EYE CONT Flashcards
1
Q
as the light passes through the corena and the lens the image is ?
A
inverted and reversed
and refracted
2
Q
emmetropia is normal _
light waves reflected from _ sources are focused on the retina
focal length equals the _ length of the eye
A
refraction
distant
acial
3
Q
hyperopia is _
the eye is too _ for refractive power of cornea and lens, light focused behind the _
is corrected with a _ lens
A
far sightedness
too short
behind the retina
convex lens
4
Q
myopia is _
the eye is too _ for the refractive power of the corena and the lens
light is focused _ of the retina
is corrected with a _ lens
A
near sightedness
long
in front of the retina
concave
5
Q
astigmatism is the abnormal curvature of the _ and different _ powers at different axes
corrected with a _ lens
A
cornea
refractive
cylindrical
6
Q
presbyopia is a _ related loss of the ability to focus on _ objects caused by _ of the lens
A
age
nearby
hardening
7
Q
lens dislocation is _ of the lens due to trauma but does have association with systemic diseases like _ and _
A
displacement
marfan syndrome and homocystinuria
8
Q
cataracts are painless _ of the lens. Age releated _ cataract is the most common type and it invloves slowly progressive yellowing and clouding of the lens nucleus
A
opacifications
nuclear
9
Q
nuclear sclerosis cataracts increases lens _ and increases _ and decreases _.
patients may experiences _ sight with nuclear sclerosis such as being able to read without glasses/
A
refraction
myopia
hyperopia
second sight
10
Q
senile cortical cataract features _ like opacities
A
radial
11
Q
what are the two types of cataracts
A
nuclear sclerosis
cortical
12
Q
what increases risk for cataracts
A
diabestes (sorbitol under lens), glucoroticoids (nasal), excessive sunlight
13
Q
the longterm use of corticosteroids frequently causes a _ _ cataract that involves abberant migrating lens epithelial cells.
A
posterior subcapsular
14
Q
symptoms of a cataract
A
light glare during night driving
15
Q
_ _ contains cilliary procesess, _ from the ciliary processes produces aqueous humor
A
pars plicata
epithelium
16
Q
parts of the ciliary body
A
pars plicata
pars plana
17
Q
both parts of the ciliary muscle contains smooth muscle innervated by CN _ and _ receptors
A
CN III
M3 receptors
18
Q
anterior chamber of the eye is the space between the _ and _
A
cornea and iris
19
Q
posterior chamber of the eye is the space betweem the _ and _
A
iris and lens
20
Q
contraction of the ciliary muscle pulls the scleral spur _ to open the _ canal
this explains why drugs causing ciliary muscle contraction decreased _
A
posteriorly
schlemm canal
IOP it allows for the aqueous humor to get out
21
Q
what are the two route for aqueous humor flow and describe them
A
- trabecular route (main)- from the posterior chamber to the pupil to the trabecular meshwork at the angle of the anterior chamber (iridocorneal angle) to schlemms canal to the episcleral veins
- uterosclaral routs - posterior chamber to the pupil to a uveral meshwork beyween ciliary muscle fibers to the suprachoroidal space, to the episcleral veins
22
Q
2 parts of the optic disc
A
pale/pink rim and center excavation cup
23
Q
size of center excavation/cup is relative to the sive of the _ nerve
cupt to disc ration N=0.1-0.?
A
optic
O.1-O.4
24
Q
increased intraocular pressure in glaucoma can cause
A
optic nerve compression leading to cupping
compression of vessles leading to optic nerve ischemia and pallor
25
galucoma 1st visual field loss
superonasal
26
optic nerve cupping pathophysiology
the sclara turns into the lamina cribrosa at the axons exit site and the increased IOP will push at the LC weak point and pushed the sclara back together with ganglion cells axon
27
glaucoma is a group of diseases with a characteritic optic _ with _ leadiing to specific _ _ defects overtime caused by obstruciton of _ _ drainage. Most of the cases leads to elevation of _
neuropathy
with cupping
visual field
aqueous humor draingae
intraocular pressure
28
glaucoma leads to excavation aka _ and this proceeds the visual field loss so optic nerve examination is critical. Progressive optic nerve _ is a feature in all forms of glaucoma.
open angle glaucoma is when the _ _ has access to the trabecular meshwork but there is resistance to flow in the _ _. This is considered the silent thief of sight. there is no pain unless _ is very high.
Anfge closure glaucoma is when the _ overlies the trabecular meshwork and impedes the egress of _ from the eye
cupping
cupping
aqueous humor ; trabecular meshwork; IOP
IRIS; Aqueous humor
29
primary glaucoma is when the angle is _
opne (most common form)
30
secondary glaucoma is caused by?
psuedo exfoliation
pigmentary
corticosteroid induced
NEOVASCULAR
31
what is psuedoexfoliation secondary glaucoma
there is deposition of fibrillary material throughout the anterior segment causing impedndence of AH IOP and cupping
32
what is neovascular secondary glaucoma
this is a characteristic of type 2 diabetes in the proliferative stage of their diabetic retinopathy ( causes a closure of the angle)
33
angle closure glaucoma has _ _ shallowing. It shows _ which are small anterior subscapular opacities.
there are _ atrophies secondary to _ _ of acute angle closure glaucoma
anterior chamber
gleukomflecken
iris atrophy
prior episodes
34
the acute attack of angle closure glaucoma has increased _ the pupil is _ and _ and there is eye _, headache, N/V, and decrease in vision.
IOP
irregular and dilated
eye ache (not dependent on movement of the eye)
*nausea due to the trigeminal nerve being so close to the vagus and PSNS being activated)
35
between attacks of acute angle glaucoma there is normal _ and what are the symptoms
IOP
shallow AC, iris atrophy, slight dilation (from paralysis of the muscle to constrict pupil)
myadriasis (pupil dilation), glaukomflecken and NO pain
36
anterior uveitis ( inflammation of the uvea)
2 parts:
iritis (inflammation of iris)
iridocyclitis (iris and ciliary body inflmmation)
37
posterior uveitis
chorioditis
## Footnote
there is a continous layers of the uvea and can spread to involve all the laters
38
iris shape in uveitis
miosis, irregular in shape
39
uveitis has _ which is purulence in the anterior chamber
hypopyon
40
uveitis has _ injection
AACG has _ injection
ciliary
mixed ( connjunctiva and iris)
41
iridocyclitis vs AACG
iridocyclitis: ciliary injection (redness), ciliary pain (touch ciliary body=pain), MIOSIS, syncechiae (iris is stuck to the lens)
AACG: mixed injection, sudden pain, MYADRIASIS (dilation), glaukomflecken, increased IOP
42
uveitis is associated with _ _ diseases
systemic inflammator diseases
**sacrcoidosis
43
sarcoidosis is 10 times more frequent in _ , check for in patients if they have recurrent bilateral _ . Uveitis can proceed pulmonary symptoms by several years. There can also be orbital and eyelid non caseating granulomas.
aferican americans
uveitis
## Footnote
HLA B27
44
sarcoidosis eye exam
candle wax dripping
45
pathophysiology of rental detachement
1. seperation of the _ retina from the _
2. loss of _ blood supply causing hypoxia
3. degeneratio of _
neurosensory retina from the retinal pigment epithelium
choroidal BS
photoreceptors
## Footnote
is a surgical emergency
46
rhegamatogenous
retinal detachement due to a retinal tear
47
non-rehemategenous
retinal detachement that is due to tractional or exudative fluid accumulation
48
retinal detachment patient history revolves around _ and _ due to posterior vitreous detachement
if it develops futher there will be _ loss with the curtain drawn _
on fundoscopy there will be _ of the retina nd chanfe in the trajectory of retinal _. The retina will _ or loos transparent (usually the red is due to the vessels in the chorioid)
floaters and flashes
vision
dwon
crinkling
vessels
opacify
49
hypertensive retinopathy from long time hypertension
mild signs:
retinopathy
moderate signs: choridopathy
severe signs: optic neuropathy
mild: narrow aterioles, AV nicking, ateriolar thickening with copper/silver wiring
moderate: flame shapped hemorrages, hard exudates, cotton wool spots
severe: papilledema from optic disc swelling, macular star
50
Hypertensive retinopathy pathophysiology
if arterioles thicken they get shiny brownish reflec called _ wiring or if they get occuldes they get _ wiring
thickened arterioles compress the venules if they cross above them termed _ _
the exudate accumulates between the RPE and retinal layers and this is seen as _ _ _
exudation of blood gives you rentinal _
exudation of lipids gives you _ _
as hypertensive retinopathy continues exudate accumulated in the _ givining you a macular star
severe HTN can lead to increased intracranial pressire causing optic nerve _ and _
copper
silver
AV nicking
cotton wool spots
hemorrhages
hard exudates
macula
ischemia and papilledema
51
if we see papilledema and histor of HTN it is urgent to ?
reduce BP
52
central vein occlusion
"blood and thunder"
blood can enter the eye but cannot exir leading to vein dilation and hemorrhage
blurry vision and subacte panless vission loss
(floaters)
53
treatment of central vein occlusion depends on the presence of absence of _
if present treat with _
edema
edema present- bevacizumab
54
central artery occlusion
cherry red macular and retinal atery attenuation
+sudden and painless vision loss
blood cant get into the eye; pallor around the macula
55
pathophysiology of diabeteic retinopathy
1. glycation
2. earliest microscopic sign: _ loss; usually provide vascular satibility and controls endothelial proliferation
3. inflammatory _activation
4. reduction in _ nerve axons
pericyte
glial
optic
56
glycation of the capillary wall has two effects: _ and _
pericyte loss/BM thickening
and increased permeability
57
pericyte loss and BM thickening leads to
capillary occlusion and microanurysems
## Footnote
non proliferative stage
58
increased permeability of vessles leads to
## Footnote
in diabetic retinopathy
macular edema, dot hemoorhages, lipid lead
## Footnote
non proliferative stage
59
in the proliferative stage of diabetic neuropathy
there is chronic _ that leads to _ which has 2 effects; what are they
ischemia
neovascularization
2 effects: creation of new capillaries and traction leading to retinal detachment
block the AC angle and increased introcular pressure causing secondary neovasular glaucoma with eye pain
60
treatment of non proliferative diabetic retinopathy
glucose control
61
treatment of proliferative diabetic retinopathy
anti vegF injections (neovasularization)
photocoagulation
watch IOP
62
what is retinitis pigmentosa
this is a hereditary disorder that has rod selected cell death there will be lacy black intra retinal pigment at the periphery and narow vasculature. The macula is normal!
good central vision- poor peripheral vision
**night vision (nycaltopia) and constricted peripheral vision
63
fundus of eye is a mirror of the _
brain
64
the optic nerve is an extension of the brain it is sutronded by _ and _
meninges and csf
65
importantto understand the papilledema is an increase in IOP and _
ICP
66
central retinal artery runs in the center of the optic nerve and supplies the _ part of the optic nerve
posterior
67
the _ _ arteries supply the optic disc (anterior part)
posterior cilliart
68
papliedema is increased _ pressure in the subarachnoid space which compresses the optic nerve fibers. The causes edema of the _ nerve aka papilla
optic nerve
## Footnote
both eyes are effected, little to no cision loss, blurry vision *difference between the degree of swelling and vision problem
69
optic neuritis
inflammation of the optic disc due to demyelination and increased hyeremia (increase in blood supply)
70
papilledema
swellingof the optic disc (main cause is ICP)
71
optic nerutitis is usually in the _ part of the optic nerve (central retinal artery supplies this part) and the most common type is _ neuritis
posterior part
retrobulbar neuritis
72
optic neuritis is typically _ocular and presents with _ vision loss, there is moderate eye pain.
monoocular
subacute
73
in 60 % of CN II involvement in Multiple sclerosis (more common in middle aged women) there is _ optic neuritis affecting the posterior part of the nerve (there is a _ optic disc apperance on fundoscopy
_ vision accopnained development of partial _ blindness
attacks resolve _ and and involves one eye and next time the other eye
baseline _ is important to diagnose and presict the future risk of MS
_ is important treatment for acute attacks
retrobulbar neuritis
normal
blurry; color
spotaneously
MRI
glucocorticoids
74
what is the leading cause of blindness in the world
age related macular degeneration
75
what is age related macular degeneration and the two forms
damage to the macular (center vision)
metamorphosia is the earliest sign
-dry form and wet form
76
what is the dry form of AMD
non neovascularitization and gradual vision loss due to drusen bodies
77
what are drusen bodies
these are small dotted deposts between the bruch membrane and the retinal pigmented epithelium
78
drusen bodies cause geopgraphic _ of the reitnal pigmented epithelium
atrophy
79
what is wet AMD
rapid decrease in vision due to choroidal bleeding and neovascularization
the vessels penetrate through the bruch membrane beneath the RPE
80
treatment of dry AMD with drusen -
treament of wet type AMD with neovascularization-
dry: antioxidants and multivitamins
wet type- intravitreal injections of vascular endothelial growth factors and VEGF antagoinsits
81
what is retinopathy of prematurity (ROP)
risk factors?
a pathological condition of immature retinal tissue that may lead to RETINAL DETACHMENT, VISUAL LOSS, BLINDNESS
risk: premature infants, LBW, respiratory distress, exposure to hyperoxia
82
ROP pathogenesis
at birth vessels on the periphery are _. in terms of babies with no excess of O2 and vessels grow supplying o2. In _ the growth of vessels stop.
After O2 is no longer supplied this causes _ of the retina to form becuase the periphery vessels are underdeveloped and this causes _ to start.
These new vessels are incompetents and can leak leading to traction and _ _
## Footnote
leak cytokines, proteins, contract the vitreous body
underveloped
Hyperoxia
hypoxia
neovascularization
retinal detachment
83
what can mimic ROP
infecitons, retinoblastoma
84
retinoblastoma is the most common _ tumor in children
it is caused by a germinal mutation on chromosome _
60% of cases are _ and 40% are _
most often the parent first detects the symptoms of RB with _ or _.
Be alert to the possibility of new _ development before the age of 1
there is spread to the brain, bone marrow, and lungs
_ is a sensitive method to detect calcification in a tumor and the intraocular extent even if calcification is absent
_ is good to evalute retinoblastoma compared to ultrasound and MRI
children
13q14
sporadic
iherited
leukocria (white pupil) or strabismus
tumor
CT
optical coherence tomography (OCT)
85
RB histology
white, encephaloid (brain)apperance with chalky calcifications
small hyperchromatic cells, necrosis and calcifications
RB depends on blood supply, necrosis is found in avascular regions
86
RB gene predisposes to the RB high risk of _ tumors, extracranial _ and melanoma
pineal
sarcomas
87
RB can arise from fully matured nerves in the retina called _ _
horizontal interneurons
88
conjunctival melanoma is in what age group?
risk factors?
if you suspect conjunctival melanona refer to a specialist without a _ as this may shed malignant cells
middle aged/elderly
chronic sun exposure
biopsy
89
risk factors for uveral melanoma
light skin
freckles and welding
90
if uveal melanoma is large and affects the macula what are the symptoms
reduced vision, scotomas, flashes and floaters
91
spread of metastasis for uveal melanoma
hematogenous to the liver
92
ciliary body melanona tends to be a _ diagnosis it may cause a _ _ _ _ due to displacemnt of the lens and iris
developing a dilated _ episcleral vessel overlying the tumor is common
late
secondaru angle closure glucoma
tortuous
93
what is uveal choridal melaoma
an elevated dome shaped gray brown lesion of the choiroid with irredular fuzzy marigins
it has a classic mushroom shape
94
uveral choroidal melanomas tend to be more than _ mm thick
it damages the _ and its vasular supplu as a result subretinal fluid accumulated causing an exudative detachment of the retina
they lie close to the _ _
often orange _ accumulated over the surface of melanoma
2 mm
retinal
optic disc
lipfuscin
95
the three common cells in uveal melaonma
type a and B spindle shaped melanocytes (spindle cells) with elongated nuclei
epitheloid cells
96
epitheliod cells in uveal melanoma can _ easilt and are considered the makeup of more _ risk lesions and _ prognosis
mestatasize
high
worse
97
uveal melanoma has _ mimicrcy
vascular
98
what is vascular mimicy
formation of spaces connected to blood vessels
they transport plasma and blood to the tumor. (worse prognosis)
99
diagnosis of choroidal melanona
clinical features on funduc exam
ancillary tests: fundus autoflouresence, B scan ultrasound (primary diagnositc test) color dopple ultrasound
100
color dopple ultrasound to diagnoise choriodal melanoma shows
pulsatile blood flow at the tumor base (not seen in nevi)
101
risk factors for a nevus to transform into a melanoma
thickness greater than 2mm
subretinal fluid (greatest indicator)
flashes, floaters
orange lipofuscin
close to optic disc (3mm)
DRUSEN ABSENCE
HALO ABSENCE
102
halo of dipigmentation around the pigmented choridal lesion is more commonly seen in _
the depigmentation respresents a _ infiltrate and correlated with the stability of a nevus
nevi
lymphohistiocytic infiltrate
