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OMS - 2 Neuro Final > Acute Visual Loss > Flashcards

Acute Visual Loss Flashcards

1
Q

Define ophthalmoscopy

A

Looking in the back of the eye

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2
Q

Sudden visual loss questions to ask the patient

A

Age

medical condition

visual loss transient, persistent, or progressive?

visual loss monocular or binocular?

Severe is the loss of vision?

  • What was the tempo? Did the visual loss occur abruptly, or did it develop over hours, days, or weeks?
  • Did the patient have normal vision (with glasses if needed) in the past?
  • Was pain associated with the visual loss?
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3
Q

What are the 6 things included in an eye exam?

A
  1. Visual acuity (VA) testing
  2. Pupillary reaction
  3. Confrontation field testing
  4. Ophthalmoscopy (red reflex & fundus)
  5. Penlight examination
  6. EOM motility
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4
Q

What is a media opacity

A

Something in the eye that prevents the patient from seeing out of their eye and you from seeing into it)

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5
Q
A

abnormal red reflex

(indicates retinoblastoma- urgent referral)

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6
Q

Define red reflex

A
  • Reflection of light off of the ocular fundus
  • red in color
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7
Q
A
  1. Peripheral Iris shuts off the trabecular meshwork and it elevates the intraocular pressure
  2. Severely painful → nausea and vomiting
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8
Q

Symptoms of acute angle closure glaucoma

A
  1. pain
  2. red eye
  3. hazy/cloudy cornea
  4. decreased vision
  5. pupil mid-dilated and fixed (no rxn to light)

(black people 1/3 will not have pain)

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9
Q

Acute angle closure glaucoma can develop from which medical procedure?

A

Dilating a patient’s eye with a narrow angle glaucoma

(if it does, they need to be referred immediately)

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10
Q

What is this?

A

trauma to the eye may disperse blood in anterior chamber

(if they sit for 20 minutes the blood will collect at the bottom)

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11
Q
A

Mature cataract: total opacity to the eye

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12
Q
A

Acute vitreous hemorrhage

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13
Q
A

Retinal detachment

(must be dilated to view)

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14
Q

Retinal detachment symptoms

A
  • Sudden shower of floaters & lightning streaks
  • Straight ahead vision absent

+/- A shadow curtain Falls over there vision

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15
Q

Why is a retinal detachment and urgent referral?

A
  1. It can be repaired if the macula remains intact
  2. Vision will remain intact
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16
Q
A

Dry form of macular degeneration

(note pigmentation)

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17
Q

MCC have legal blindness in the United States

A
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18
Q

Most patients with the dry form of macular degeneration will also develop ______.

A

The wet form of macular degeneration

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19
Q
A

What form of macular degeneration

(donut looking structure = retinal pigment epithelium elevation, deep net of new vessels push it upward. also seen with hemorrage)

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20
Q

What is a typical sign of this condition?

A

The patient will say that tables look tilted and telephone poles look bent

(Wet Macular Degeneration - urgent)

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21
Q
A

Leaking sub retinal net in the fovea visualized via fluorescein angiography (injected into arm vein)

(trmt: anti-VEGF)

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22
Q

What are these? Where are they typically seem?

A
  • Hollenhorst plaques
  • Bifurcation of arteries

(typically do not obstructs the artery; typically comes from the Atria of the heart or carotid a.)

23
Q

How will the patient present?

A

Sudden blindness

(the cherry red spot is the only part of the normal retina left)

24
Q

What is the cause of this?

A

Stroke

(if this is not fixed immediately, they will be permanently blind)

25
Q

What is the treatment for acute central retinal artery occlusion (cherry-red spot)?

A
  • SED rate
  • prednisone

(current recommendations are to send them to a stroke center. If you do not they could develop a CVA)

26
Q
A

Branch retinal artery occlusion with hollenhorst plaque

27
Q
A

” blood and Thunder fundus”

Central retinal vein occlusion, blood pours everywhere

(poor prognosis)

28
Q
A

Branch retinal vein occlusion with macular edema

29
Q

Branch retinal vein occlusion with macular edema: treatment

A

Intravitreol injections of anti-VEGF Rx

30
Q
A
31
Q

Optic neuritis is associated with _____ (disease)

A

multiple sclerosis

32
Q

____ % of patients with multiple sclerosis will develop optic neuritis.

If someone presents with optic neuritis, ______% of the time they will develop multiple sclerosis.

A
  • 50
  • 15
33
Q

Symptoms of optic neuritis

A
  • Decrease vision
  • Afferent pupillary defect (APD)
34
Q

Retrobulbar neuritis:

A

decrease vision and APD, BUT fundus looks normal bc nerve inflammation is BEHIND the globe, and before the optic chiasm.

35
Q

Optic neuritis is most common in which patient population?

A

MC in females 20-30s

36
Q

What is the difference of papillitis and papilledema on examination

A
  • Both have swollen disc in the back of the eye
  • Papillitis: Vision will be decreased, only in one eye, APD
  • Papilledema: will not have decreased vision, it will be both eyes.
37
Q

Ischemic optic neuropathy (ION) types

A
  • nonarteritic (NAION)
  • Arteritic (AION)
38
Q

Nonarteritic (NAION) symptoms:

A
  1. Swollen disc
  2. Decrease vision
  3. Altitudinal field defect (they can’t see the upper field as well as the lower or vice versa)

(seen in patients over 60 y.o.)

39
Q

Arteritic optic neuropathy (AION) is seen in which patient population?

A

70’s-80’s

40
Q

Arteritic optic neuropathy (AION) symptoms

A
  1. SED rate ~ 70
  2. Giant cell arteritis
  3. TIA (they will say, “I went blind for 5 min and it went away. I’m find. )
41
Q

TIA is an urgent referral to ______

A

stroke center

42
Q
A

ischemic optic neuropahty

43
Q

What is the cause of ischemic optic neuropathy?

A

unknown

44
Q

Define the 2 types of hemianopia

A
  1. Homonymous hemianopia: half the field on same side
  2. Bitemporal hemianopia: temporal portions affected
45
Q

What is the cause of hemianopia?

A

lesion of the pituitary

46
Q

What do the pupils look like in a patient with cortical blindness?

A

Normal: pupillary fibers do not go to the occipital cortex.

They go to optic tracts → decussate in the optic chiasm → right and left geniculate body → dive down to the Edinger Westphal nucleus in the midbrain → decussate → follow the third nerve out to the eye

47
Q

Cortical blindness symptoms

A
  • normal pupils
  • confabulation: they think that they can see (if you ask them how many fingers you are holding up, but you hold up none, they will give you an answer)
48
Q

List two functional ophthalmologic disorders

A
  1. Hysteria
  2. Malingering
49
Q

Define hysteria

A

psychosomotic blindness

(ex: they are a sniper and going to be deployed in war and they all of the sudden can’t see. They really experience blindness, but it is not true)

50
Q

Define malingering

A

saying that you have a disability for gain (ex: worker’s comp, to get a medical leave)

51
Q

Acute central retinal artery occlusion will lead to a ______ if not treated immediately.

A

stroke

52
Q

What are the two ophthalmology emergencies?

A
  1. Acute Central retinal artery occlusion
  2. Chemical Alkali Burns
53
Q

What would you expect to see when a young overweight patient states that they stood up from squatting and they lost vision, but it came right back

A

bilateral papilledema

(pseudotumor cerebri)

OMS - 2 Neuro Final (36 decks)

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