Vision Loss Flashcards by Rebecca Lea

components of eye exam that pertain to vision loss

visual acuity, visual fields, pupils (PERRLA), tonometry, slit lamp/ pen light, dilated fundus

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amsler grid

tests changes in vision

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acute angle closure is rare/ common

rare

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acute rise of IOP due to outflow obstruction (aqueous outflow)

acute angle closure

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IOP

intraocular pressure

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acute angle closure has a ____ mechanism than open angle glaucoma

different

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which is more common, acute angle closure or open angle glaucoma

open angle glaucoma

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glaucoma with acute narrowing of angle, inc IOP, optic nerve damage

acute angle closure glaucoma

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glaucoma with chronic narrowing of angle, optic neuropathy, IOP not always significantly elevated, optic nerve damage

open angle glaucoma

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crescent shadow occurs

because chamber is shallow, light cant pass through

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crescent shadow might indicate

acute angle closure glaucoma (because of inc IOP)

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ACUTE decresed vision, halos around lights, headache, N/V, severe eye pain, feeling of “pressure” (inc IOP)

acute angle closure

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decreased vision, circumlimbal injection/ ciliary flush, steamy cornea, mid-dilated pupil, narrow anterior chamber, firm globe

acute angle closure

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acute angle closure is a

ophthalmologic emergency

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acute angle closure tx

topical ocular HTN meds (beta blockers, alpha 2 agonists), oral/IV osmotic agents (mannitol), laser peripheral iridotomy, surgical trabeculectomy, NO MYDRIATICS

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early presentation of open angle glaucoma is

asymptomatic

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late presentation of open angle glaucoma is

chronic painless visual field loss (1st peripheral, then central)

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increased IOP, inc cup:disc (optic nerve), no AV nicking, no exudates

seen in open angle glaucoma exam

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tx for open angle glaucoma

topical ocular HTN meds (beta blocker, alpha 2 agonists), laster trabeculoplasty, sx trabeculectomy

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1 cause of central legal blindness in western world

macular degeneration

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lens opacity (age related, congenital, traumatic), gradual, CHRONIC & PAINLESS loss of vision, “foggy vision”, glare at night, dec visual acuity, clouding/ opalescent changes to lens

cataracts

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cataracts tx

glasses, sx (extracapsular cataract extraction, intraocular lens implant)

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the prognosis for cataracts is

excellent

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macular degeneration is caused by

aging (ARMD- Age Related Mac Degeneration) or toxic drug effects

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gradual/acute blurred vision, metaorphopsia, central scotoma, +/- decreased vision, amsler grid distortion

macular degeneration

metamorphopsia

wavy/ distorted vision

central scotoma

blind spot

drusen bodies

lipid deposits

drusen bodies, pigment mottling, geographic atrophy, vision loss slow/ gradual, uni or bilateral

Dry ARMD

subretinal neovascular degeneration, subretinal fluid or blood, fibrosis/ scarring, rapid vision distortion, loss of central vision, usually unilateral

Wet ARMD

macular degeneration tx

vitamins (antiox, zinc, omega 3's), smoking cessation, daily amsler grid changes, photocoagulation, photodynamic therapy, intravitreal steroids/monoclonal antibodies, low vision aids, stop the offending drugs

separation of retina from underlying epithelial layer

retinal detachment

posterior vitreous detachment, traumatic RD

rhegmatogenous RD

traction RD (associated with DM), exudative (extremely rare)

nonrhegmatogenous RD

painless, rapidly progresses, floaters, photopsias, complete/partial vision loss, curtain like vision loss, may be peripheral only, raised whitish retina, bilateral 20% of the time

retinal detachment

photopsias

light flashes

curtain like vision loss is from ___ to __

top to bottom

emboli in artery, edema in the retina, the only place the retina does not line is fovea

cherry red spot

worry about thrombotic events more in pts with

HTN

tx of RD

Surgery: laser/cryo/ scleral buckle/ vitrectomy

retinal vascular changes due to systemic HTN

hypertensive retinopathy

asymptomatic, arteriolar narrowing, arteriolar sclerosis, AV crossing changes, nerve fiber layer infarcts, retinal hemorrhages, retinal edema/ exudates, disc edema

hypertensive retinopathy

arterial narrowing looks like

copper wiring

arteriolar sclerosis looks like

silver wiring

AV crossing changes looks like

AV nicking

nerve fiber layer infarcts look like

cotton wool spots

hypertensive retinopathy tx

systemic BP control

severe hypertensive retinopathy can cause

associated visual loss

2 classifications of diabetic retinopathy

nonproliferative and proliferative

blurred vision, retinal hemorrhage, retinal edema, macular edema, cotton wool spots, venous dilation, microaneurysms

nonproliferative diabetic retinopathy

microaneurysms seen as

hard exudates

neovascularization, preretinal and vitreous hemorrhage, subsequent fibrosis, traction retinal detachment, macular edema

proliferative diabetic retinopathy

macular edema

retinal thickening and edema involving the macula

preretinal and vitreous hemorrhage can cause ___ and subsequent ___

preretinal and vitreous hemorrhage can cause sudden blindness and subsequent fibrosis

diabetic retinopathy tx

blood sugar control, laser photocoagulation, vitrectomy

when you think about IOP also think about

hyphema and hypophyon

central retinal artery occlusion is

embolic

central retinal vein occlusion is

thrombotic

CRAO

central retinal artery occlusion

CRVO

central retinal vein occlusion

acute TOTAL painless loss of vision, "black as night", "no light perception", afferent pupillary defect, whitening of retina, cherry red spot

CRAO

acute VARIABLE painless loss of vision, variable vision, +/- afferent pupillary defect, "blood and thunder" retinal appearance

CRVO

CRAO tx

no effective tx, eval etiology to prevent future strokes (carotid plaques, cardiac thrombi)

CRVO tx

aspirin, observation, tx retinal edema/ischemia, eval etiology if young (severe HTN, hypercoagulable)

acute inflammatory demyelination of the optic nerve

optic neuritis

monocular vision loss over hours to days, central scotoma, painful, +/- abnromal color vision, +/- flashes of light, 1/3 visible papillitis with disc swelling

optic neuritis

optic neuritis tx

MRI brain and orbits, IV methylprednisolone for severe loss or 2+ white matter lesions on MRI, no tx (improves in 2-3 weeks, typically 20/40 vision by one year)

IV methylprednisone has a ____ recovery and ____ long term vision fxn in the tx of optic neuritis

IV methylprednisone has a MORE RAPID recovery and DOES NOT IMPACT long term vision fxn in the tx of optic neuritis

when doing a history, think ___ and ___

when doing a history, think ACUTE and CHRONIC

perform a careful eye exam and do not forget

vision

when performing an eye exam, go from ___ to ___

outside to in

Vision Loss Flashcards

(72 cards)