Optho Flashcards
(32 cards)
1
Q
3 Red Eye Red Flags
A
- Dec vision
- Severe pain
- Cloudy cornea
2
Q
Vital Signs of the Eye
A
- 1- Visual acuity
* 2- Pupils (look for relative afferent defect)
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”
4
Q
10 Step Optho Exam
A
- Measure visual acuity for each eye (@20 ft)
- Confrontation field test for each eye (examiner closes opposite eye)
- Inspect lids and surrounding tissues
- Inspect conjunctiva and sclera
- Extra-ocular movements
- Superior oblique moves, inferior oblique moves eye up
- Test pupils - direct and consensual
- Inspect cornea and iris - fluorescein stain will show areas of bright green where there is disruption or absence of epithelium; binds to exposed collagen
- 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
- 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
- Tonometry - if suspect acute angle-closure glaucoma (measure IOP)
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)
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
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
8
Q
Signs of Corneal Ulceration
A
mucus secretion (mattering)
PAINFUL
photophobia
9
Q
Hyphema v Hypopyon
A
Hyphema = blood in anterior chamber
Hypopyon = pus in anterior chamber
10
Q
Keratoconjunctivitis Sicca
A
dry eye (lacrimal insufficiency)
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
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
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)
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
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
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
5 Classes Glaucoma Meds
* 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
Signs and Sx Macular Degeneration
* 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
Tx Macular Degeneration
* 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
3 General Causes Amblyopia
* 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
4 General Causes Strabismus
* 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
Testing for Strabismus (4)
* 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
5 Stages Diabetic Eye Changes
* 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
Follow-Up by Stage of Diabetic Eye Changes
* 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
