visual & sensory

Question 1

define cataracts

Answer 1

cloudy lens.
gradual onset of painless blurry vision.
if left untreated, may end in blindness.

Question 2

cataracts: risk factors

Answer 2

Older age
Eye trauma
Congenital risk
Diabetes
Corticosteroid use
Smoking and ETOH consumption

Question 3

Cataract manifestations

Answer 3

Painless
Uni- or bilateral vision changes
Blurry
Halo around lights
Altered color perceptions
Glare issues at night
Decreased accommodation

Question 4

treatment of cataracts

Answer 4

surgery

Question 5

Diabetic retinopathy: nonproliferative retinopathy

Answer 5

Capillary microaneurysms, retinal swelling, hard exudate
Macular edema- plasma leaks from macular blood vessels
Capillaries rupture, leading to “dot or blot” hemorrhaging

Question 6

Diabetic retinopathy: proliferative retinopathy

Answer 6

Advanced retinopathy
New blood vessels are fragile and leaky

Question 7

hypertensive retinopathy

Answer 7

Etiology: high BP creates blockages in retinal blood vessels.
Initially there no vision changes
Sustained, severe HTN can cause sudden visual loss related swelling of the optic disc and nerve.
Normal vision is restore with treatment of the HTN

Question 8

define detached retina

Answer 8

Retina has a tear or leak.
Vitreous humor flows behind the retina.
Rapid, progressive detachment from the choroid.
Usually spontaneous.

Question 9

who is most likely to have a detached retina?

Answer 9

people who have myopia.
Over 40.
Traumas to the head: Eye tumors, Complication or history of cataract surgery

Question 10

Clinical manifestations of detached retina

Answer 10

SUDDEN, unilateral vision loss
Painless
May see floaters
Flashes of light

Question 11

myopia

Answer 11

nearsightedness
cant see far away

Question 12

Age related macular degeneration

Answer 12

Most common cause of irreversible vision loss in people over 60 in the US

Question 13

2 types of Age related macular degeneration

Answer 13

Dry (non-exudative)- most common, 90% of cases
Wet (exudative)- only 10%

Question 14

etiology of Age related macular degeneration

Answer 14

retinal aging

Question 15

risk factors of Age related macular degeneration

Answer 15

Family history, genetics, UV light, hyperopia, smoking, light-colored eyes

Question 16

what food is protective for age related macular degeneration

Answer 16

Dark green, leafy vegetables

Question 17

Dry macular degeneration

Answer 17

Yellow deposits in the retinal pigment epithelium

Question 18

wet macular degeneration

Answer 18

Growth of new, leaky blood vessels in an abnormal location of the retina

Question 19

manifestations & treatment for age related macular degeneration

Answer 19

Early on– usually no symptoms
Later: Blurred, darkened vision, Blind spots (scotomas), Distorted vision (metamorphopsia).
Vision does not improve, treatment is limited, Medications are injected into the eye.

Question 20

glaucoma

Answer 20

Elevated intraocular pressure (IOP) PLUS + Vision changes OR optic nerve damage.
Chronic condition
Usually bilateral eye involvement

Question 21

what are the 2 types of glaucoma?

Answer 21

Open-angle
Closed-angle

Question 22

Risk factors of Open-Angle Glaucoma

Answer 22

Elevated IOP
Age- older
Race: African-Americans 3-4x higher risk
Family history
Myopia
Diabetes, HTN, migraines

Question 23

hyperopia

Answer 23

farsightedness
inability to see close objects

Question 24

Open-angle glaucoma pathogenesis

Answer 24

Abnormal trabecular meshwork.
Reduced drainage of aqueous humor into canal of Schlemm.
Imbalance between inflow and outflow.
Results in increased IOP and vision problems.

Question 25

Open-angle glaucoma: clinical manifestations

Answer 25

None usually Progressive loss of sight Vague eye pain Halos around lights Tunnel vision

Question 26

Closed-angle glaucoma

Answer 26

Much less common Abnormal angle between the iris and later cornea Outflow is blocked when the pupil is DILATED

Question 27

closed angle glaucoma is also known as:

Answer 27

Acute angle-closure glaucoma (AACG) Narrow-angle glaucoma

Question 28

closed angle glaucoma: risk factors

Answer 28

Asian American ethnicity Females Hyperopia Family history Older age

Question 29

is Acute angle-closure glaucoma an emergency?

Answer 29

YES!! Outcome based on time from onset to treatment

Question 30

What triggers an acute episode of closed angle glaucoma?

Answer 30

anticholinergic drugs

Question 31

Acute closed-angle glaucoma: clinical manifestations

Answer 31

Typically UNILATERAL:Other eye is at risk SEVERE eye pain Nausea and vomiting Blurry vision, halos Reddened eyes Dilated pupil– non-reactive to light Cloudy cornea

Question 32

Glaucoma and blindness

Answer 32

d/t the increased IOP More pressure on inner eye structures Decreased blood flow to optic nerve Nerve fiber death leads to blindness

Question 33

which drugs decrease AH production

Answer 33

timolol betaxolol brimonidine

Question 34

which drug increases AH drainage

Answer 34

latanoprost

Question 35

timolol- nonselective & betaxolol- B1 receptor blocks

Answer 35

Class: Optic-topical beta-blockers MOA: Block SNS stimulation of beta receptors SE: Transient burning & discomfort, If allowed to go systemic- can have systemic effects Contraindications: Same as oral beta-blockers Therapeutic use: Open-angle glaucoma maintenance treatment, If acute-angle closure– need drops asap and other interventions Patient teaching: Must take– otherwise will progress to blindness, Apply nasolacrimal pressure with instillation.

Question 36

latanoprost

Answer 36

class: Prostaglandin analogs MOA: increases outflow drainage of aqueous humor Indications: Open-angle glaucoma, Ocular hypertension SE: well-tolerated

Question 37

brimonidine

Answer 37

class: Alpha-adrenergic agonist MOA: decreases AH production, may increase drainage/outflow Indication: Used for open-angle glaucoma & increased IOP SE: Burning/stinging, Dry mouth, Fatigue, H/A, blurred vision, hypotension

Question 38

dozolamide

Answer 38

class: Carbonic anhydrase inhibitor MOA: decreased production of aqueous humor SE: Stinging, Bitter taste, Allergic reactions (conjunctiva or lid reactions) Second-line treatment: Open-angle and increased IOP

Question 39

meniere disease

Answer 39

Endolymphatic hydrops Episodic disorder of the middle ear Can be unilateral or bilateral Excessive endolymph and pressures in the membranes disrupt vestibular (balance) and hearing function

Question 40

CM & treatment of Meniere Disease

Answer 40

recurring episodes of vertigo [usually with nausea & vomiting], hearing loss, ringing in the ears (tinnitus), and feeling of fullness Treatment is symptomatic