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Specialty Care > Optho > Flashcards

Optho Flashcards

1
Q

3 Red Eye Red Flags

A
  • Dec vision
  • Severe pain
  • Cloudy cornea
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2
Q

Vital Signs of the Eye

A
  • 1- Visual acuity

* 2- Pupils (look for relative afferent defect)

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3
Q

Measures of Visual Acuity

A
  • Measure visual acuity for each eye (@20 ft)
  • If unable to complete, may reduce distance so change numerator
  • If still unable to complete, count fingers (CF at blank feet)
  • If still unable to complete, hand motion (HM at blank ft)
  • If still unable to complete, light perception or “no light perception”
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4
Q

10 Step Optho Exam

A
  1. Measure visual acuity for each eye (@20 ft)
  2. Confrontation field test for each eye (examiner closes opposite eye)
  3. Inspect lids and surrounding tissues
  4. Inspect conjunctiva and sclera
  5. Extra-ocular movements
    • Superior oblique moves, inferior oblique moves eye up
  6. Test pupils - direct and consensual
  7. Inspect cornea and iris - fluorescein stain will show areas of bright green where there is disruption or absence of epithelium; binds to exposed collagen
  8. Assess anterior chamber depth
    • Shine light on temporal side of eye across front of the eye and if 2/3+ of the nasal iris if in shadow then the anterior chamber is likely narrow
  9. Direct ophthalmoscope - clarity of lens (red reflex), optic disc, vessels (arteries lighter and fewer), macula (central vision - in middle of retina
    • Fovea is center of macula - foveal reflex (light reaction)
    • Use tropicamide to dilate
  10. Tonometry - if suspect acute angle-closure glaucoma (measure IOP)
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5
Q

Tx of Conjunctivitis

A
  • cool compress, antibiotic drops 4-6X a day if bacterial (gentamicin, sulfacetamide)
  • May use artificial tears PRN for irritation
  • DO NOT USE STEROIDS (may potentiate conjunctivitis caused by herpes or fungus, may cause cataract formation, may cause inc IOP)
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6
Q

Iritis / Ciliary Flush

A
  • inflammation of iris or iris+ciliary body (uveitis); SERIOUS
  • Bold redness right near limbus
  • Best seen in natural light
  • Associated w/ ocular sarcoidosis, SLE, ankylosing spondylitis, etc
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7
Q

Signs of Acute Angle Closure Glaucoma & Tx

A
  • Inc IOP (eyeball itself may feel hard)
  • Corneal opacification (corneal edema)
  • Shallow anterior chamber (> 2/3 nasal shadow when shine temporal light)
  • conjunctival injection, inflammation

TX = peripheral iridectomy

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8
Q

Signs of Corneal Ulceration

A

mucus secretion (mattering)

PAINFUL

photophobia

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9
Q

Hyphema v Hypopyon

A

Hyphema = blood in anterior chamber

Hypopyon = pus in anterior chamber

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10
Q

Keratoconjunctivitis Sicca

A

dry eye (lacrimal insufficiency)

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11
Q

4 Benign Causes of Red Eye

A
  • Subconjunctival hemorrhage (in potential space between conjunctiva and sclera; from force (cough, sneeze, etc); BENIGN
  • Blepharitis - inflammation of eyelid itself
    • Tx - warm compress in morning and before bed; topical bacitracin or erythromycin if staph infection
  • Stye/hordeolum (acute) v. chalazion (chronic) inflammation of hair follicles or glands of eyelid
    • Tx - warm compress 4X a day
    • Refer for incision and curettage if still there in 3-4 wks
  • Pterygium - wing-shaped growth; treated with cold compresses and tear drops
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12
Q

Recognition and Mgt of Ruptured Globe

A
  • Flat anterior chamber +pupil distortion (tear drop shape)
  • Look for it is prolapse
  • DO NOT PRESS ON EYE
  • Tx - IV abx, NPO, CT orbit if think there may be a foreign body
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13
Q

Marcus Gunn Pupil

A
  • relative afferent pupil defect

* Swinging flashlight test - 3 sec R, 3 sec L, shift back to R (if R is abnormal there will be a relative dilation)

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14
Q

Parinaud Syndrome

A

(dorsal midbrain damage)

  • loss of upward gaze, nystagmus with up gaze, light-near dissociation of pupil reaction
  • May be caused by hydrocephalus, MS, stroke, midbrain hemorrhage, pineal tumor
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15
Q

CN 3, 4 and 6 Damage

A

CN3 - if not working, down and out

CN4 - superior oblique; if not working, vertical diplopia
esp when looking down

CN 6 - lateral rectus; if not working, horizontal diplopia esp when gazing toward affected side

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16
Q

INO

A
  • lesion in MLF (send CN6 output to opposite CN3 for horizontal gaze)
  • Named for the side with inadequate CN3 input; so R INO means that when you look to the L, the L eye can abduct but the R eye cannot adduct
  • May also have nystagmus in the abducting eye on lateral gaze
17
Q

Optic Nerve Lesion

Chiasm Lesion

Optic Tract Lesion

Occipital Lobe Lesion

A
  • Optic nerve itself (anterior to chiasm) - monocular loss (ipsilateral eye)
  • Chiasm - bitemporal hemianopia (lose temporal vision in both eyes)
    • pituitary adenomas, craniopharyngioma, parasellar masses
  • Optic Tract - homonymous hemianopia (lose L or R field of both eyes)
    • R side of both retinas –> R brain (represents the L field)
    • So … lesion of R optic tract means loss of L visual field in both eyes
  • Occipital Lobe - high degree of congruity of vision loss in 2 eyes; usually homonymous hemianopia with central sparing
18
Q

Optic Neuritis

A

50% cases associated w/ MS

color vision loss

IV steroids will dec duration but it is self limiting

get MRI

19
Q

Amaurosis Fugax

A

transient monocular vision loss from embolic source

do carotid US on same side as well as ECHO

20
Q

Ischemic Optic Neuropathy

A

arteritic (associated with giant cell arteritis)

or non-arteritis (associated with atherosclerosis)

both result in either unilateral or bilateral sudden, painless vision loss due to ischemia of optic nerve

21
Q

Cataract Risk Factors

A

Risk Factors = age (change in lens protein), trauma, inflammation, DM, radiation, smoking, sun

22
Q

Definition of Glaucoma

A
  • Optic nerve damage and visual field loss (peripheral); damage to retinal nerve fibers
  • Cup:disc > 4 or difference b/n sides > .2
23
Q

Definition of Inc IOP

A

> 21 mmHg

meas w/ tonometry

24
Q

Glaucoma Risk Factors & Screening

A

1- family hx

2- DM

3- age > 45

4- african american

SCREENING

  • If under 45 and no risk factors - q 4 yrs
  • If above 45 OR risk factors - q 2 yrs
  • If above 45 AND risk factors - q 1 yr
25
Q

5 Classes Glaucoma Meds

A
  • Beta blocker - dec aqueous humor production (timolol, cartelol, metpranolol)
  • Miotics - inc trabecular meshwork flow (pilocarpine)
  • Alpha agents - dec aqueous humor production (apraclonidine, brimonidine)
  • Carbonic anhydrase inhibitors - dec aqueous humor production (dorzolamide)
  • Prostaglandins - inc non-trabecular meshwork flow (latanoprost, travaprost)
26
Q

Signs and Sx Macular Degeneration

A
  • Drusen -deposits in Bruch’s membrane; hard (discrete) v soft (irregular, indistinct edges)
  • Retinal pigment epithelium becomes hyper or hypo pigmented due to atrophy –> loss of photoreceptor function
  • Wet or neovascular - subtype involving extension of new, leaky vessels from choroid thru weakened Bruch’s membrane (CNVM - choroidal neovascular membrane)
  • Dry - gradual, mild dec central vision, distortion and waviness of straight lines (metamorphopsia)
    • Waves on Amsler Grid
  • Wet - more sudden loss of central vision; central scotoma
27
Q

Tx Macular Degeneration

A
  • Dry - NONE
  • Wet - photodynamic therapy (IV dye –> new vessels; then activated by correct light frequency), anti-VEGF antibodies injected into vitreous cavity –> regression of vessels, historically laser treatment used (permanent blind spots and scarring)
  • STOP SMOKING
28
Q

3 General Causes Amblyopia

A
  • 1- Strabismus - misalignment so brain turns off signal from 1 eye –> atrophy
  • 2- Refractive error - very high error in both (both paths do to develop) or asymmetric (suppress blurry eye)
  • 3- Occlusion - by congenital cataract, corneal scar or ptosis - path of occluded eye does not develop
29
Q

4 General Causes Strabismus

A
  • 1- Dec sensory input into 1 or both eyes –> dec vision –> dec stimulus to track together
  • 2- If very far-sighted then may have issues with accommodation / convergence when seeing near –> esotropia
  • 3- Restriction of extra-ocular muscle due to trauma or fibrosis (congenital / thyroid)
  • 4- Paralysis / denervation of 1 or more extra-ocular muscles (MS, MG, DM, CNS tumor, stroke)
30
Q

Testing for Strabismus (4)

A
  • May be obvious deviation on inspection
  • Corneal light reflex - reflection of light should be in same place relative to pupil in both eyes
  • Cover test - see above
    • If open eye moves inward then the natural deviation is exotropia (OUT)
    • If open eye moves outward then natural deviation is esotropia (IN)
  • Visual acuity for sensory problem
31
Q

5 Stages Diabetic Eye Changes

A
  • 1- NO retinopathy
  • 2 - Background Retinopathy
    • Micro-aneurysms - seen as tiny red dots, saccular outpouchings of capillaries that leak
    • Hemorrhages - evidence that blood is leaking
      • Dot
      • Blot
      • Flame - elongated in nerve fiber layer
  • 3- Exudative Retinopathy
    • When plasma and lipids leak out of micro aneurysms
      • Hard exudates - yellow dots of lipid deposits
      • Retinal thickening - because fluid accumulates in retinal layers
        • If in central retina = macular edema
        • If close to fovea then high chance of vision loss = clinically sig macular edema
  • 4- Pre-proliferative Retinopathy (ISCHEMIA)
    • Cotton Wool Spots - infarcts in nerve fiber layer
    • Venous dilation and tortuosity
  • 5- Proliferative Retinopathy
    • Ischemia –> new blood vessel growth (weak and leaky) –> vitreous hemorrhages OR retinal detachment
32
Q

Follow-Up by Stage of Diabetic Eye Changes

A
  • No retinopathy - q 1 yr
    • **Diabetic women should be examined before or during first trimester
  • Background - q 6-12 mo depending on severity
  • Macular Edema or Pre-proliferative - q 4-6 mo
  • Clinically Sig Macular Edema or Proliferative - q 2-4 mo
    • Get focal laser treatment if CSME
    • Get pan retinal photocoagulation to decrease angiogenic drive / regression of neovasculaturization if proliferative

Specialty Care (5 decks)

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