5: Decreased Vision/Neuro Flashcards
How do you tell the difference between decreased vision and a refractive error?
Check both distance and near vision. If a refractive error, only 1 of the 2 is reduced.
If a refractive error, vision will improve while looking through a _____.
Pinhole occluder
Sudden, painless, transient blurring of vision that improves with blink.
Dry eye syndrome
Sudden, painless, transient blurring of vision that affects parts of field of vision. Lasts 10-60 minutes.
Migraine (visual aura)
Sudden, painless, transient blurring of vision that lasts a few seconds and is bilateral. Medical emergency!
Papilledema. Increased ICP is always bilateral. Look for absence of spontaneous venous pulsation.
Sudden, painless, transient blurring of vision that lasts a few minutes and is caused by hypoperfusion of the globe. It is usually unilateral (except for vertebrobasilar artery insufficiency).
Amaurosis fugax
With amarousis fugax, you check for _____ symptoms.
TIA
When is amarousis fugax urgent?
With TIA symptoms
What is management for amarousis fugax (3)?
- Carotid artery evaluation
- Hypercoagulable blood work
- Cardiac evaluation
A “curtain” in the vision that is sometimes preceded by flashes/floaters.
Retinal detachment
Which type of retinal detachment is more urgent and why?
If central vision is intact, as this indicates the macula is still attached and can be saved. If central vision is lost, then the macula is not attached and the damage is already done.
Usually d/t an embolus.
Retinal artery occlusion
What would you expect to find with a central artery occlusion?
Cherry red spot
There is a _____ window to dislodge the embolus in retinal artery occlusions.
24-hour window
What is treatment for retinal artery occlusion (2)?
- Decrease IOP.
2. Dilate blood vessels.
Patients 50 and older with retinal artery occlusions need what?
Urgent giant cell arteritis workup (stat CRP/ESR, platelets, temporal artery biopsy).
This type of occlusion is “blood and thunder.”
Central Occlusion
This type of occlusion has only a partial loss of field of vision.
Branch Occlusion
Is central or branch occlusion more urgent?
Central. Will only treat branch if macular edema or neovascularization.
Why do you have regular eye exams for the first 6 months with retinal vein occlusion?
Check for neovascularization.
What do you check with retinal vein occlusion (2)?
- BP
2. Cholesterol
Patients 50 and older with retinal vein occlusions need what?
Urgent giant cell arteritis workup (stat CRP/ESR, platelets, temporal artery biopsy).