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Neuro > Eye Diseases > Flashcards

Eye Diseases Flashcards

1
Q

What are the components of a basic eye exam?

A

Vision, pupils, confrontation visual fields, extra-ocular motility, direct ophthalmoscopy

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2
Q

What region of the retina is tested in visual acuity tests?

A

Fovea

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3
Q

What is meant by vision results like “20/XX” (ex. 20/20, 20/80)?

A

It means the patient can read at 20 feet what a “normal” person can see at XX feet

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4
Q

What is fluorescein angiography?

A

Dye is injected into the arm and photographs are taken of the retina

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5
Q

What is optical coherence tomography?

A

Non-contact digital optical instrument that generates cross sectional images of the retina

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6
Q

Why is it important to check visual fields in a patient complaining of visual loss who has an otherwise normal eye exam?

A

Patients can have normal tested vision but have a visual field defect due to a brain lesion

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7
Q

If a patient has abnormal motility and visual loss, what do you need to be concerned about?

A

Multiple cranial nerve palsies, may need brain/orbit imaging

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8
Q

What should you see on fluroscein angiography if a patient has ophthalmic artery occlusion?

A

The ophthalmic artery supplies both the central retinal artery and the ciliary arteries, so you would see delay in filling of both circulations

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9
Q

What are the most common causes of “red eye” and what history and findings are important?

A

Conjunctivitis - discharge from eye, follicles on conjunctiva, recent illness

Uveitis - light sensitivity, progressive symptoms

Corneal ulcer - contact lens wearer

Allergy - itchy and teary eye

Subconjunctival hemorrhage - very red, minimal symptoms

Dry/irritated eye - lack of sleep, dust exposure, burning/sharp pain

Chemical injury

Angle closure glaucoma - check intraocular pressure

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10
Q

What are the symptoms of a cataract?

A

Changes in refraction, contrast, glare, decreased night vision, overall blurred vision (later symptom)

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11
Q

What are the causes of cataracts?

A

age, UV exposure, diabetes, uveitis, steroids, trauma, medications/medical conditions

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12
Q

What is the difference between open angle glaucoma and angle closure glaucoma?

A

Open angle - slowly progressive and generally not symptomatic in mild to moderate disease

Angle closure - acute, accompanied by severe pain, nausea, headaches

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13
Q

What are treatments for glaucoma?

A

Medically: beta-blockers, alpha-agonists, carbonic anhydrase inhibitors, prostaglandin analogs, systemic carbonic anhydrase inhibitors

Surgery: laser procedures, incisional surgery

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14
Q

How can a ruptured globe be recognized, and how is it managed?

A

Usually occurs post-trauma - diagnosed with CT scan and siedel test

The globe should not be touched - it should be shielded and ophthamology should be consulted

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15
Q

What conditions require an ophthamology consult?

A

Acute glaucoma, corneal ulcers, ruptured globes, severe chemical injury, significant flashes/floaters, decreased vision

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16
Q

What is the limbus?

A

The edge of the cornea - the point where the sclera and conjunctiva began

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17
Q

What is the conjunctiva?

A

A clear membrane attached to the eyelids and the limbus to prevent foreign objects from accessing the orbit

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18
Q

What is conjunctivitis?

A

hyperemia (engorgement) of the conjunctival blood vessels

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19
Q

What is episclera?

A

Outermost layer of the sclera, situated between the sclera and conjunctiva

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20
Q

What is episcleritis?

A

Benign, often self-limiting inflammation of the episclera

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21
Q

What is scleritis?

A

inflammation of the sclera that is painful and tender to the touch, can cause vision loss if it affects the retina

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22
Q

What systemic disorders are associated with scleritis?

A

rheumatoid arthritis, granulomatosis with polyangitis, polyarteritis nodosa, and lupus

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23
Q

What are the five layers of the cornea?

A

epithelium (outermost), Bowman’s layer, stroma, Descemet’s membrane, endothelium (innermost)

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24
Q

How much of the total refractive power of the human eye is from the cornea?

A

40 of the 60 total diopters

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25
Q

What is myopia?

A

near-sightedness

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26
Q

What is hyperopia?

A

far-sightedness

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27
Q

What is the most common risk factor for corneal ulcers?

A

history of contact lens wearing

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28
Q

What is the effect of herpes virus in the cornea?

A

It can infect different layers, herpetic keratitis of the epithelial layer is the most common

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29
Q

What should the initial treatment be for chemical injury to the eye?

A

Copius high volume and pressure irrigation

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30
Q

What are cataracts?

A

Opacification of the lens as a result of aging or disease

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31
Q

How are different types of cataracts categorized?

A

By their location - capsule, nucleus, or cortex of the lens

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32
Q

What type of cataract is typically age related? What are the symptoms?

A

Nulcear cataract

Symptoms = myopia, decreased contrast sensitivity, yellow tint to vision

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33
Q

Which eye disease is most directly related to a smoking history?

A

cataracts

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34
Q

What is glaucoma?

A

A disease of high pressure that causes damage to the optic nerve that causes a loss of peripheral vision first and ultimately total blindness if left untreated

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35
Q

What is the appearance of the optic nerve on fundoscopy in glaucoma?

A

It has a small central depression (cup) in the optic nerve

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36
Q

What is laser iridotomy?

A

A surgical procedure where a hole is put in the iris to allow the aqueous humor to flow

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37
Q

What is the seidel test?

A

A test for anterior chamber leakage from a wound, visualized with fluorescein dye

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38
Q

What are possible vitreous-related conditions?

A

posterior vitreous detachment (normal part of aging)

vitreo-retinal interface abnormalities

vitreous hemorrhage

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39
Q

What are the symptoms of retinal tear/detachment?

A

flashing lights, floaters, curtain effect (loss of vision in top of visual field bilaterally)

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40
Q

What is the treatment for retinal tears/detachment?

A

surgical intervention (scleral buckle, pars plana vitrectomy)

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41
Q

What are the types of diabetic retinopathy?

A

nonproliferative and proliferative

nonproliferative is an earlier stage, proliferative involves angiogenesis

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42
Q

What features can be seen on fundoscopy of diabetic retinopathy?

A

microaneurisms, exudates, blot hemorrhages

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43
Q

What is the treatment for diabetic macular edema?

A

anti-VEGF and focal laser photocoagulation

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44
Q

What are drusen?

A

Deposits found in dry age related macular degeneration

45
Q

What is neovascular age related macular degeneration?

A

A form of age related macular degeneration where there is vascular growth in the sub-RPE and sub-retinal spaces

46
Q

What are the current treatments for neovascular age related macular degeneration?

A

anti-VEGF agents, anti-oxidants

47
Q

What should you consider when a patient presents to you with flashing lights and floaters?

A

flashing lights = stimulation to retina (pulling or fluid)

floaters = something floating in vitreous (vitreous condensations, blood, wbc)

together these are signs of a retinal detachment

48
Q

Why should a diabetic patient receive eye exams routinely?

A

DM can affect the integrity of blood vessels in the eye that result in microaneurysms, hemorrhages, cotton wool spots, and exudates. Neovascularization can occur in advanced retinopathy

49
Q

Why should patients with macular degeneration be counselled to monitor each eye separately?

A

Early treatment is important for maintaining good central vision

Suddent distorted vision may mean macular degeneration has become exudative (requires prompt treatment)

50
Q

What systemic conditions would you consider in a patient with retinal artery occlusion? Retinal vein occlusion?

A

Artery occlusion: hypertension, diabetes, hypercholesterolemia, embolism, giant cell arteritis (in elderly patients)

Vein occlusion: hypertension, diabetes, hypercholesterolemia, hypercoaguable state

51
Q

What is the cause of the pie in the sky visual field defect?

A

Defect of the temporal lobe lesion

52
Q

What is the effect of occipital lobe defects on vision?

A

either both on left or both on right side, often quadrantanopia

also often macula sparing

53
Q

What is the cause of anisocoria that is worse in the dark?

A

Dilation problem, smaller pupil

can be caused by Horners syndrome

54
Q

What is the cause of anisocoria that is worse in the light?

A

Constriction problem

larger pupil - Adies pupil, third nerve palsy

55
Q

What is anisocoria?

A

Different sized pupils

56
Q

What are “imposters” of 6th nerve syndrome?

A

Duane’s syndrome, thyroid eye disease, convergence spasm, myasthenia

57
Q

What are common lesions that cause a sixth nerve palsy?

A

meningiomas, chorodoma, nasopharyngeal cancer

58
Q

What are some conditions that limit adduction?

A

Internuclear ophthalmoplegia (brainstem stroke or multiple sclerosis)

partial third nerve palsy

myasthenia gravis

59
Q

What are the signs/symptoms of fourth nerve palsy?

A

vertical binocular diplopia

head tilt or turn

inferior oblique overaction

“three step test” diagnosis

60
Q

What are clinical features of third nerve palsy?

A

eye “down and out”

binocular diplopia with ptosis

weakness of two or more muscles

anisocoria worse in light

61
Q

What are the clinical features of optic neuritis? What systemic disease is associated with it?

A

acute, unilateral vision loss with pain on eye movement

associated with multiple sclerosis

62
Q

What are the findings of the optic neuritis treatment trial?

A

contrast sensitivity most often abnormal

fundus findings often normal

MRI findings frequently normal or can have T2 bright lesions

63
Q

What is the clinical presentation of anterior ischemic optic neuropathy?

A

older patients with vasculopathic risk factors experiencing sudden vision loss and mild pain that can progress for 2+ weeks

64
Q

What are the physical exam findings of anterior ischemic optic neuropathy?

A
  • any level of acutiy possible
  • dyschromatopsia
  • afferent pupil defect
  • inferior altitudinal VF
  • swollen nerve (pale swelling)
  • splinter hemorrhages
65
Q

What are the eye symptoms of giant cell arteritis? Systemic/other symptoms?

A

Ocular: visual loss, diplopia, pain, amaurosis fugax (blindness due to lack of blood flow)

Other: occult giant cell temporal arteritis, headache, scalp tenderness, jaw claudication, fever, weight loss, malaise

66
Q

What is the treatment for giant cell arteritis?

A

steroids and hydration (IV when vision loss is present) and possibly anticoagulation

67
Q

What is papilledema?

A

optic disc swelling due to increased intracranial pressure

68
Q

What are the ophthalmoscopic features of papilledema?

A

bilateral disc elevation, obscured disc margins/blood vessels, venous distension/tortuosity, absent spontaneous venous pulsations

69
Q

What is the clinical presentation of pseudotumor cerebri (idiopathic intracranial htn)?

A

Often presents with a headache in obese young women, may cause blinding, transient visual obscurations, diplopia

70
Q

How is idiopathic intracranial htn diagnosed? What are known causes?

A

Diagnosis of exclusion

Known causes: decreased flow through arachnoid granulations, Addison’s disease, nutritional disorders, metabolic alterations, steroids

71
Q

What are the treatments for idiopathic intracranial hypertension?

A

weight loss, diamox, csf shunting procedure or optic nerve sheath fenestration

72
Q

What is ametropia?

A

A condition in which light does not focus on the retina

73
Q

What is myopia?

A

Light focuses anterior to the retina in an eye that is overpowered

74
Q

What is hyperopia?

A

Light focuses posterior to the retina in an eye that is underpowered

75
Q

What is astigmatism?

A

Light focuses to different points depending on the axis of incident light

76
Q

What is presbyopia?

A

Reduced accomodation (occurs with advanced age)

77
Q

What is amblyopia?

A

blurred vision due to failure of the visual pathway to fully develop - occurs piror to age 9 either because a clear image is not presented to the retina or the eyes are properly aligned, may be reversible if diagnosed early

78
Q

What is the synkinetic reflex?

A

convergence of the eyes and miosis linked to accomodation

79
Q

What is the most powerful refractive element of the eye?

A

Cornea

80
Q

Nuclear cataract (increases/decreases) lens power by (increasing/decreasing) the index of refraction?

A

Nuclear cataract increases lens power by increasing the index of refraction?

81
Q

What axial length is associated with myopia?

A

Long

82
Q

What corneal contour is associated with myopia?

A

Steep

83
Q

What lens changes are are associated with myopia?

A

nuclear cataract, altered shape and position

84
Q

What accomodation deficits are associated with myopia?

A

Spasm of near sighted vision

85
Q

What axial length is associated with hyperopia?

A

Short

86
Q

What corneal contour is associated with hyperopia?

A

Flat

87
Q

What lens changes are associated with hyperopia?

A

aphakia (no lens), shape and position

88
Q

Irregularities in what structures are associated with astigmatism?

A

Cornea and lens (lenticular)

89
Q

What vision disorder does this test output represent:

+3.50

A

Hyperopia

90
Q

What vision disorder does this test output represent:

+3.00, +1.50 x 90deg

A

Hyperopic astigmatism

91
Q

What vision disorder does this test output represent:

-2.00, +1.00 x 180deg

A

Myopic astigmatism

92
Q

What vision disorder does this test output represent:

-1.50, +2.20 x 45deg

A

Mixed astigmatism

93
Q

What is refraction as a diagnostic tool?

A

It measures refractive error in vision

94
Q

What does keratometry measure?

A

The corneal component of astigmatism

95
Q

What is the criteria for screening for retinopathy of prematurity?

A

<1500 g (weight) or <30 weeks gestational age

96
Q

What is the treatment for retinopathy of prematurity?

A

Diode laser retinal photocagulation, avastin

97
Q

What physical exam findings can be associated with leukocoria?

A

strabismus, glaucoma, poor vision, orbital cellulitis, heterochromia

98
Q

What is retinoblastoma?

A

A malignant intraocular tumor of retinal cell origin caused by a mutation of tumor suppressor gene RB1 on chromosome 13q1 (two hit model)

It presents with leukocoria (white reflex)

99
Q

What is the treatment for retinoblastoma?

A

enucleation, chemotherapy, laser, cryotherapy

needs to be treated or it can metastasize to the optic nerve

100
Q

What clinical features are associated with amblyopia?

A
  • abnormal visual experience
  • decreased visual acuity
  • anatomic changes in the brain (striate cortex ocular dominance columns, decreased gray matter)
101
Q

What are the treatment goals for strabismus? How is it treated in children?

A
  • orthophoria (binocular vision)
  • mono-fixationrange misalignment

Treatment: Eye patch over “good eye”

102
Q

Until what age is eye patching useful to treat amblyopia?

A

9-10 years old

103
Q

At what age should one perform congenital cataract surgery?

A

6 weeks

104
Q

What is the purpose/goal of strabismus surgery?

A

Orthophoria, mobilization syndrome, improved stereopsis, improved appearance

105
Q

What premature infants are at risk for retinopathy of prematurity?

A

low birth weight and earlier gestation age are two biggest risks; anemia and supplemental oxygen are risks as well

106
Q

When does the embryonic fissure close?

A

6th week

107
Q

What is a coloboma?

A

incomplete closure of the embryonic fissure

108
Q

What are some causes of congenital cataracts?

A

hereditary, infectious (TORCH), metabolic disease, trauma, spordaic

Neuro (12 decks)

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