUS OCULAR SURG
-use of fluoroquinolones
-trauma to eye
-family history
-marfan disease
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5
Q

Causes of retinal detachment

A
  • retinal tears or holes
  • traction on the retina caused by systemic influence
  • tumors
  • exudative process
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6
Q

SX of retinal detachment

A
  • increasing number of floaters
  • flashes of light in visual field
  • shower of black spots in visual field
  • curtain spreading over visual field
  • cloudy or smoky vision
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7
Q

Differentials for retinal detachment

A
  • vitreous hemorrhage
  • vitreous inflammation
  • ocular lymphoma
  • intraocular foreign body
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8
Q

What does ophthalmoscopic exam reveal in retinal detachment

A

retinal hydration lines
“billowing sail”
“rippling on a pond”

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9
Q

Treatment of retinal detachment

A

CONSULT

  • drainage of subretinal fluid
  • laser photocoagulation
  • cryotherapy to sclera
  • pneumoretinopexy
  • scleral buckle placement
  • vitrectomy surgery
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10
Q

What is photocoagulation

A

in office procedure that uses small laser to burn the eye and create adhesions for retina to become reattached

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11
Q

What is cryotherapy or cryoretinopexy

A

in office procedure that freezed through the sclera, choroid and the retina to form adhesions to reattach the retina

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12
Q

What is pneumoretinoplexy

A

in office procedure for large retinal detachments that uses a gas bubble to push the retinal back into place

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13
Q

What is scleral buckle placement

A

done in the operating room , suture an explant into the sclera and closing retinal breaks allowing adhesions to form

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14
Q

When is vitrectomy surgery done

A

if fovea is detached or appears imminently detached

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15
Q

Optic neuritis

A

common inflammatory disease of the optic nerve

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16
Q

What does the fundus exam initally show with optic neuritis

A

NOTHING

“the doctor sees nothing and the patient sees nothing”

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17
Q

What is optic neuritis associated with

A

demyelinating diseases

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18
Q

Causes of optic neuritis

A

DEMYELINATION

  • sarcoidosis
  • neuromyelitis optica
  • herpes zoster
  • systemic lupus erythematosus
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19
Q

Symptoms of optic neuritis

A
  • unilateral vision loss that develops over a few days
  • field loss usually centrally
  • loss of color vision
  • pain behind the eyes that is exacerbated by movement
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20
Q

Differential diagnosis for optic neuritis

A
  • infections involving the optic nerve
  • retinal detachment
  • giant cell arteritis
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21
Q

Management of optic neuritis

Study These Flashcards
A
  • usual gradual recovery without treatment
  • consult neuro
  • possible systemic steriods
22
Q

What do you treat multiple demyelinating plaques with

Study These Flashcards
A

interferon beta-1a

23
Q

Papilledema

Study These Flashcards
A

physical exam finding during fundoscopic exam, loss of definition of the optic disc due to edema of the head of the optic nerve

24
Q

Causes of papilledema

Study These Flashcards
A

-increased intracranial pressure transmitted along the optic nerve (only true cause)

25
Causes of increased intracranial pressure
- intracranial mass lesions - cerebral edema - hydrocephalus - obstructed venous outflow - idiopathic intracranial hypertension
26
What are the three stages of papilledema
- early - fully developed - chronic
27
Early papilledema
- loss of spontaneous venous pulsations | - optic cup is retained
28
Fully developed papilledema
- optic disc elevated - optic cup is obliterated - disc margins are obscured - blood vessels burried - engorged veins - flame hemorrhages - cotton wool spots
29
Chronic papilledema
- cup remains obliterated - hemorrhagic and exudative components resolve - nerve appears flat with irregular margins - disc pallor
30
Diagnostic testing with papilledema
- MRI or CT - lumbar puncture to check opening pressure - visual field testing
31
What is normal opening pressure for an LP
70-180
32
Management of papilledema
* specific to underlying etiology | - reduce intracranial pressure
33
Ways to decrease intracranial pressure
- osmotic therapy and diuresis - hypertonic saline - glucocorticoids - hyperventilation - barbiturates - shunt to remove CSF - decompressive craniectomy
34
Clinical features of idiopathic intracranial hypertension
- nausea, vomiting, headaches, blurred vision - cranial nerve VI paresis/horizontal diplopia - bilateral papilledema - spontaneous venous pulsations are absent - visual field defects
35
Medication for treatment of idiopathic intracranial hypertension
acetazolamide
36
Differential diagnosis for papilledema
- hypertensive retinopathy - pseudopapilledema - diabetic papillopathy
37
What causes retinal artery occlusions
embolism or thrombus
38
What causes retinal vein occlusion
- HTN - diabetes - sickle cell anemia - conditions that slow venous blood flow
39
Retinal artery occlusion
acute, painless loss of monocular vision
40
Two types of retinal artery occlusion
- central retinal artery occlusion | - branch retinal artery occlusion
41
Most common etiology of retinal artery occlusion
carotid artery atherosclerosis
42
Symptoms of central retinal artery occlusion
- sudden profound vision loss in one eye - typically painless - occasionaly preceeded by transient monocular blindness
43
Symptoms of branch retinal artery occlusion
monocular vision loss which may be restricted to just part of the visual field
44
What do you find on funduscopic exam with retinal artery occlusion
- ischemic retinal whitening | - cherry red spot in the macula
45
Pupillary defect in retinal artery occlusion
marcus gunn pupil
46
Management of acute retinal artery occlusion
- check sed rate and C reactive protein to r/o giant cell arteritis - consult ophthalmology
47
Classifications of retinal vein occlusion
- branch retinal vein occlusion (small area) - central retinal vein occlusion (entire retina) - hemiretinal vein occlusion(superior or inferior portion)
48
Associated conditions of retinal vein occlusion
- DM - HTN - leukemia - sickle cell disease - multiple myeloma
49
Clinical presentation of retinal vein occlusion
-sudden painless loss of vision
50
What does fundoscopic exam show with retinal vein occlusion
varies from a few scattered retinal hemorrhages and cotton wool spots to a marked hemorrhagic appearance
51
Management of acute retinal vein occlusion
CONSULT - intravitreal injections of VEGF inhibitor or triamcinolone - retinal laser photocoagulation - surgical techinques - vitrectomy w/ direct injection of tPA

Clin Med Exam II (11 decks)

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