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PPO 2 Midterm (Pg. 9-18) > Conditions > Flashcards

Conditions Flashcards

1
Q

What does RAPD stand for?

A

Relative Afferent Pupillary Defect. Aka o Marcus-Gunn pupil.

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2
Q

What causes a RAPD?

A

Due to massive retinopathy or optic neuropathy (lesion on optic nerve of the non-dialating eye located before the optic chiasm). NOT due to cataract, corneal scar, or functional amblyopia.

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3
Q

What is Light-Near Dissociation?

A

Pupils constrict when accommodating, but not from light.

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4
Q

What is Anisocoria?

A

Pupil size is more than 0.5mm difference between two eyes

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5
Q

What is an Amaurotic pupil?

A

A “blind” pupil (no light reflex)

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6
Q

What is a Hutchinson’s pupil?

A

Unilateral, fixed, dilated pupil; usually seen in coma

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7
Q

What is a miotic pupil?

A

A pupil that stays constricted. Usually more noticeable in the dark.

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8
Q

What can cause a miotic pupil?

A 
o	Drops
o	Iritis
o	Horner’s syndrome
o	Argyll Robertson’s pupil
o	Long standing Adie’s pupil
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9
Q

What is a mydriatic pupil?

A

A pupil that stays dilated. More noticeable in bright light.

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10
Q

What can cause a mydriatic pupil?

A 
o      Trauma
o	Adie’s tonic pupil
o	3rd nerve palsy
o	Drops
o	Hutchinson’s pupil
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11
Q

The defect of which branch of the ANS causes Horner’s Syndrome?

A

Sympathetic Nervous System.

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12
Q

What are the observable symptoms of Horner’s Syndrome?

A
  • Ptosis
  • Miosis
  • Anhydrosis
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13
Q

How is ptosis caused by Horner’s syndrome measured?

A

Measure by measuring entire palpebral fissure and then from Herschberg corneal reflex up to upper lid on right eye and write as a fraction; then repeat for left

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14
Q

What is physiological anisocoria?

A

Difference in pupil size that is no larger than 0.5mm.

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15
Q

What percent of the population has physiological anisocoria?

A

20%

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16
Q

Does the level of physiological anisocoria change with level of illumination?

A

No

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17
Q

Damage to which types of neurons can lead to Horner’s Syndrome?

A

First order, second order and 3rd order neurons.

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18
Q

What is the path of travel of a 1st order neuron?

A

Origin: posterior hypothalamus
Passage: down spinal cord
Destination: synapse in the Cilliospinal center of Budge (C8-T1,2).

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19
Q

What is the most common cause of first order neuron damage?

A

A lesion that this caused by a cerebro-vascular accident (CVA). ie. Multiple sclerosis, Neck trauma.

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20
Q

What is the path of travel of a 2nd order neuron?

A

Origin: Cilliospinal center of Budge (C8-T1,2)
Passage: exits SC, travels over apex of lung
Destination: Synapse in the superior servical ganglion

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21
Q

What is the most common cause of 2nd order neuron damage?

A

A lesion caused by:

  • Pancoast’s tumor
  • Tuberculosis (TB)
  • Metastatic breast cancer
  • Trauma
  • Thyroid neoplasm/ surgery
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22
Q

What is the path of travel of a 3rd order neuron?

A

2 paths:
1) Post ganglionic neuron leaves SCG and follows the Internal Carotid A. -> Nasociliary N. -> Long Cilliary N. which innervates pupil dialator

2) Post ganglionic neuron leaves SCG and follows the Internal Carotid A. -> Ophtalmic A. then innervates Muller’s muscle.

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23
Q

What is the most common cause of 3rd order neuron damage?

A

-Path 1 (to pupil dialator):
• Internal carotid dissection and aneurysm
• Nasopharyngeal carcinoma

-Path 2 (to Muller’s muscle):
• Migraines

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24
Q

What can cause congenital Horner’s Syndrome?

A
  • Brachial plexus injury during birth

- Other factors Associated with heterochromia (different color irises)

25
Q

What can cause Accuired Horner’s Syndrome in children under 5?

A

Neuroblastoma in sympathetic chain of chest and neck. Must refer to pediatrician to rule this out.

26
Q

What causes Adie’s pupil?

A

A disorder of the Para-Sympathetic NS. De-nervated ciliary ganglion -> Sectoral palsy of the iris sphincter

27
Q

What are symptoms of Adie’s pupil?

A
  • Unilaterally dilated pupil
  • Poor reaction to light
  • Slow tonic re-dilation
28
Q

Is Adie’s pupil usually found in one eye or both?

A

80% unilateral and will become bilateral at a rate of 4% per year

29
Q

What is Light-Near Dissociation?

A

o Response to accommodation is stronger than to light

o Accommodation fibers outnumber pupil fibers 30:1

30
Q

What can cause Light-Near Dissociation?

A

o Midbrain lesion close to pretectal nucleus

o Can be found in severe retinopathy and optic neuropathy

31
Q

In what conditions is the phenomenon of Light-Near Dissociation observed?

A

-Adie’s tonic pupil
-Argyll-Robertson pupil
- Caused by Diabetes
Others:
-Dorsal midbrain syndrome
-Aberrant regeneration of
-CN III: miosis with ADDuction
Amyloidosis

32
Q

What are the symptoms of Argyll-Robertson Pupils?

A

o Both pupils are constricted and irregular
o Near-light dissociation
o Dilate poorly in dark, and respond poorly to dilating agents

33
Q

Argyll-Robertson Pupils can be seen in individuals suffering from what conditions?

A 
Syphilis
Diabetes
Chronic alcoholism
Multiple sclerosis
Sarcoidosis
34
Q

Why is the maintaining of an appropriate IOP important?

A
  • IOP affects the shape of the eye which is essential for optical properties of the eye
  • An IOP that is too high can cause Optic Nerve damage and loss of vision
35
Q

What factors affect IOP?

A
  • Rate of filtration
  • Change of rate of production
  • Body position
  • Blood pressure
  • External pressure on the globe
  • Central venous pressure
36
Q

How will a decrease in filtration affect IOP?

A

IOP will increase

37
Q

How will excess production of aqueous humor affect IOP?

A

IOP will increase

38
Q

Which body position coincides with the larges increase in IOP?

A

Supine (laying on back) from early morning till just before noon; Sitting coincides with highest IOP in the afternoon

39
Q

In what structures can a change in aqueous humor filtration occur?

A

o Anterior chamber angle
o Trabecular meshwork
o Canal of Schlemm
o Episcleral vessels

40
Q

What is the balance between IOP and blood pressure called?

A

Perfusion Pressure

41
Q

How is Perfusion Pressure calculated?

A

Diastolic BP - IOP = Perfusion Pressure

42
Q

When does BP and Perfusion pressure become vitally important when it comes to vision?

A

When the optic nerve becomes damaged (glaucoma)

43
Q

What phenomenon helps keep Perfusion pressure constant?

A

Autoregulation

44
Q

What can cause external pressure on the globe? How does this affect IOP?

A
  • Forceful closure/ blepharospasm
  • Digital pressure
  • Tumor
  • Varix
45
Q

How is Central Venous Pressure (CVP) related to IOP?

A

Linearly, CVP is 1/2 IOP

46
Q

What can cause an increase or decrease in Central Venous Pressure?

A
  • Excess IV fluids raise CVP, can cause myocardial infraction
  • Blood loss decreases CVP
47
Q

What associated conditions typically occur together in the “Glaucoma triad”?

A
  • Increased IOP
  • Optic Nerve damage
  • Visual field loss
48
Q

What are the symptoms of gradual IOP increase?

A

It is asymptomatic

49
Q

What are the symptoms of acute IOP increase?

A
  • Nausea
  • Pain
  • Haloes
50
Q

What condition can result from a dramatically decreased IOP?

A

Phtisis Bulbi (deflated and non-functional eye)

51
Q

What is a scotoma?

A

An absolute or relative area of poor visual function surrounded by a normal visual field

52
Q

What are the types of scatomas?

A
  • Arcuate

- Annular

53
Q

What is a central visual field defect?

A

A defect in the portion of the field involved in fixation

54
Q

What is a centrocecal visual field defect?

A

Defect in the field from fixation to the blind spot

55
Q

What is a paracentral visual field defect?

A

Defect in the field adjacent to the area of fixation

56
Q

What is a pericentral visual field defect?

A

Defect in the field surrounding fixation

57
Q

What is a Homonymous visual field defect and where is the lesion located?

A

same side visual field loss, lesion posterior to chiasm

58
Q

What is a Heteronymousvisual field defect and where is the lesion located?

A

opposite sides of visual field loss, lesion at the chiasm; bi-temporal visual field loss

59
Q

What is a Congruous visual field defect?

A

relatively similar in location and size. The more “posterior” the lesion is on the visual tract, the more congruous the visual field defects will be between the two eyes

PPO 2 Midterm (Pg. 9-18) (3 decks)

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