41A evaluation of vision loss

Question 1

TIA affecting the vision in one eye

Answer 1

usually lasts 5-10 mins and are usually the result of platelet thrombin emboli from athermoatous plaques in the carotid artery on the same side.
-amaurosis fugax

Question 2

Basilar Artery insufficiency

Answer 2

transient loss of vision in both eyes simultaneously

Question 3

Papilledema

Answer 3

short-lived loss of vision in one eye is associated with papilledema

Question 4

Migrane

Answer 4

recurrent episodes of vision loss with sparking lights that being in a small area on one side and enlarge over 25-45 mins followed by headache nausea vomiting

Question 5

painless vision loss examples

Answer 5

cataract
central retinal artery or vein occlusion
retinal detachment
possibly tumor

Question 6

optic neuritis

Answer 6

pain on eye movement with loss of central vision and a relative afferent pupillary defect

Question 7

arterial or venous occlusion

Answer 7

-sudden loss of vision in one eye in older adults (over 50)

Question 8

optic neuritis

Answer 8

-unilateral visual loss in a younger patient is more likely optic neuritis but we must rule out demylenating diseases

Question 9

Presence of a RAPD is usually associated with?

Answer 9

-disease of optic nerve, chiasm, or optic tract anterior to the exit of the pupillary fibers

Question 10

Patients with retrobulbar optic neuritis have normal appearance of their optic disk but an abnormal ___?

Answer 10

-positive RAPD

Question 11

A scotoma in only one eye is usually associated with ?

Answer 11

-retinal or optic nerve lesion in that eye

Question 12

Retinal vascular lesions usually respect?

Answer 12

the horizontal midline

Question 13

optic nerve disease usually causes?

Answer 13

a central scotoma

Question 14

compression of the optic chasm typically results in a ?

Answer 14

bitemporal visual field defect

Question 15

Damage to the visual pathways behind the chasm produces?

Answer 15

-homonymous hemianopsia

Question 16

Homonymous defects will respect ?

Answer 16

vertical midline

Question 17

Patient complains of fairly rapid loss of central vision in one eye and may have pain on motion of that eye?

Answer 17

-optic neuritis

Question 18

Optic neuritis

Answer 18

• loss of central vision in one eye
• pt will have positive RAPD
• colors may not be as bright
• fundus exam of optic disk may be normal in retrobulbar and swollen in papillitits

Question 19

Treatment for those patients with significant visual loss from optic neuritis?

Answer 19

-IV corticosteroids

Question 20

Optic neuritis is usually the presenting sign of what?

Answer 20

-Multiple sclerosis

Question 21

Lesion of the optic chiasm?

Answer 21

• reduction in VA in one or both eyes
• bitemporal hemianopsia-asymmetric
• optic nerve appears pale

Question 22

Most common cause of compression of optic chiasm?

Answer 22

-pituitary adenoma

Question 23

Lesion posterior the optic chiasm will produce?

Answer 23

-homonymous hemianopsia

Question 24

Damage between the chiasm and the lateral geniculate body will produce ?

Answer 24

• optic atrophy

- if asymmetric a positive RAPD on the more involved side

Question 25

Lesion posterior to the lateral geniculate body?

Answer 25

-pupillary responses should be normal and no positive RAPD or optic atrophy should be noted

Question 26

The more anterior the lesion is located in the post chasmal pathway the more ____ the visual field defect general is.

Answer 26

-incongruous

Question 27

Dense homonymous hemianopsia in an older patient?

-

Answer 27

-almost always associated with a loss of profusion to the occipital cortex on the opposite side of the field defect

Question 28

Papilldema

Answer 28

bilateral swelling of the optic nerve head due to increase intracranial pressure

Question 29

Two most common causes of papilledema?

Answer 29

• space occupying mass

- pseudotumor cerebri

Question 30

Typical ocular findings in pts with papilledema

Answer 30

• normal VA
• VF full with enlarged blind spot
• no pain on eyemovment
• no afferent pupillary defect
• headaches, N/V due to increased ICP
• may or may not have a 6th cranial nerve palsy

Question 31

Signs of papilledema

Answer 31

• both discs are elevated and hyperemic
• disc margins blurred, indistinct
• small vessels at margin obscured
• retinal vessels are tortuous, dilated
• hemorrhages and exudates
• spontaneous venous pulsations are absent

Question 32

What pt population do we see ischemic optic neuropathy in?

Answer 32

-older patients

Question 33

Ischemic optic neuropathy

Answer 33

• acute loss of vision in older patient
• usually only one eye
• afferent pupil defect present
• disc is swollen and pale
• ischemia of disc
• altitudinal hemianopsia common
• must R/O temporal arteritis

Question 34

Central retinal artery occlusion

Answer 34

• retine will be pale due to welling secondary to ischemia
• optic disc will be pale
• arteries will be narrowed
• macula will have cherry red spot

Question 35

Central retinal vein occlusion

Answer 35

• hemorrhagic infarct of the retina
• disc is swollen and hyperemic
• prominent venous distention and flame shaped

Question 36

what defects are associated with optic atrophy?

Answer 36

• optic nerve, chiasm, or optic trant anterior to the lateral geniculate body
• possibly wide spread retinal damage

Question 37

Causes of optic atrophy?

Answer 37

• tumors
• demyelinating diseases
• toxins

Question 38

optic atrophy + pallor of disc + large optic cup=

Answer 38

advanced chronic open angle glaucoma

Question 39

Chronic open angle glaucoma

Answer 39

-increased ICP
-optic nerve is damaged
-enlargement of optic cup and pallor
-