Clinical Opthamology Flashcards
What are the Big 3 eye problems?
Cataracts
Macular Degeneration
Glaucoma
What is a cataract?
Causes?
Opacity of the normally clear lens
caused by age, metabolic disorder, trauma or heredity
Use surgery to replace lens with implant
What is macular degeneration?
loss of vision in the center of the visual field (the macula) because of damage to the retina.
A major cause of vision impairment and blindness in older adults
What is the difference between wet and dry macular degeneration?
Dry: drusen (tiny yellow or white accumulations of extracellular material)
progressing into: pigmentary retinopathy and atrophy of retina, diminished vision
Wet: It is exudative, defects in deep retinal layers, growth of blood vessels under and in the retina, edema, hemorrhage, fibrosis and scarring. loss of vision
Treatment for dry and wet macular degeneration:
Dry Macular Degeneration: quit smoking, nutritional recommendations, AREDS supplements, manage systemic diseases
Wet Macular Degeneration: above recommendations plus conventional laser, photodynamic therapy, anti-vegf drugs(Avastin, Eyelea, Lucentis, Macugen) - these drugs will dry up the exudative stuff
What is glaucoma?
How do you treat it?
Increased Ocular Pressure causes optic nerve loss
Treat: lower eye pressure through medicine, surgery or laser
What is a pathological sign that can be monitorred over time to see worsening glaumoma?
Optic nerve cupping
Cup is enlarged due to loss of run tissue
(this indicates loss of optic nerve fibers which is common is glaucoma)
(cupping can be other stuff too, watch out!)
How do glaucoma meds work?
Decrease IOP by decreasing aqueous production or increasing outflow
How is acute/narrow angle glaucoma more severe than open angle?
The onset is acute, it causes severe pain and los of vision
The ocular pressure is extremely high because the narrow angle is actually closed and will not let any fluid outlfow occur
How do you treat acute glaucoma?
Pilocarpine
Acetazolamide
Laser iridotomy - opthamologist (opens up iris to allow for aqueous flow once more)
What is diabetic retinopathy?
What is the pathology behind it?
How do you treat it?
Increased glucose -> VEGF -> Increased capillary permeability & abnormal vsoproliferation
Prevent with managed blood sugar
Treat with laser , vetrectomy, and anti-VEGF drugs
Detail clinical stages of Diabetic retinopthy:
1- Non-proliferative Diabetic Retinopathy
Blot hemorrhage, cotton wools spots, microanyeurisms, macular edema, hard exudate
2 - Pre-proliferative Diabetic Retinopathy
Same, also increaed anteretinal vascular anormalities and venous beading
3 - Proliferative Diabetic Retinopathy
Neovascular vitreoretinopthy, vitreous hemorrhage (new blood vessels leak and block vision) Can even increase risk of retinal detachment
How often should diabetics recieve eye exams?
Refer them upon diagnosis of type 2
Should get a yearly dilated eye exam from then on.
What happens in hypertensive retinopthy?
Narrowing and sclerosis of arterioles
Flame hemorrhages
Severe Cases Cotton wool spots Optic Nerve edema Silver-wired arterioles hard exudates
What things can cause sudden visual loss?
Amaurosis Fugax (plaque from carotid travels to eye arteries)
Migraine Scotoma (migraine aura)
Retinal Detachment (retina pulls away from supporting tissues)
Retinal Artery Occlusion
Retinal Vein Occlusion
Temporal Arteritis (one or more arteries become inflammed, swollen, and tender)
Stroke
What can be an early warning sign of amaurosis fugax?
A hollenhorst Plaque
embolic material within the retinal arteriole
True or false - retinal detachment will heal spontaneously?
FALSE! never will
What does a cherry red spot indicate?
Acute central retinal artery occlusion
pale retina with red fovea
How do you manage acute arterial occlusion before opthamolgy treatment?
Breathing CO2 in a bag causes aterial dilation
Timolol, Levobunolol, and acetazolamide lower ocular pressure
Massage globe with eyes closed
Upon examination a patient’s retina looks like a squashed tomato.
You immediately shout:
Eureka! It’s Central Retinal Vein Occlusion!
Why is a BRVO less serious than a CRVO?
B=branch
Less damage in the retina, so less erious vision loss
A pateint comes in with headache and scalp tenderness
She has a fever, so you think meningitis?
Then you find out she has jaw claudication and muscle aches
She also is experiencing some vision loss in both eyes with a cherry red spot
What do you think doc?
Temporal Ateritis!
vision loss secondary to retinal arteriolar occlusion
How do you treat temporal arteritis?
Systemic Steroids
Patient says:
I do’t know what happened I was eating a chili dog and all the sudden I feel like I can’t see anything to the left.
You think:
Hmmm Sounds like a CVA
Either the occipital cortex or anywhere in the visual pathway
Cranial nerve palsy in CN3
Symptoms:
Ptosis
May have dilated pupil
Eye down and out
Cranial nerve palsy in CN4
Symptoms:
Paralysis of Superior Oblique muscle
Vertical Diplopia
Subtle findings
-If in doubt, refer to Ophthamology
Cranial nerve palsy in CN6
Symptoms:
Paralysis of lateral rectus muscle
Affected eye is esotropic (turned in) causing horizontal diplopia
Movement of affected eye partially or totally limited in lateral gaze
Worse kind of chemical keratoconjunctivitis?
Alkali burn!
How do you treat chemicals in eye!
flush until ph reads neutral!
What tecnique is used to localize abrasions of the cornea?
Fluorescein stain under UV light will show where there is an abrasion
What is a hyphema?
blood in the anterior chamber of the eye
What do you NOT prescribe for a corneal abrasion?
Topical anesthesia!
How do you tell the difference between a bacterial and viral conjunctivitis?
Bacterial has purulent discharge
Viral has clear discharge
Hallmark of allergic conjunctivitis?
Itchy!
ALso will have a longer history, intermittent
Diffuse conjunctival injections is most likely a sign of:
Conjunctivitis
Ciliary injection is likely a sign of?
Uveitis
Anterior Uveitis Characteristics:
Conjunctivitis that wont go away
Ciliary injection No discharge Light sensitive Deep achey pain Anisocoria (unequal pupil size) Posterior Synechia (iris adheres to lens) Associated with systemic disease
Lets say a patient arrive in the office with blood on the surface of the sclera(under conjunctiva) without inflammation, pain, or discharge…
what is it?
harmless subconjunctival hemorrhage
