BASICS Flashcards
What is the primary mechanism of acute visual loss/compromise in acute angle closure glaucoma?
Corneal edema.
What is a common cause of corneal edema and how does it present?
Sudden opacification of cornea, w/ ground glass appearance; dulling of incident light. Common cause is increased IOP.
What does mimics corneal edema?
Any infectious/inflammatory process of the cornea (HSV, ZOSTER, KERATITIS)
What are the hallmarks of iritis/uveitis, and what IS it?
Eye pain w/ photophobia, and eventually meiosis d/t inflamed ciliary body, iritis/uveitis is usually autoimmune/idiopathic inflammation of the uvea (iris, ciliary body, and choroid, which sits b/t the sclera & retina and supplies it w/ blood). On exam, there are cells in the anterior chamber, and iris may be fixed & small.
What is associated w/ iritis/uveitis?
blunt trauma, HLA-B27, SLE, sarcoidosis,
What are complications of iritis/uveitis, and what is the treatment?
Complications of iritis/uveitis include glaucoma, cataracts, adhesions of iris to lens (= posterior synechiae), and in posterior uveitis, retinal hemorrhage, perivasculitis, neovascularization of peripheral retina. Treatment is STEROIDS topical and/or systemic.
What 6 things do you need to examine in acute vision loss?
visual acuity, confrontation field testing (homonomous hemianopsia may have nL acuity!), pupillary rxns, Opthalmoscopy including red reflex, penlight if slitlamp not available, tonometry
What is a hyphema and what conditions are associated?
anterior chamber blood, whether a li’l or lots. Ass’c w/ BLUNT TRAUMA, and abnL iris vessels associated with causes of neovascularization like tumors, DM, intraocular surgery, chronic inflammation.
What should you consider in sudden vision loss in pts with cataracts?
sudden changes in hydration or blood sugar, which can change the optical properties of the lens.
What exam finding suggests vitrrous hemorrhage, and what conditions are associated w/ this ominous condition?
Absent red reflex, but clear lens w/ opthalmoscopy; Consider causes like retinal tears, proliferative diabetic retinopathy, proliferative sickle cell retinopathy, trauma, retinal vein occlusion, SAH/Intracranial aneurysms!
WHat retinal diseases can cause sudden vision loss?
REtinal detachment, retinal vascular occlusion like amurosis fugax, retinal tears, acute angle glaucoma, and inflammatory conditions like vasculitides, infectious chorioretinitis, and idiopathic inflammation, bleeding from neovascular nets of macular degeneration
What’s the classic presentation of retinal detachment?
Photopsia (flashing lights) followed by large numbers of or very large floaters, then a shade over vision in one eye. A relative APD may be appreciable if detachment is severe.
What do you do if u suspect retinal detachment?
dilate eye and look while you emergently consult an opthalmologist who will save the day. Retina appears elevated, +/- folds, and choroidal background is indistinct.
What do you do for all pts >50yo w/ unlilateral vision loss lasting several minutes?
ipsilateral carotid duplex, cardiac ultrasound valves and chambers, and referral to neuro, ophto, and or surg
A person presents w/ 1 hr hx of sudden painless unilateral vision loss that is nearly complete. On fundoscopy their retina is relatively unremarkable, showing only narrowing of arterial blood columns and boxcarring of veins. What’s the dx and what would u expect to see w/ fundoscopy a few hours later?
Central Retinal Artery Occlusion. Narrowing of arterial blood columns in arteries is d/t lack of flow, as is boxcarring, which is clear blood-free space b/t corpuscles. In a few hours, the retina becomes opalescent, losing most transparency around the fovea and producing pallour surrounding the fovea which is still red (is there collateral flow?) b/c the retina is thinnest there and choroid is still visible. This causes CHERRY RED SPOT. MAJOR OPHALMOLOGIC EMERGENCY!!!
