vision loss

Question 1

transient loss of vision in one eyecausedby

Answer 1

transient ischemic attack caused by platelet thrombin emboli from atheromatous plaques in carotid artery on same side –> AMAUROSIS FUGAX

Question 2

what causes transient loss of vision in both eyes?

Answer 2

Basilar artery insufficiency

Question 3

short lived (a few seconds) loss of vision caused in one eye by?

Answer 3

papilledema

Question 4

casues of painful loss of vision (4)

Answer 4

optic neuritis

acute narrow glaucoma

uveitis

endopthalmitis

Question 5

painless loss of vision (3)

Answer 5

cataracts

central retinal artery or vein occlusion

retinal detachment

Question 6

sudden loss of visison in one eye adult? kids?

Answer 6

adults - vascular (HTN, diabetes, etc)

kids - optic neuritis R/O demyelinating disease

Question 7

if bilateral nonreactive pupils discovered, what shoudl you test?

Answer 7

near reflex (accomodiation, miosis, constriction) (could be argyl robinson pupil - neurosyph)

Question 8

vision loss caused by lesion posterior to the exit of the pupillary fibers will not be associated with abnormalities of ___________

Answer 8

pupillary reflex

Question 9

presence of relative afferent pupillary defect usually associated with _______

Answer 9

diseases of optic nerve, chiasm or optic tract anterior to the exit of pupillary fibers and arterial or venous occlusive diseases

Question 10

pts w/retrobulbar optic neuritis have a positive _______ even though their optic disc looks normal

Answer 10

relative afferent pupillary defect

Question 11

which test - move light straight back from one pupil to the other and go back several times

Answer 11

relative afferent pupillary defect (RAPD) test. tests for marcus gunn pupil =afferent pupillary defect

Question 12

do not expect to find what if confrontation visual field testing?

Answer 12

subtle VF defects (how to do test. have pt cover left eye and look directly at your left eye w/their uncovered right eye)

Question 13

visual field: retinal or optic nerve lesion lesion produces

Answer 13

central scotoma (retinalvsualr lesions usually respect horizontal midline)

Question 14

chiasmal compression produces:

Answer 14

bitemporal hemianopsia

Question 15

lesions behind chiasm produce

Answer 15

congrous HH - occipital cortex

incongroups HH - more anterior

Question 16

describes what :

1. usually occcurs in young, middle aged adults
2. sudden loss of vision inone eye

may have pain on motion of eye

AFFERENT PUPILLARY DEFECT PRESENT

CENTRAL VISUAL FIELD DEFECT (pt cannot see object when look directly at it, but can see it when look to side)

COLOR DESATURATION IN AFFECTED EYE

DISC NORMAL OR SWOLLEN

Answer 16

OPTIC NEURITIS

Question 17

what is a centrocecal scotoma (eg found in optic neuritis)

Answer 17

central scotoma that connects w/physiologic blind spot

Question 18

disc in REtrobulbar Optic neuritis?

disc in papillitis?

vision loss for how long in optic neuritis?

when does vision improve?

prognosis for return to vision?

tx?

Answer 18

retrobulbar - optic disc normal

papillitis - optic disc swollen

vision loss over 10-14 days

improves over 3+ weeks

prognosis for vision to return = >90%

tx: IV corticosteroids

Question 19

* papillitis vs. pailledema*

disc inolvement?

RAPD?

visual acuity?

scotoma?

Answer 19

papillitis: ONE disc, +RAPD, DECREASED visual acuity, CENTRAL scotoma
papilledema: BOTH discs, -RAPD, NORMAL visual acuity, ENLARGED physiologic blind spot

Question 20

sigificance of optic neuritis?

Answer 20

Maybe presenting complaint of MULTIPLE SCLEROSIS!!!!

Question 21

chiams lesions:

how is VA?

is bitemporal hemianopsia symmetric/optic atrophy?

MC cause?

other causes (3)

Answer 21

VA reduced in one or both eyes

bitemporal hemianopsia and optic atrophy- asymmetric (usually w/ eye with RAPD in eye w/poor vision w/pale optic disc (atrophic)

MC cause: pitutiary adenoma

others: meningitioma,craniopharyngioma,aneurysm

Question 22

lesion btw chiasm and LGB produce

Answer 22

optic atrophy and RAPD

Question 23

lesions posterior to LGB produce

Answer 23

normal pupil and normal RAPD, NO Optic atrophy.

Question 24

post chiasmal lesiosn produce?

Answer 24

homonymous hemianopsia

Question 25

in a homonymous hemianopsia, congrous, what owuld you be worried about in old pt?

Answer 25

stroek in old; tumor in young pt.

Question 26

normal optic disc: what should you check for? 4Cs + 2 more

Answer 26

color contour circumference(margins) cup size spontaneous venous pulsations retina/vessels

Question 27

what is a bilateral swelling of the optic discs secondary to increased intracranial pressure? which two conditions must be ruled out?

Answer 27

papilledema. RULE OUT: pseudotumor cerebri and BRAIN TUMOR.

Question 28

what is seen with: normal visual acuity visual field full w/enlarged blind spot no pain on eye movement no RAPD Headaches, nausea, and vomiting +/- CN6 palsy

Answer 28

papilledema

Question 29

signs inlcude: both discs elevated and hyperemic disc margins blurred, indistinct, small vessel margin obscured retinar vessels tortous, dilated hemorrhages and exudates spontaneous venous pulsations absent

Answer 29

signs of papilledema.

Question 30

what is described below: acute loss of vision in one eye in older pt AFFERENT PUPILLARY DEFECT PRESENT DISC SWOLLEN and PALE ISCHEMIA of DISC(small vessel occlusion) altitudinal hemianopsia common what must you rule out?

Answer 30

ISCHEMIC OPTIC NEUROPATHY must R/O temporal arteritis

Question 31

what is seen with pale retina w/central aretry occlusion secondary to ischemia pale optic disc narrowed arterioles cherry red macula R/O temporal areritis

Answer 31

central retinal artery occlusion

Question 32

what is seen with: hemorrhagic infarct of retina swollen, hypereremic disc + venous distention flame shaped _ other hemorrhages seen in pt w/diabetes, chornic open angle glaucoma, blood disease that Increases viscosity of blood:PCV and multiple myeloma.

Answer 32

central retinal vein occlusion

Question 33

ocular disease associated with: increased intraocular pressure, damaged optic nerve, characterized by ENLARGEMENT OF optic Cup and eventual pallor -ealry visual field loss (ASYMPTOMATIC) LOSS OF CENTRAL VISION -LATE

Answer 33

CHRONIC OPEN ANGLE GLAUCOMA

Question 34

SUGGESTED BY PALE COLOR OF ATROPHY USUALLY POOR VISION AND VISUAL FIELD MAY BE CAUSED BY LESION IN RETINA, OPTIC NERVE, CHIASM, OR OPTIC DISC ATROPHY WITH LARGE OPTIC DISC CUPS- USUALLY GLAUCOMA

Answer 34

OPTIC ATROPHY