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OD3 - Clinical Optometry Practice > DIS - Optic Nerve V - Week 10 > Flashcards

DIS - Optic Nerve V - Week 10 Flashcards

1
Q

List three types of optic neuritis based on the involvement of optic nerve fibres.

A

Retrobulbar neuritis
Papillitis
Neuroretinitis

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2
Q

Is optic neuritis generally uni- or bilateral?

A

Unilateral

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3
Q

How does optic neuritis affect vision? What about colour vision and visual fields? How does it affect brightness?

A

Acute vision loss
Visual field loss
Abnormal colour vision
Abnormal brightness and colour comparison

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4
Q

How long do symptoms worsen for with optic neuritis and when do they peak? Is full recovery expected?

A

Symptoms worsen for 7-10 days, peaking within 1-2 weeks

May not fully recover

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5
Q

List 6 possible causes of optic neuritis.

A 
Infections
Multiple sclerosis
Tumours
Drug/chemical exposure
Post-vaccination
Idiopathic
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6
Q

List four infections that can cause optic neuritis.

A

Meningitis
Syphilis
Viruses
Herpes zoster

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7
Q

Does optic neuritis affect more men or women?

A

Women twice as often as men

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8
Q

What is the typical age of patients with optic neuritis (range)?

A

20-45

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9
Q

What is the most common type of optic neuritis?

A

Retrobulbar

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10
Q

Retrobulbar neuritis is the inflammation of what?

A

Between the back of the eye and the brain

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11
Q

What four things should you check if you suspect retrobular neuritis?

A

RAPD
Pain, especially on eye movement
Acute vision loss
Brightness and colour comparison

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12
Q

List an obvious ophthalmic sign of retrobulbar neuritis.

A

There arent any initially

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13
Q

Is there any disc oedema with retrobulbar neuritis? Explain.

A

It may become apparent due to axoplasmic stasis

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14
Q

List the four stages of retrobular neuritis progression.

A

No obvious signs
Mild disc oedema
Loss of RNFL
Optic atrophy

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15
Q

How long until optic atrophy with retrobulbar neuritis?

A

3-6 months

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16
Q

What is papillitis?

A

Inflammed area at the optic nerve head

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17
Q

What five things should you check if you supect papillitis?

A 
RAPD
Pain, especially on eye movement
Acute vision loss
Brightness and colour comparison
Disc oedema
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18
Q

What is neuroretinitis (3)?

A

Inflammed optic nerve head and retina, including the macula

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19
Q

What is neuroretinitis often caused by?

A

Infective diseases

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20
Q

List 6 diseases that can cause neuroretinitis.

A 
Toxoplasmosis
Cat-scratch disease
Syphilis
Lyme disease
AIDS
Herpes zoster
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21
Q

Is there an association between neuroretinitis and multiple sclerosis?

A

Not usually

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22
Q

What is visual loss and prognosis like with neuroretinitis?

A

Can be much more severe with poorer prognosis

-especially if macula is involved

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23
Q

List 8 things to check for if you suspect neuroretinitis.

A 
RAPD
Pain
Acute vision loss
Brightness and colour comparison
Disc oedema
Macula wing/star
Photostress abnormal
Retinal thickening, possibly macular oedema
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24
Q

Is RAPD always present with optic neuritis?

A

Not always, it may not if neuritis is bilateral or a past event indicating for RAPD

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25
Q

Describe how to carry out a photostress test (6).

A

Determine distance VA for one eye
Occlude the other eye
Hold light source 2-3cm away from the eye
Ask patient to look at it directly for 10 seconds
Remove it and ask to read their best VA line after central scotoma is gone (using their Rx)
Time how long it takes to read it

26
Q

What does the photostress test measure?

A

Rate of photoreceptor pigment re-synthesis after bleaching

27
Q

What does the photostress test probvide an index of (in terms of function, 3)?

A

Macula function

  • photoreceptors
  • bruchs membrane
  • choroid
28
Q

What is an abnormal photostress recovery time?

A

> 50 seconds

29
Q

What should you do when assessing optic neuritis?

A

Dilated fundus exam

30
Q

What should you refer a patient with optic neuritis for (2)? What needs to be ruled out? What is the treatment?

A

Refer for serology and imaging
Rule out raised ICP as a cause for disc oedema
Systemic steroids

31
Q

Who should you refer for optic neuritis (3)?

A

Anyone with recurrence
Children
Teenagers

32
Q

What do studies suggest of the difference between oral and IV steroids for treating optic neuritis? Note which hastened recovery time and which increased rate of recurrence.

A

IV hastened recovery

Oral increased rate of recurrence

33
Q

What is a possible consequence of using IV steroids?

A

There is some indication it may promote later multiple sclerosis

34
Q

What does demyelination usually produce?

A

Retrobulbar neuritis

35
Q

What is the major cause of multiple sclerosis? List four other causes of demyelination that may be confused for multiple sclerosis.

A 
Demyelination
Guillain-barre syndrome
Miler fisher syndrome
Devics disease
Carbon monoxide poisoning
36
Q

What is the most common acquired chronic neurological condition affecting young adults?

A

Multiple sclerosis

37
Q

What is the age range at which multiple sclerosis is diagnosed?

A

20 to 40

38
Q

What is multiple sclerosis? What does it interfere with?

A

Immune system attacks myelin, interfering with nerve impulses and conduction

39
Q

What is seen in nerves with multiple sclerosis?

A

Demyelination plaques

40
Q

What is the most common kind of multiple sclerosis?

A

Relapsing-remitting MS

  • unpredictable attacks that worsen symptoms followed by recovery
  • each wave causes more and more disability unless there is remission
41
Q

What happens with primary progressive MS?

A

Steady increase in disability without attacks

42
Q

What happens with secondary progressive MS?

A

An initial relapsing-remitting MS that begins to have steady decline with no remisison periods

43
Q

What happens with progressive-relapsing MS?

A

Steady decline since onset with unpredictable attacks

44
Q

What is the key requirement for diagnosing multiple sclerosis (2)? Explain each (2). What is this called?

A

Evidence of CNS damage that is disseminated in time and space
Disseminated in time - damage has occurred at different dates
Disseminated in space - damage has occurred to different parts of the CNS
-mcdonald criteria

45
Q

What are three things that are assessed for multiple sclerosis?

A

MRI scans
Clinical symptoms
CSF

46
Q

What is clinically isolated syndrome?

A

If the mcdonald criteria are not met

47
Q

What may cause clinically isolated syndrome (2)?

A

Single episode of optic neuritis/transverse myelitis/ l’hermittes sign
When Ms is not yet MS and is the first clinical episode

48
Q

What is CSF-specific marker?

A

Oligoclonal immunoglobin bands in the CSF

-lab marker for MS

49
Q

List 9 clinical neurological symptoms of multiple sclerosis.

A 
Fatigue
Dizziness
Ataxia
Vision problems
Bladder problems
Weakness/numbing/tingling
Memory problems
Trouble concentrating
Uhthoffs sign
50
Q

What is uhthoffs sign?

A

Excessive fatiguing

51
Q

What kind of optic neuritis can multiple sclerosis cause?

A

Retrobulbar

52
Q

What region of the RNFL tends to be lost with multiple sclerosis vs glaucoma?

A

MS - temporal loss

Glaucoma - superior loss

53
Q

Internuclear ophthalmoplegia is due to a lesion in what part of the brain? What is this due to mostly? Give two other causes.

A

Lesion of the medial longitudinal fasiculus

  • due to Ms mostly
  • can also be due to mass or ischaemia
54
Q

What is internuclear ophthalmoplegia a disorder of?

A

Conjugate lateral gaze

55
Q

What are the two hallmark features of internuclear ophthalmoplegia?

A

Affected eye shows impaired adduction

Contralateral eye can abduct but has nystagmus

56
Q

Distinguish between anterior and posterior internucelar ophthalmoplegia and how convergence is affected for each.

A

Posterior - lower brainstem affected, convergence normal

Anterior - upper brainstem affected, convergence affected

57
Q

What should you do to assess internucelar ophthalmoplegia (3)?

A

Dilated fundus exam to rule out other retinal causes
Extensive history taking for past events
Check visiion after a brisk walk

58
Q

What counsel should be given to a patient with internucelar ophthalmoplegia (3)?

A

Vision loss could be protracted, recurrent
Counsel regarding variable vision over time
Association with MS

59
Q

Who should a patient with internucelar ophthalmoplegia be referred to and why?

A

To a neurologist for association with Ms

60
Q

How are relapses of internucelar ophthalmoplegia managed? Comment on how this may affect MS relapses.

A

IV steroids can speed recovery without affecting MS relapses

OD3 - Clinical Optometry Practice (114 decks)

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