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Flashcards in Pathology of the Eye Deck (62):
1

Why is retinal detachment an urgent problem?

loses blood supply and tissue can die

2

Where is the largest concentration of cones in the eye?

macula

3

What are the 3 visual fields?

Total visual field with both eyes: 170 degrees

Total monocular visual field: 150

Total binocular visual field: 120

4

Strabismus/Tropia

misalignment of eyes

5

Phoria

misalignment of eyes when fusion is broken

6

What is the function of the eyelids and eyelashes?

protection and lubrication of the cornea

7

Conjunctiva

Mucous membrane that lines the inside of the eyelids and some of the front of the eye

8

What is the function of the cornea? What aspect is most responsible for this?

Most external refractive media of the eye (it is avascular)

Curvature of the cornea contributes to amount of refractive error and astigmatism

Contact lenses are placed over the cornea

9

What are some functions of the anterior chamber and the angle?

Part of the refractive media

Holds the aqueous humor

Nourishes the cornea, maintains the pressure of the eye

Angle contains the structures that regulate the outflow of the eye

Affected by glaucoma, uveitis, neovasculature

10

What does the iris control? why are eye exams done in dark lighting

light into the eye

dilate pupils in dark room

11

Uveitis

Inflammation of the
uveal tissue

Etiology: idiopathic,
HLA related, arthritis,
granulomatous, many
more

12

What 2 problems can occur with the lens with aging?

With age, the lens naturally hardens and yellows --> cataract formation (blur, glare, distortion)

and ability to accommodate

13

What are myopia, hyperopia, astigmatism and presbyopia? how are all of these treated?

Myopia-nearsightedness

Hyperopia-”farsightedness”

Astigmastism-corneal shape

Presbyopia-loss of accommodation

*all corrected by lenses

14

Where is the largest concentration of the cones in the eye?

macula

15

Posterior Vitreous Detachment

Most common cause of “flashes or floaters”

Usually benign age-related

May cause retinal hemorrhage, retinal break, vitreous hemorrhage

16

What can cause poor binocular vision?

Poor monocular visual acuity

Poor monocular/binocular visual fields

Strabismus/Tropia

Phoria

Convergence/divergence abnormalities

Accommodation abnormalities

17

What is a common cause of viral red eye? What are the symptoms?

Adenovirus

Most common type of infectious red eye

Associated with upper respiratory infection

May have fever

Usually starts unilateral --> bilateral

Watery discharge

Likely have ocular irritation

Superficial punctate keratitis (SPK) on exam

Diffuse redness, “pink”

18

What eye problems can steroids cause?

cataracts

elevated intraocular pressure (IOP)--> glaucoma

19

What are some common causes of bacterial red eyes?

symptoms?

Causes: S. aureus, S. epidermidis, Strep pneumonia, H. influenza

symptoms?
Usually unilateral
Mucopurulent discharge, esp upon waking
RED eye, red in fornices
Usually no corneal involvement except if severe
Treatment

20

What is blepharitis? What normally causes is?

dry, flaky eyes

usually caused by:
*Inflammation of meibomian glands

other Causes:
Limited lacrimation-Sjogrens, lacrimal gland tumor


bilateral and chronic

21

What are the causes, symptoms and treatment of Subconjunctival Hemorrhage?

Causes: Trauma (even mild), valsalva, HTN, bleeding disorders, antiplatelet/anticoag tx

symptoms: “Bruise” of the eye
BRIGHT RED eye, often sectoral
NO vision changes, NO pain, NO discharge

Tx: nothing for the hemorrhage but look into work up of the cause

22

What are causes, symptoms of anterior uveitis? How is it treated?

Causes: idiopathic, trauma, HLA-B27 associated, post operative, many more

Symptoms
Pain! Photophobia (hallmark), redness, tearing, blur

Signs
Diffuse injection, esp perilimbal
Cells and flare in the anterior chamber

tx: Refer to eye doctor!
High doses of topical steroid and cycloplegics

23

What causes Acute Angle Closure Glaucoma? Signs and symptoms?

closed iridocorneal angle-->Blocks outflow of aqueous humor

Symptoms
PAIN! Headache, significant blur, nausea/vomiting

Signs
*acutely high intraocular pressure (IOP), Unreactive pupil, corneal edema, closed angle

24

When do you need to refer a red eye to an eye doctor?

Pain
Decreased vision
No improvement within 3 days of treatment
Needs steroid
Unsure of cause

25

What is the leading cause of blindness globally?

cataracts

26

What is done to treat cataracts?

simple outpatient surgery -->
Removal of opacified lens
and insert an implant (IOL)

27

What are the 3 most common types of cataracts?

Nuclear:
brownish in center
Symptoms: blur, myopic shift, possible glare
Age

Cortical:
white opacities
Symptoms: glare, later blur
Age, trauma

Posterior subcapsular (PSC):
between capsule and lens
Symptoms: blur
usually from DM and steroids**,
Age, trauma, intraocular surgery

28

What is the most common cataract? What are some symptoms?

Age related cataract

Often a combination of lens opacities

Symptoms:
BLUR-usually so slowly progressive that the patient is only mildly aware
Glare

29

What is the leading cause of blindness in the US for over the age of 55? what are the causes? some risk factors?

Age-related Macular Degeneration

unknown cause

risk: AGE, smoking, family history, vascular disease, Northern European ancestry

30

What vision is lost in Age-related Macular Degeneration?

center vision lost

peripheral vision still in tact

31

what defines dry vs wet macular degeneration?

dry=no leakage
Dysfunctional RPE (Retinal Pigment Epithelium) does not clear waste debris so the waste (drusen) clumps underneath--> RPE atrophies
90% of cases
(dry normally progresses to wet)

wet=choroidal neovascularization present because of stress to choroidal circulation to try to get rid of waste
New blood vessels develop and bleed
Usually dramatic change in vision or visual distortions occur
Can scar



32

What can the pinhole show?

there is a refractive component

33

What is acute vs chronic glaucoma?

damage to the structure of the optic nerve

Most cases are chronic
Slowly progressive, over many years

Acute:
Angle closure-SEVERE, emergency
Secondary open angle
Extreme IOP increase
Usually won’t cause quick damage to optic nerve head and subsequent severe loss of vision

34

What is the most common type of glaucoma? What are some characteristics? What is the goal in management?

Primary Open Angle Glaucoma

Characteristics:
Usually elevated IOP
Open angle
Glaucomatous optic nerve
Visual field loss (normally only later in the dx)

goal: prevent visual field loss (decrease the IOP)

35

What is more effective in treating glaucoma, topical or oral meds?

topical

36

What glaucoma could cause a red eye?

angle closure glaucoma

37

What type of glaucoma is likely to cause an acute attack?

narrow angle glaucoma suspect

(steroid will take a long time to affect the eye)

38

What can cause retinal hemorrhages (vascular problems) in the eye?

diabetic retinopathy, hypertensive retinopathy (or artery/vein occlusions), anemia retinopathy

*focus most on DM and hypertension

39

What are the diabetic eye diseases?

Unstable refractive error
-->Changes in water content of lens
Cranial nerve palsies
Glaucoma
Retinopathy
-Nonproliferative
-Proliferative (including of the iris)
-Macular edema

40

What are the risk factors for diabetic retinopathy?

DM for over 10 years (type I or II)
Chronic hyperglycemia (HbA1c >8%)
HTN
Nephropathy

41

What symptoms do most people with diabetic retinopathy have?

usually no symptoms

may have: blur, or flashes/floaters

42

What is the lowest state of diabetic retinopathy?

Mild Nonproliferative Diabetic Retinopathy

Microvascular changes:
-Loss of pericytes
-Increased vascular
permeability

Effects:
-Microaneurysms
-Leakage
-Hemorrhages
-Exudates

Tx: none

43

What happens in Moderate/Severe Nonproliferative Diabetic Retinopathy?

-capillary occlusion and non-perfusion
-veins start to be affected---> venous bleeding
-cotton wool spots (microvascular infarcts)
-intraretinal macrovascular abnormalities--> form collateral networks

also, no treatment. monitor

44

What is proliferative diabetic retinopathy? What is the treatment?

new vascularization==> BAD

can cause retinal detachment of vitreous hemorrhages

Tx: laser photocoagulation or vitrectomy

45

What is diabetic macular edema? What is the treatment?

Leakage of fluid and exudates in the macula

Most common cause of visual impairment

Treatment
Laser-direct and grid
Intravitreal steroid
Intravitreal anti-VEGF

46

What can hypertensive retinopathy cause? Will it cause noevascularization?

Microvascular changes:
-Vessel changes
-Vessel leakage
-Capillary non-perfusion

Effects:
-Vessel attenuation
-->hardening
-Leakage
-->Flame shaped Hemes
-->Exudates
-Cotton wool spots

*will NOT cause neovascularization on its own

47

What are different types of retinal plaques?

1. Cholesterol/”Hollenhorst”
Orange/refractile, non-occlusive
From carotid arteries

2. Calcium
White, occlusive
From cardiac valves

3. Fibrin/platelet
Dull white, non-occlusive
From carotid arteries


can cause blockage in the eye or no symptoms

48

What will happen due to artery occlusion? what can cause this?

acute vision loss

significant pupil defect in the affected eye

Cause: embolism from heart or carotid artery; atherosclerosis, giant cell arteritis

49

What can happen with a vein occlusion? What are the likely causes?

blood backed up==> get really ugly bloody retina

caused by DM*, HTN*, blood dyscrasias

50

What is papilledema? What are the differentials?

swollen in both optic nerves coming from something behind the eye causing an increase in intracranial pressure


Differentials:
Malignant hypertension, tumor, pseudotumor cerebri, bilateral ischemic optic neuropathy, bilateral optic neuritis


51

What is Ischemic optic neuropathy?

Infarction in the ON, can be segmental--> rare to have in both eyes at the same time

Etiology: HTN, DM, arteriosclerosis, hyperlipidemia, giant cell arteritis

Permanent loss of visual function*

52

What is optic neuritis?

Inflammation of ON

Etiology: idiopathic, multiple sclerosis, severe infection, inflammation

Many have full return of visual function*

53

What eye condition can happen from inflammation/immune system associations? What is the most common?

-itis

uveitis (anterior=most common)
scleritis
keratitis

(conjunctivitis is NOT normally)

54

What are some ocular urgency symptoms?

Trauma (foreign body or head trauma)
Sudden vision loss
Flashes/floaters
Pain

55

What are some conditions that are ocular urgencies?

Retinal detachment
Iritis
Neovascularization
Corneal ulcer

56

What does transient vision loss normally indicate?

loss of blood flow

cardiac problem/circulation problem --> normally a brain, not an eye issue

vision normally returns within 24 hours

57

what normally causes Acute Permanent Vision Loss?

vision loss for >24 hours

usually vascular but can also be optic neuropathy or retinal detachment as well

58

What normally causes flashes? What normaly causes floaters?

retinal stimulation

Usually caused by objects anterior to the retina

most common causes: Posterior Vitreous Detachment
Migraine
Retinal break
Retinal detachment

59

What is a retinal break?

Retinal tear, retinal hole, retinal dialysis
Defect in the retina where the retina has pulled away from the RPE
Precursor to RD in many cases

60

When do you test for Retinal Detachment?

Anyone with “flashes and floaters” MUST have a dilated retinal exam to rule out Retinal Detachment

Causes:
Lattice degenerationretinal break
Trauma
Neoplasm
Vascular

tx: laser photocoagularion, scleral buckle and cryotherapy

61

What can cause ocular pain?

Effects of trauma
Corneal abrasion, etc
Corneal ulcer
Uveitis
Angle closure glaucoma

--> need to find the cause to treat

62

What is not an urgent condition caused by a tennis ball to the eye?

vertebrobaslar artery insufficiency