Common Causes of Vision Impairment Flashcards
which visual acuity scores are indiciative of
- no / mild visual impairment?
- moderate visual impairment?
- severe visual impairment?
- mild to none: 20/30 - 20/50
- moderate: 2/70 or worse
- severe: 20/200 or rose
following an eye complaint, a physician should complete what examinations before consulting a specialist?
- Visual acuity testing of each eye individually
- Confrontation visual field testing
- Extraocular motility
- Pupillary reaction
- Tonometry (pressure)
- Ophthalmoscope
corneal abrasian
- causes
- clinical presentation
- workup
- treatment
- causes: trauma, contacts
- clinical presentation: foreign body sensation, redness / pain
- work-up: f_lourescein staining_
- treatment:
-
psuedomonas covering topical Abx:
- CLS
- fluoroquinilones
- cyclopentate / atropine - for comfort
-
psuedomonas covering topical Abx:
what should not be used to to treat corneal abrasian?
numbing drops - tetracaine / procrainamide
these can inhibiting growth & healing of corneal epithelium
discuss the protocols for prescribing the following ocular treatment
- numbing drops
- topical steroids
- numbing drops (procainamide / tetracaine) - NEVER
- topical steroids - only by an eye doctor specifically
fill out
viral conjunctivitis
- clinical presentation?
- type of disarchage?
- inflammation pattern?
- other exam findings
- treatment
- presentation: presents with cold sx +/- migrates from one eye → other
- discharge: watery
- inflammation: follicular pattern
- other exam findings: swollen pre-auricular lymph nodes
- treatmentL: typically no meds (is self limited)
viral conjunctivitis
- clinical presentation?
- type of disarchage?
- inflammation pattern?
- other exam findings
- treatment
- presentation: recent cold sx +/- migrates from one eye → other
- discharge: watery
- inflammation: follicular pattern
- other exam findings: swollen pre-auricular lymph nodes
- treatmentL: typically no meds (is self limited)
bacterial conjuncitivitis
- clinical presentation?
- type of discharge?
- inflammation pattern?
- other exam findings
- treatment
- presentation: no cold sx
- discharge: mucopurulent
- inflammation: papillary reaction
- other exam findings: n/a
- treatment: topical Abx + consider STIs
which STIs are common causes of bacterial conjuncitivis?
how are they different?
how are they treated?
- chlamydia - chronic, indolent
- gonococcal - virulent, dangerous
systemic treatment
allergic conjunctivitis
- clinical presentation
- treatment
- presentation: bilateral itching in young patients
- treatment:
- cool compresses
- artificial tears
- topical / oral: anti-histamines, mast cell stabilizers
what is the most common cause of conjunctivitis?
viral
herpes keratitis
- clinical presentation
- inflammatory reaction
- other exam findings
- presentation: foreign body sensation + pain/redness
- inflammatory reaction: follicular
- other exam findings: dendritic branches on flourescein staining
- treatment: anti-virals + referring to opthalmology
herpes zoster opthalmicus
- presentation
- treatment
- complications
i.e., herpez zoster keratititis
- presentation: unilateral painful rash over CN V area, including multiple crusted blisters on nose
- treatment: oral anti-virals within 72 hours + urgent referral to optho
- complications: post-herpetic neuralgia
corneal ulcer from infectious keratititis
- causes
- presentation
- treatment
- causes: bacterial m/c, consider herpes, fungal, acanthamoeba
- treatment: based on etiologic agent. NO STEROIDS - they worsen fungal & acanthamoeba causes
identify
viral conjuncitivitis
watery discharge
follicular reaction
identify
bacterial conjuncitivits
mucopurulent discharge
papillary reaction
identify
herpes keratitis
dendritic branching (flourescein staining)
- identify
- explain cause
- note the treatment
- herpes zoster opthalmicus (keratitis)
- reactivation of VZV via nasocilliary nerve
- treatment: ORAL antivirals within 72 hours + urgent optho referral to prevent post-herpetic neuralgia
identify
corneal ulcer
presbyopia
- definition
- cause
- treatment
- definition: age-related far-sightedness (can’t see near)
- cause: hardening of lens throughout aging → inability to acomodate
- treatment: reading glasses + reassurance
ambylopia
- definition
- cause
- work-up
- ambylopia: delayed eye movement - “lazy eye”
- causes: m/c = strabismus - poor ocular alignment
- work-up:
- cover test / uncover test
- brucker screening test
- deviated eye = whiter / brighter reflex
what is this test?
what is showing?
bruckner screening test - dx of ambylopia
deviated eye = whiter / brighter reflex
define & identify the cause of
- myopia
- hyperopia
- astigmatism
cataracts
- definition
- cause
- treatment
- definition: painless clouding of the lens
- cause: aging m/c
- treatment: surgery
glaucoma is the ___ cause of blindness in the US?
2nd leading
what are the risk factors for primary open angle glaucoma?
- increased IOP
- increased cup:disc ratio
- increased age
- thinner central corneal thickness
- family hx - 6x inc w/ 1st degree relatives
- AA - 6x higher > caucasions
what is normal intraocular pressure (IOP)?
10-21
what exam findings are evident of increased cupping of the optic nerve?
- enlarged, hollow spot on disc
- C:D ratio > 0.5
- assymetry
physicians should check what things if suspicious of primary angle glaucoma?
- visual fields
- intraocular pressure - IOP > 21
- optic nerve cupping - C:D ratio > 5, assymetry, hollow disc spot
primary open angle glaucoma - treatment
all target lowering IOP:
- eye drops that reduce production / increase outflow of aqueous humor
- laser procedures / other surgeries
which glaucoma eye drops
- decrease aqueous humor synthesis
- increase aqueous humor outflow?
decrease production
- alpha agonists - epinephrine (a1), brimonidine (a2)
- b-blockers - olols: timolol, carteolol, betaxolol
- diuretics - acetazolamide
increase outflow
- cholinomimetics - physiostigmine, pilocarpine, carbachol
- prostaglandins - prosts: bimatoprost, lataoprost
place the glaucoma eye drops in their correct position in the cart
age related macular degeneration (AMD)
- epidemiology
- cause
- risk factors
- exam finndings
- treatment
- epidemiology: leading cause of irreversible central visual loss amongst people > 50 in the US
- presentation: metamorphopsia (distortion) → scotoma (vision loss)
- cause: macula has high [] of cones centrally → fine detailed central vision
- exam findings:
- drusen: yellow lipid & protein deposits
- wetness: choroid neovascularization
- risk factors:
- smoking
- HTN
- nutrition
- treatment:
- dry AMD: high dose anti-oxidants + smoking cessation / lifestyle changes
- wet AMD: anti-vascular endothelial growth factor intraocular injection
age related macular degeneration (AMD) is the leading cause of ___ ?
irreversible central vision loss amongs people > 50 years in the US
what major risk factors pre-dispose AMD?
- smoking
- HTN
- nutrition
what is the treatment for dry AMD?
- high dose antioxidants
- smoking cessation + other lifestyle changes
what exam finding is indicate of wet AMD?
what is the mainstay treatment for wet AMD?
what are the pros / cons of this treatment?
- finding: choroidal neovascularization
- mainstay tx: anti-vascular endothelial GF intraocular injection
-
cons:
- requires monthly visits
- requires many needles
- high tx burden for elderly patints
-
cons:
