Acute Visual Loss Flashcards
Define ophthalmoscopy
Looking in the back of the eye
Sudden visual loss questions to ask the patient
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?
What are the 6 things included in an eye exam?
- Visual acuity (VA) testing
- Pupillary reaction
- Confrontation field testing
- Ophthalmoscopy (red reflex & fundus)
- Penlight examination
- EOM motility
What is a media opacity
Something in the eye that prevents the patient from seeing out of their eye and you from seeing into it)
abnormal red reflex
(indicates retinoblastoma- urgent referral)
Define red reflex
- Reflection of light off of the ocular fundus
- red in color
- Peripheral Iris shuts off the trabecular meshwork and it elevates the intraocular pressure
- Severely painful → nausea and vomiting
Symptoms of acute angle closure glaucoma
- pain
- red eye
- hazy/cloudy cornea
- decreased vision
- pupil mid-dilated and fixed (no rxn to light)
(black people 1/3 will not have pain)
Acute angle closure glaucoma can develop from which medical procedure?
Dilating a patient’s eye with a narrow angle glaucoma
(if it does, they need to be referred immediately)
What is this?
trauma to the eye may disperse blood in anterior chamber
(if they sit for 20 minutes the blood will collect at the bottom)
Mature cataract: total opacity to the eye
Acute vitreous hemorrhage
Retinal detachment
(must be dilated to view)
Retinal detachment symptoms
- Sudden shower of floaters & lightning streaks
- Straight ahead vision absent
+/- A shadow curtain Falls over there vision
Why is a retinal detachment and urgent referral?
- It can be repaired if the macula remains intact
- Vision will remain intact
Dry form of macular degeneration
(note pigmentation)
MCC have legal blindness in the United States
Most patients with the dry form of macular degeneration will also develop ______.
The wet form of macular degeneration
What form of macular degeneration
(donut looking structure = retinal pigment epithelium elevation, deep net of new vessels push it upward. also seen with hemorrage)
What is a typical sign of this condition?
The patient will say that tables look tilted and telephone poles look bent
(Wet Macular Degeneration - urgent)
Leaking sub retinal net in the fovea visualized via fluorescein angiography (injected into arm vein)
(trmt: anti-VEGF)
What are these? Where are they typically seem?
- Hollenhorst plaques
- Bifurcation of arteries
(typically do not obstructs the artery; typically comes from the Atria of the heart or carotid a.)
How will the patient present?
Sudden blindness
(the cherry red spot is the only part of the normal retina left)
What is the cause of this?
Stroke
(if this is not fixed immediately, they will be permanently blind)
What is the treatment for acute central retinal artery occlusion (cherry-red spot)?
- SED rate
- prednisone
(current recommendations are to send them to a stroke center. If you do not they could develop a CVA)
Branch retinal artery occlusion with hollenhorst plaque
” blood and Thunder fundus”
Central retinal vein occlusion, blood pours everywhere
(poor prognosis)
Branch retinal vein occlusion with macular edema
Branch retinal vein occlusion with macular edema: treatment
Intravitreol injections of anti-VEGF Rx
Optic neuritis is associated with _____ (disease)
multiple sclerosis
____ % of patients with multiple sclerosis will develop optic neuritis.
If someone presents with optic neuritis, ______% of the time they will develop multiple sclerosis.
- 50
- 15
Symptoms of optic neuritis
- Decrease vision
- Afferent pupillary defect (APD)
Retrobulbar neuritis:
decrease vision and APD, BUT fundus looks normal bc nerve inflammation is BEHIND the globe, and before the optic chiasm.
Optic neuritis is most common in which patient population?
MC in females 20-30s
What is the difference of papillitis and papilledema on examination
- 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.
Ischemic optic neuropathy (ION) types
- nonarteritic (NAION)
- Arteritic (AION)
Nonarteritic (NAION) symptoms:
- Swollen disc
- Decrease vision
- 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.)
Arteritic optic neuropathy (AION) is seen in which patient population?
70’s-80’s
Arteritic optic neuropathy (AION) symptoms
- SED rate ~ 70
- Giant cell arteritis
- TIA (they will say, “I went blind for 5 min and it went away. I’m find. )
TIA is an urgent referral to ______
stroke center
ischemic optic neuropahty
What is the cause of ischemic optic neuropathy?
unknown
Define the 2 types of hemianopia
- Homonymous hemianopia: half the field on same side
- Bitemporal hemianopia: temporal portions affected
What is the cause of hemianopia?
lesion of the pituitary
What do the pupils look like in a patient with cortical blindness?
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
Cortical blindness symptoms
- 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)
List two functional ophthalmologic disorders
- Hysteria
- Malingering
Define hysteria
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)
Define malingering
saying that you have a disability for gain (ex: worker’s comp, to get a medical leave)
Acute central retinal artery occlusion will lead to a ______ if not treated immediately.
stroke
What are the two ophthalmology emergencies?
- Acute Central retinal artery occlusion
- Chemical Alkali Burns
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
bilateral papilledema
(pseudotumor cerebri)
