Chronic Ophthalmologic Disorders Flashcards
Refractory error
The lens of the eye loses the ability to focus due to loss of elasticity
Effects - Difficult to see objects up close
Presbyopia
Most common age-related problem in ophthalmology
Presbyopia
This disease is 50-100 different versions of an optic nerve disease
(neuropathy) with characteristic optic nerve head and visual field
changes
Glaucoma
What are the types of glaucoma?
Primary Open-Angle (most common)
Angle Closure (emergency)
Childhood
Secondary (after trauma or disease)
What is the most common type of glaucoma?
Primary Open-Angle
What demographics/groups are at more risk for glaucoma?
Common in patients who may be least able to treat themselves or
gain access to care
Elderly
African Americans
Diabetics and CV disease
Individuals with elevated IOP
1st degree relatives with glaucoma
Which type of glaucoma is described below?
High incident in AA population
Adult onset
More likely to go blind
Bilateral (but not always symmetric)
Usually takes years or even decades (can slowly result in complete
blindness)
Compliance an issue
Primary Open-Angle Glaucoma
List some causes of secondary glaucoma
Trauma
Iritis
Chronic Steroid use
Diabetic Retinopathy
Ocular Vascular occlusion
What is the most important testing in glaucoma?
Visual Field Testing
What are the screening guidelines for a Type 1 diabetic?
Annual ophthalmologic exams starting 5 years after diagnosis
What are the screening guidelines for a Type 2 diabetic?
Annual ophthalmologic exams starting at the time of diagnosis
What are the two main glaucoma characteristics?
Optic Nerve Head Changes
Visual Field Changes
In glaucoma, what are the goals of treatment?
Halt further vision loss (cannot regain what is lost)
Halt further optic nerve damage
Slow progression
Vision loss in the center of the field of vision - Loss of central vision ONLY
Leading cause of permanent visual loss in older population
Caused by the deterioration in the central portion of the retina known as the macula
Macular Degeneration
What is the leading cause of permanent visual loss in older population?
Macular Degeneration
What is the macula responsible for?
responsible for focusing central vision in the eye, and it controls our ability to read, drive a car, recognize face/colors, and see objects in fine detail
What are the two classifications of macular degeneration?
Atrophic
Neovascular
What type of macular degeneration is described below?
Gradually progressive bilateral loss of vision due to atrophy and
degeneration of the outer retina and retinal pigment epithelium
Atrophic
What type of macular degeneration is described below?
Choroidal new vessels grow between the retinal pigment epithelium and brunch membrane leading to accumulation of fluid, hemorrhage, and fibrosis
Onset of vision loss is more rapid and more severe
Neovascular
Which type of macular degeneration accounts for 90% of all cases of
legal blindness d/t macular degeneration?
Neovascular
List some risk factors for macular degeneration
Caucasian
Female > male
Family history
Cigarette smoking
Which risk factor for macular degeneration doubles the risk?
Cigarette smoking
What tool is used to assess for macular degeneration?
Amsler grid
What does the Amsler grid assess?
Asses for acute vision changes in macular degeneration
What is the cost common cause of vision loss after refractive error?
Cataract
What is the most common cause of blindness worldwide?
Cataract
A wing-like structure, typically found on the nasal side of cornea
Fleshy and typically triangular
A benign pathologic change in the bulbar conjunctiva at the palpebral
fissure that develops in an eye exposed to drying elements such as sun, wind, and dust
Pterygium and Pinguecula
What is the difference between Pterygium and Pinguecula?
Pinguecula - Does not involve the cornea
Pterygium - Invades the cornea
What are the indications for surgery in cases of Pterygium and Pinguecula?
Growth threatening vision by approaching the visual axis
Marked induced astigmatism
Severe ocular irritation
What is the most common cause of blindness in working age Americans?
Diabetic Retinopathy
What is the best predictor of diabetic retinopathy?
A1c
At what A1c level needs to be achieved to help prevent diabetic retinopathy?
must keep below 7
Defined as spontaneous, rhythmic, back-and-forth movement of one
or both eyes
Rhythmic “jumping”
Nystagmus
What are the three most common types of nystagmus?
End gaze
Jerk (drug induced)
Pendular
What type of nystagmus is described below?
Attempt to maintain gaze in extreme lateral gaze
Not unusual for eye to drift back slightly from the extreme horizontal gaze and then refixate with a small jerk movement
Disappears as gaze is shifted
End gaze
What type of nystagmus is described below?
Drug induced
Dilating, barbiturates, sedatives – jerk nystagmus in all positions of gaze
Jerk (drug induced)
What type of nystagmus is described below?
Searching
commonly seen in individuals who are visually impaired from birth
Pendular
What types of nystagmus should alert the provider to central lesion ideology?
Vertical, bidirectional, or unilateral
Peripheral or central nystagmus?
Horizontal nystagmus may be present
Bilateral
Unidirectional
Rotary/horizontal
NEVER vertical
Improves with visual fixation
Peripheral (outside CNS)
Peripheral or central nystagmus?
Vertical nystagmus may be present
Bilateral or unilateral
Bidirectional or unidirectional
Usually no change with fixation
Central (brainstem or cerebral dysfunction)
Misalignment of visual axis, one or both eyes are divergent away from the midline
Imbalance in ocular muscles
Strabismus
20% of patients with retinoblastoma present with what symptom/sign?
strabismus
What are the four types of strabismus?
Esotropia
Exotropia
Hypertropia
Hypotropia
What type of strabismus is described below?
“in” or “cross-eyed”
One or both eyes deviated towards the nose
Age of onset: 2-5 years
After age 5, suspect a CNS disease
Esotropia
What type of strabismus is described below?
“out”
One or both eyes deviated outward
Exotropia
What type of strabismus is described below?
“up”
Most often seen in adults after trauma or stroke, but do also occur in children
Hypertropia
What type of strabismus is described below?
“down”
Most often seen in adults after trauma or stroke, but do also
occur in children
Hypotropia
What tests can be used to diagnose strabismus?
Cover/uncover test
Corneal light reflex (Hirschberg test)
Unilateral or bilateral decrease in visual acuity that occurs as a result
of a lack of a clear image falling on the retina
Asymptomatic – detected only by screening
Amblyopia
This condition is why we screen for strabismus
Amblyopia
This condition can only occur during the critical period of development
Birth to 8-9 years
Amblyopia
What is the treatment for Amblyopia?
Occlusion - Force the “lazy” (wandering) eye to work
What is the concern and complication of Amblyopia?
loss may be permanent
Once it’s turned off, you can’t turn it back on
