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Ophthalmology > Acute Vision Loss > Flashcards

Acute Vision Loss Flashcards

1
Q

Acute Vision Loss ?s

A 
Monocoluar/binocular?
Pain?
Photophobia?
Chronology?
Other sx?
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2
Q

Pain w/ AVL suggests

A

cornea, iritis, acute glaucoma, optic neuritis

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3
Q

No pain w/ AVL suggests

A

retina, retinal vessels, brain

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4
Q

Photophobia w/ AVL suggests

A

uveitis (iritis/iridocyclitis), acute glaucoma, corneal abrasion/trauma

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5
Q

Eye Hx

A

Baseline vision w/ correction
Cataracts, glaucoma, mac degeneration, diabetic retinopathy
Traumas, surgeries, amblyopia, eye drops?

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6
Q

Age and Medical Hx

A

HTN, Dyslipidemia, Diabetes
Rheumatologic (RA, SLE, IBD)
Cancer

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7
Q

Review of systems Hx

A

Think stroke/TIA

HA, dizziness, numbness, weakness, nausea

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8
Q

PE Tools

A

Visual acuity chart (best corrected w/ pinhole). Don’t rush.
Flashlight/penlight.
Direct ophthalmoscope
Slit lamp

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9
Q

Eye Vital Signs

A 
External exam
VA
Pupils
Eye pressur
Ocular motility
Confrontation
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10
Q

Relative afferent pupillary defect (RAPD)

A

lesions of optic nerve (optic neuritis, ischemic optic neuropathy) or >50% retina (detachment, vascular occlusion)

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11
Q

Slit Lamp Examines what

A

Cornea, anterior chamber, iris

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12
Q

Extended eye exam

A

Direct Ophthalmoscope for red reflex, optic nerve (nasal side), vessels

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13
Q

Vascular acute vision loss

A

diabetes, vascular occlusions, amaurosis

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14
Q

Infectious acute vision loss

A

HSV/VZV, bacterial keratitis/contact lens use, endophthalmitis

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15
Q

Traumatic acute vision loss

A

abrasion, ruptured globe, hymphema

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16
Q

Autoimmune acute vision loss

A

Uveitis, optic neuritis, temporal arteritis

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17
Q

Metabolic acute vision loss

A

diabetes (lens swelling)

18
Q

Iatrogenic acute vision loss

A

psych meds, immune modulators

19
Q

Neoplastic acute vision loss

A

Don’t usually create ACUTE vision sx

20
Q

Degenerative (age-related) acute vision loss

A

cataracts, glaucoma, AMD

21
Q

Corneal abrasions

A

Anterior

Hx: sudden onset, painful, FBS, photosensitivity, tearing, blurred vision, Associated w/ trauma, FB, contact lens

Exam: Decreased acuity, fluorescein uptake, pain improves w/ topical anesthetics (CANNOT GIVE TO TAKE HOME)

Tx: Evert lids to remove foreign body, topical abx (polymixin-trimethoprim gtt or erythromycin for non CTL wearers and Vigamox gtt or Ciloxan ung for CTL wearers)
Epithelium heals quickly, breaks allow infection

22
Q

Corneal ulcers

A

Infection of corneal stroma
Hx: untreated abrasion w/ secondary infection
Exam: corneal INFILTRATE (focal opacity in stroma)
Tx: CONSULT ophthalmology for possible culture, abx or antifungal drops

23
Q

Corneal edema

A

Opacification, dulling of light reflex
DDx: uveitis/inflammation, increased IOP (angle closure), corneal endothelial dystrophies

Ophtho or opto referral

24
Q

Herpetic Keratitis

A

Hx: FBS, eye pain, photophobia, blurred vision; previous or current HSV or VZV; skin vesicles/SKIN RASH

Exam: dec acuity, possible fluorescein uptake (dendritic), possible corneal edema, possible AC cell/flare

Tx: OPHTO consult for dilated exam; treat w/ oral acyclovir/valacyclovir, topical abx to prevent secondary infection, cycloplegic

25
Q

Hyphema

A

Blood in anterior chamber
Hx: blunt trauma (most); abnormal iris vessels and neovascularization (ischemic conditions)

Exam: vision variable by hyphema size (normal to LP); IOP possible elevated

Tx: OPHTHO URGENT REFERRAL: No ASA/NSAIDS, bedrest, upright/HOB elevated, eye shield; topical steroid & cycloplegic, +/- IOP drop; Dilated exam or US to r/o retinal detachment; may need to evaluate for sickle cell disease

26
Q

Anterior Uveitis

A

Hx: Blurry vision, CONSENSUAL photophobia, redness, pain (does not improve w/ topical anesthetics); Most idiopathic (can be ass w/ conditions or infections)

Exam: decreased acuity, AC cell/flare, typically need to do slit lamp exam to see

Tx: URGENT OPHTHO CONSULT, treat w/ steroid drops once infection ruled out; cycloplegic

27
Q

Hypopyon

A

Prurulence in anterior chamber

Hx: recent open eye surgery/trauma (EXOGENOUS ENDOPHTHALMITIS), severe systemic infection (ENDOGENOUS ENDOPHTHALMITIS, rare), severe corneal ulcer (AC rxn), severe eye pain, decreased vision, redness

Exam: red, painful eye, decreased vision, HYPOPYON

Tx: EMERGENT OPHTHO CONSULT, if endophthalmitis, need IV abx or surgical vitrectomy

28
Q

Uncontrolled Glaucoma

A

Most commonly angle closure glaucoma (other forms possible); Increased IOP

Hx: HA, Eye pressure/pain, nausea, rainbows/halos, decreased vision, +/- photophobia, may have glaucoma hx

Exam: increased IOP, corneal edema (if sudden), mid-dilated pupil (if sudden), +/- closed/narrow angle, +/- abnormal iris vessels, +/- AC cell/flare

Tx: OPHTHO CONSULT >30 and EMERGENT >40mm Hg, start IOP lowering drops +/- oral diamox depending on IOP

29
Q

Lens change/cataract

A

Hx: most develop slowly (except traumatic); some pt interpret progression as sudden visual loss (acute discovery of chronic loss)

Exam: Lens opacities

Tx: OUTPATIENT OPHTHO (unless traumatic, then urgent)

Clear lenses? acute hyperglycemia alters lens hydration and shape, causes large change in refractive error

30
Q

Vitreous hemorrhage

A

Hx: painless vision loss/darkening, floaters
Can be caused by long-standing ischemic conditions (diabetes, retinal vein occlusions) or seen in retinal tears/detachments

Exam: decreased acuity, POOR RED REFLEX

Tx: URGENT OPHTHO CONSULT for dilated exam and/or US

31
Q

Posterior Vitreous Detachment

A

Hx: flashing lights, floaters

Exam: +/- decreased visual acuity

Tx: URGENT OPHTHO CONSULT for dilated exam

32
Q

Retinal tear/detachment

A

Hx: same as posterior vitreous detachment +/- shade or curtain in peripheral vision

Risks: myopia, trauma, family hx, age

Exam: Visual field loss, possible poor red reflex, possible detachment/tear on US, visual acuity may be normal

Tx: URGENT OPHTHO CONSULT for dilated exam, possible OR

33
Q

Age-related Macular Degeneration

A

Hx: slow loss of central vision for DRY form; SUDDEN METAMORPHOPSIA (distortion of vision, wavy lines) or decreased vision for WET form. DRY can become WET

Exam: macular drusen (yellow subretinal deposits), +/- subretinal hemorrhages

Tx: OPHTHO OUTPT w/in 1 week if suspect new onset WET AMD, needs dilated exam

34
Q

Retinal artery/vein occlusion

A

Hx: SUDDEN PAINLESS VISION LOSS IN MIDDLE AGE PATIENT w/ HTN, DM, DYSLIPIDEMIA; or young pt w/ hypercoagulability

Exam: decreased vision or field loss (ARTERY: pale white fundus +/- cherry red spot; VEIN: blood and thunder diffuse hemorrhages and edema)

Tx: STAT OPHTHO CONSULT; may need systemic work-up including carotid US and echo for arterial oclusion

35
Q

Amaurosis Fugax

A

Hx: monocular vision loss, painless, transient lasting minutes (often described as a shade that comes down but full vision returns)

MANY potential causes: MOST COMMON = EMBOLIC/HEMODYNAMIC from CAROTID DISEASE

Considered form of TIA & treated as such (may indicate serious vascular disease, such as embolic stroke)

WORKUP: complete PE, Carotid duplex US, echo, +/- head imaging

36
Q

Optic Neuritis

A

Hx: younger (female) pt w/ vision loss

Exam: decreased acuity, pain w/ eye movement, color vision change, RAPD, swollen optic nerve (1/3)

Tx: consult ophthalmology, MRI, +/- IV steroids

37
Q

Ischemic Optic Neuropathy

A

Hx: Older pt w/ painless vision loss, h/o HTN, DM, HLD

Exam: decreased acuity and/or visual field loss (altitudinal), no pain, RAPD, swollen optic nerve acutely

Tx: consult ophthalmology, screen for TEMPORAL ARTERITIS (>60 yo w/ myopia, jaw pain)

38
Q

Papilledema

A

bilateral disc edema due to increased ICP
Hx: HA, tinnitus, no/mild visual disturbance (positional), NV

DDX: IC Mass/bleed, hydrocephalus, pseudotumor cerebri (IIH), meningitis/encephalitis, AVM, venous sinus thrombosis

WORKUP: start w/ imaging, +/-LP, CALL OPHTHO and NEURO

39
Q

Orbital cellulitis

A

Posterior problem (optic nerve)

Hx: swelling/redness of eyelids, eye pain, decreased vision, pain w/ eye movement, +/- recent sinusitis or tear duct blockage

Exam: tender, red swollen eyelids, chemosis (swelling of conjunctiva), +/- (decreased vision, APD, color vision change, motility deficits)

Tx: CT, OPHTHO CONSULT POSSIBLE EMERGENT OR, Hospital admission, IV abx

40
Q

Temporal arteritis

A

Vasculitis than can cause permanent vision loss from ischemic optic neuropathy
EMERGENT

Hx: transient or permanent vision loss, HA, scalp tenderness, fever, jaw claudication, hip/shoulder pain, typically in pt > 50yo

Exam: optic nerve edema or pallor, artery occlusion also possible

Labs: ESR, CRP

Tx: High dose prednisone STAT (to prevent further vision loss), Consult OPHTHO (or other surgical service) for temporal artery biopsy w/in 1 week

41
Q

Migraines

A

Hx: bilateral loss of vision, lasts 1-60 min, often w/ aura, vision recovers completely +/- HA

Exam: transient decrease in VA

Tx: migraine meds, further eval if HA severe or patient has other neuro sx

42
Q

Stroke

A

Hx: bilateral loss vision or visual field, older pt w/ field loss or neglect, often w/ other neuro sx

Exam: decreased vision or loss visual field bilaterally (often hemianopia)

Tx: imaging, NEURO OR NEUROSURG CONSULT

Ophthalmology (9 decks)

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