Acute Vision Loss

Question 1

confrontation

Answer 1

Peripheral vision

Question 2

Marcus-Gunn pupil

Answer 2

Lesion is anterior to the optic chiasm

Question 3

Iris Synechia

Answer 3

Iris is tethered to the anterior lens capusle

Question 4

Tx for Iris Synechia

Answer 4

Try to dilate the eye and let it break carefully but it may be stuck

Question 5

What is this?

Answer 5

Iris Synechia

Question 6

What is the appearance of corneal edema?

Answer 6

Ground glass appearance

Question 7

What causes corneal edema?

Answer 7

Increased intraocular pressure, damage to the corneal tissue by dystrophies, trauma, surgery

Question 8

Signs of acute angle closure glaucoma

Answer 8

Intense pain, fixed pupil, red eye, corneal edema, very high IOP. This is an EMERGENCY! Often after pt. was in darkness and suddenly exposed to light. Pt. is very sick in this case

Question 9

Tx for acute angle closure glaucoma

Answer 9

laser iridotomy

Question 10

What is this?

Answer 10

Corneal Edema

Question 11

What is this?

Answer 11

Acute angle closure

Question 12

Hyphema

Answer 12

Blood in the anterior chamber, usually traumatic. Spontaneous in rubeosis (neovascularization- may be caused by diabetes, tumors, s/p surgery, chronic inflammation)

Question 13

What is this?

Answer 13

Hyphema

Question 14

What don’t you do with someone who has hyphema?

Answer 14

Lay them down

Question 15

Hypopion

Answer 15

WBC’s forming pus in the anterior chamber, usually from infection but can be sterile

Question 16

What is this?

Answer 16

Hypopion

Question 17

What is this?

Answer 17

Cataract

Question 18

Signs of vitreous hemorrhage

Answer 18

Reduction in vision from opaque blood blocking light- poor red reflex. If the lens appears clear but you can’t see the fundus- suspect

Question 19

What is this?

Answer 19

Vitreous hemorrhage

Question 20

What is one distinctive sign that an eye lesion is a vitreous hemorrhage?

Answer 20

The retinal architecture is still intact but it is obscured

Question 21

Signs of retinal detachment

Answer 21

Flashing lights, shower of floaters, curtain or cloud in vision, painless. “little bugs in vision”

Question 22

What is this?

Answer 22

Retinal detachment

Question 23

Macular disease

Answer 23

Painless reduction in visual acuity

Question 24

Most common cause of macular disease

Answer 24

Subretinal neovascularization form age related macular degeneration

Question 25

Symptom of macular disease

Answer 25

Central metamorphopsia (wavy vision)

Question 26

What is the number 1 cause of blindness in the US and other developed countries?

Answer 26

Macular degeneration

Question 27

What is this?

Answer 27

Metamorphopsia

Question 28

Transient monocular loss

Answer 28

amaurosis fugax

Question 29

Signs of central retinal artery occlusion

Answer 29

sudden painless often complete visual loss "like a curtain drawn down over the eyes"

Question 30

Early findings of central retinal artery occlusion

Answer 30

narrowed arterioles, after several hours, cell death occurs causing white retinal edema

Question 31

Besides Tay-sachs and niemann-pick, what eye defect displays a cherry red spot?

Answer 31

central retinal artery occlusion

Question 32

What is this?

Answer 32

Cherry red spot from central retinal artery occlusion

Question 33

Tx for central retinal artery occlusion

Answer 33

Firm digital compression for 10 sec cycles, try to dislodge the embolus, paracentesis of the anterior chamber

Question 34

What is the mortality rate with central retinal artery occlusion?

Answer 34

50% five year mortality rate (from underlying cardiovascular conditions)

Question 35

Management of retinal vein occlusion

Answer 35

ASA qd, some forms need laser treatment, can lead to neovascular glaucoma

Question 36

Retinal vein occlusion

Answer 36

painless subacute loss of vision, often severe, causes HTN, DM, vasculopathies

Question 37

Which disorder of the eye is associated with a "blood and thunder" fundus?

Answer 37

Retinal Vein Occlusion

Question 38

What is this?

Answer 38

Retinal vein occlusion

Question 39

Inflammation of optic nerve

Answer 39

optic neuritis

Question 40

pain with eye movements

Answer 40

optic neuritis

Question 41

What is this?

Answer 41

Optic neuritis

Question 42

Tx for optic neuritis

Answer 42

MRI to rule out tumor, aneurysm, etc. If MS, may treat with high dose methylprednisolone 1g IV over 45 mins qd x 5 (No PO steroids first!)

Question 43

Optic nerve inflammation

Answer 43

Papillitis

Question 44

Bilateral swelling of optic disc from increased intracranial pressure

Answer 44

Papilledema

Question 45

systemic disease in older patients. Presents with malaise, headache, fever, weight loss, pain and tenderness of muscles and joints, scalp tenderness and JAW CLAUDICATION

Answer 45

Giant cell (temporal) arteritis

Question 46

Standard of care for giant cell arteritis

Answer 46

sed rate and CRP

Question 47

TX for giant cell arteritis

Answer 47

If sed rate is over 60, treat with high dose corticosteroids and H2 blocker. Also obtain a temporal artery biopsy, don't wait to treat

Question 48

What is the major concern over the progression of giant cell arteritis?

Answer 48

progression to other eye with profound vision loss and systemic sequelae

Question 49

Where is the lesion most often in homonymous hemianopia?

Answer 49

retrochiasmal

Question 50

where is the lesion in bitemporal hemianopia?

Answer 50

chiasm

Question 51

complete loss of vision, normal pupillary light response, and normal fundus exam

Answer 51

Cortical blindness