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