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KMK > Crash course: Optic Nerve/Neuro-ophthalmic pathways & glaucoma > Flashcards

Crash course: Optic Nerve/Neuro-ophthalmic pathways & glaucoma Flashcards

1
Q

What are drusen made of?

A

Hyaline bodies

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2
Q

What is the gold standard test for drusen of the optic nerve?

A

B-scan ultrasonography (hyperreflective lesion)

5 line raster OCT can be used as well

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3
Q

What are B-scans used for?

A
  1. Blocked fundus (heme or dense cataract
  2. nevus vs melanoma
  3. Drusen
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4
Q

What conditions are associated with drusen?

A
  • Sharp drusens can lead to glaucoma-like visual field defects but does NOT progress over time
  • Optic disc edema
  • Angioid streaks
  • CNVM (can have PPA)
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5
Q

What is the first thing you should test for in a patient swollen optic nerves?

A

BP > MRI > lumbar puncture

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6
Q

What is an abnormal LP measurement?

A

> 200 mmH20 in normal non-obese adults
250 mmH20 in obese adults
280 mmH20 in children

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7
Q

Define Malignant HTN

A

BP > 220/100

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8
Q

An increase pressure can cause which type of palsy?

A

lateral rectus palsy

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9
Q

Treatment for IIH

A

Initial treatment: Weight loss & acetazolamide
2nd option: gastric bypass, shunt,
If only ocular issues & no systemic issues: optic nerve sheath decompression

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10
Q

For a pt with IIH, what is the target weight?

A

6% of their current body weight

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11
Q

Other initial findings for IIH

A

Visionloss, Bilateral enlarged blind spots on VF (common in papilledema), lateral rectus palsy (high pressure compresses CN on the petrous ridge) - anything high pressure in the brain THINK CN 6

papilledema can occur

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12
Q

Signs of NAION

A
  • Acute sudden vision loss in one eye, older pts with systemic conditions, w/ APD
  • Small C/D ratio, <0.2, disc edema
  • Systemic (HTN, DM, high cholesterol)
  • 50 - 60 yo
  • heme confined near the optic nerve
  • NAION 10x more common than AAION, Rule out AAION (jaw claudication, HAs, scalp tenderness, polymyalgia rheumatica, transient vision loss)
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13
Q

If you see unilateral disc edema in a 30 yo F, what should you be thinking?

A

Optic neuritis or lupus

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14
Q

What blood test should you order for AAION

A
  • CBC, ESR, CRP

- Temporal biopsy is the gold standard

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15
Q

What are the norms for CBC, ESR, CRP?

A

CBC - ?
ESR - age/2 (men) or age + 10/2 (women)
CRP - 0.8 - 1.0 mg/dL or lower is normal

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16
Q

What is the pathophysiology of NAION?

A

Ischemia of the SPCA

17
Q

What causes optic nerve edema?

A
  1. Compressive (meningioma)
  2. Ischemia
  3. Ophthalmic
  4. Inflammatory - infectious (syphilis or TB) /non-infectious (sarcoid or lupus) /other (optic neuritis)
18
Q

Tx for NAION

A
  • treat underlying risk factors (HTN, DM, smoking, sleep apnea etc)
19
Q

What is the pathophysiology of AAION?

A

occlusion of the posterior ciliary artery

20
Q

Tx for AAION?

A

100 mg prednisone PO followed by taper & refer to rheumatology

21
Q

What is the pathophysiology of an optic nerve pit?

A

Incomplete closure of the embryonic fissure

22
Q

What complications can occur with optic pit?

A

Serous macular detachment

23
Q

Tx for serous macular detachment

A

pars plana vitrectomy

24
Q

What can cause asymmetric IOPs?

A
  • POAG
  • Pigment dispersion syndrome
  • Uveitis
  • NVG
  • Cataract surgery
  • Angle recession
  • Angle closure
  • Wrong measurement
25
Q

Elevated IOP with pseudoexfoliation is due to what?

A

Toxic accumulation of debris within the TM NOT clog the TM

26
Q

Psuedoexfoliation risk of developing glaucoma within 10 years?

A

15%

27
Q

Tx for psuedoexfoliation syndrome

A
  • treat more aggressively than POAG
28
Q

Pseudoexfoliation cataract surgery complications?

A
  • lens subluxation due to weak zonules

- poor pupil dfe

29
Q

What is the pathophysiology of pigment dispersion syndrome?

A

Pigment releaes from posteiror iris epithelium due to concave iris insertion

30
Q

What is the primary cause of elevated IOP in PDS?

A

Toxic damage to the TM due to pigment deposition

31
Q

What is the risk of developing glaucoma within 5 years in pts with PDS?

A

10%

32
Q

What happens in pts with PDS who has cataract sx and age?

A

Less pigment release and consistent elevated IOP

KMK (18 decks)

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