Painful Loss of Vision + Glaucoma Flashcards Preview

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Flashcards in Painful Loss of Vision + Glaucoma Deck (47)
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1
Q

What causes painful loss of vision

A

Acute angle close glaucoma
Corneal abrasion
Optic neuritis
GCA
Choroditis / retinitis if immunocompromised
Posterior scleritis - pain > degree of red
Chemical or mechanical injury

2
Q

What causes acute angle closure glaucoma

A

Angle is blocked acutely so AH cannot drain through trabecular meshwork
Due to structural change at cornea / iris
Typically in hypermetropia (long eye) so not enough room
Lens get bigger as you age
Iris bulges foreward and blocks trabecular meshwork
Causes rapid rise in IOP
Axonal death occur and optic neuropathy

3
Q

What are the symptoms

What are complications

A
Short history 
Sudden onset pain - headache / ocular
Hard red eye 
N+V
Photophobia 
Vision loss
HARD eye on palpation 
Opaque hazy cornea as IOP drives fluid in = oedema 
Iris / ciliary / conjunctiva vessels = injected 
Pupil 
N+V / abdo pain / headache can occur  

Complications

  • Visual loss
  • Central retinal artery or vein occlusions
4
Q

What happens to pupil

A

Mid dilated

Non reactive / sluggish

5
Q

What is visual loss like

A

Periphery
Blurring
Halo around eye due to build up of fluid

6
Q

What are RF

A
Age
Female
FH
Hypermetropia
Mydratic eye drop as dilates eye 
Pupil dilation
Functional block due to large lens
7
Q

What do you do if suspect

A

Urgent referral

8
Q

How do you Dx

A

Slit lamp = shallow chamber
Tonometry = diagnostic as shows high pressure
Gongioscopy is only way to exclude an occluded angle

Do U+E

9
Q

How do you Rx initially

A
Analgesisa
Anti-emetic
Avoid dark room as encourage further dilation
Lie patient supine
URGENT OPTHAMOLOGY
10
Q

What is 1st line Rx

A
Prostaglandin eye drop (Latanoprost) 
IV carbonic anhydrase (Azetazolomide) 
A agonist (Apraclonidine) 
Mucarinic agonist
Mitotic eye drop to constrict and open angle 
Topical steroid eye drop 
BB if no CI
11
Q

What does prostalgnaidn eye drops do

A

Constrict eye and increase outflow through chamber

12
Q

What do all the other medications do

A

Reduce production of AH

13
Q

What do you do after this

A

Chek IOP after 1 hour

Consider IV mannitol if not responding as osmotic agent and will draw fluid out

14
Q

When should you have caution prescribing mannitol

A

Cardiac function
- draws fluid out = oedema
Renal function
- Should cause diuresis but if impaired = worsens overload

15
Q

What happens after initial management

A

Keep on all medcation
Iridiotomy later to bypass (hole in iris)
Do other eye as prophylaxis
Trabeculostomy may be needed if adhesions have formed

16
Q

What are complications

A

Visual loss

Central retinal artery or vein occlusion

17
Q

What is corneal abrasion

A

Any defect in corneal epithelium

18
Q

What causes

A
Trauma
FB
Grit / contact lenses / finger nails
Tear insufficiency 
Keratconjunctivitis sicca
19
Q

What are the symptoms

A
Eye pain - mild / mod
Photophobia 
Decreased acuity
Sensation of Fb
Conjunctival injection
Increased lacrimation
20
Q

What occurs 2

A

Bacterial infection / keratitis

21
Q

How do you Dx

A

Can usually see with naked eye
Look under eyelid for FB
FLuroscein angiography shows yellow stained abrasion

22
Q

How do you Rx

A

Usually heal quick
Topical Ax to prevent bacterial infection
Topical cycloplegia for pain
Remove FB

23
Q

What Ax

A

Fluroquinolone = 1st line

Aminoglycoside may be needed but often delays healing but will sort infection

24
Q

What do you avoid

A

Topical analgesia as damages cornea

25
Q

When can you miss abrasion

A

If chemical burn as no normal epithelium to compare

26
Q

What is primary open angle glaucoma

A
Drainage through meshwork blocked
Raised IOP 
Affects drainage of AH
Slow and chronic
Leads to optic neuropathy as pressure builds up on optic nerve or interrupts blood supply
27
Q

What is normal IOP range

A

10-20mmHG

28
Q

How does it present

A
Asymptomatic and picked up by screening with optometrist 
- Elevated eye pressure - ocular HTN 
- Optic disc changes 
- Visual field loss pattern - typical 
Usually bilateral 
May present with advanced disease as occurs slowly 
- Gradual visual defect 
- Pain
- Headache
29
Q

What are the visual defect

A
Peripheral loss
Macular fibres usually preserved until very late which gives central vision 
Decreased acuity 
Halo 
Blurred
Eventually all nerve fibres die = blind
30
Q

What are optic disc changes

A

Pale and cupped as nerve fibres die

31
Q

What are RF

A
Age 
Genetics 
FH 
Black
Myopia - short sighted 
Hypertension
DM
Steroid
Thyroid eye
32
Q

Who gets screening

A
Annual from age 40 if FH
African
Myopia
DM
Thyroid eye disease
33
Q

How do you assess visual field

A

Automated perimetry

34
Q

How do you measure IOP and what is normal

A

Application tonometry

Normal = 12-22

35
Q

What other tests

A

Slit lamp with pupil dilation to assess optic nerve

Fundoscopy for optic disc

36
Q

How do you Rx

A
Prostaglandin eye drops = 1st line 
Carbonic anhydrase inhibitor
BB if no CI 
Laser trabeculoplasty to allow drainage
Trabeculectomy = definitie Rx 
May need to stop driving
37
Q

How do you reassess

A

Exclude progression and visual field loss

38
Q

SE prostaglandin inhibitor

A

Eyelash growth
Eyelid pigmentation
Iris pigmentation

39
Q

SE carbonic anhydrase

A

Paraesthesia

40
Q

What causes optic neuritis

A

MS
DM
Syphillis

41
Q

How does it present

A
Unilateral decrease in acuity
Poor colour discrmination
Red desaturation
Pain worse on eye movement 
Afferent pupil defect
42
Q

How do you Dx

A

Always check pupil defect before dilate eye as may be only sign of neuritis

43
Q

How do you Rx

A

Steroid

44
Q

What is a scrotoma

A

Particular area of blindness in eye surrounding by relatively normal blindness
Occurs due to how retinal axons are arranged

45
Q

If lower part of nerve affected

A

Upper part of vision lost

46
Q

What type of scrotoma in glaucoma

A

-ve which means patient is not aware
Usually peripheral
Can be very dangerous

47
Q

In macula disease

A

+Ve scorotoma so patient is aware of defect