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special senses > eyes > Flashcards

eyes Flashcards

1
Q

which layer is first to be affected by macular degeneration and react pathologically?

A

retinal epithelium cells react pathologically to waste products

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2
Q

Where does wave IV give information from?

A 
Lateral lemniscus (projects to midbrain) to Inferior collicus from superior olivary nucleus in pons
-dimished IV from an ear mean C/L lesion of LL
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3
Q

Where does wave IV give information from?

A

inferior colliculus located in caudal midbrain, if information does not get here then C/L hearing loss

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4
Q

sudden hearing loss with or without loud noise for over a few hours…

A

treat with steriods(prednisone) could be sudden hearing loss

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5
Q

Peripheral vestibular syndrome presents…

A

with improvement of nystagmus upon visual fixation

with improvement of dizziness upon visual fixation

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6
Q

what is produced in diabetic retinopathy that hurts the retina?

A

vascular endothelial growth factor VEGF

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7
Q

Pupillary sparing with partial third nerve palsy can be caused by…

A

vascular event in brainstem

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8
Q

What is the most common cause of untreatable vision loss?

A

cataracts

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9
Q

What is the most common cause of untreatable blindness in the elderly?

A

macular degeneration

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10
Q

What is the most common cause of blindness in the US?

A

diabetic retinopathy

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11
Q

what is the 2nd most common cause of blindness in the US?

A

glaucoma (primary open angle is most common)

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12
Q

besides macular degneration, what is another major source of aging vision loss?

A

cataracts

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13
Q

what is the patholoophys of primary open angle glaucoma?

A

genetic mutation causes decreased outflow through canal of schlemm of aqueous humor
increased intraocular pressure (can be high normal)

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14
Q

What is the presentation of primary open angle glaucoma?

A
  1. painless loss of visual fields
  2. slow progression (insidious)
  3. IOP is high normal
  4. cupping of optic disc
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15
Q

What is the presentation of close angle glaucoma?

A
  1. acute onset
  2. painful, steamy red cornea
  3. photophobia
  4. blurred vision-pupil fixed as dilated
    progresses
  5. progressive visual field loss
    periphery to fovea loss
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16
Q

What is the pathophysiology of closed angle glaucoma?

A

small anterior chamber due to…

  1. mydriatic agent (muscles slack and take up space)
  2. uveitis
  3. lens dislocation
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17
Q

What is the treatment for open angle glaucoma?

A

beta blocker to decreased aq humor outflow

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18
Q

What is the treatment for closed angle glaucoma?

A

pilocarpine to constrict the pupil

-contract pupillary sphincter muscle and cillary muscles

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19
Q

what are diagnostic tests for glaucoma?

A

cup to disc ratio
IOP measurement
visual field perimetry test

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20
Q

What is the treatment for glaucoma?

A

1.open angle-topical beta blocker (timolol)
2.closed angle-pilocarpine (topicl adrenergive cholinergic agonist)
3. other: prostaglandin analogue
carbonic annhydrase inhibitor topical or oral
4. surgery if pharmacy fails: laser trabeculoplasty

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21
Q

what are some complications to consider with glaucoma?

A

adverse effects of cholinergic agonists, B blockers

irreversible loss of sight (2nd MC cause blindness)

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22
Q

What is the best prevention for glaucoma?

A

regular screening

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23
Q

what is the general pathophysiology of glaucoma?

A

increased IOP leads to optic neuropathy change in optic cup

seen as a change in visual fields

24
Q

what is the most common cause in US of visual decline that is not correctable?

A

cataracts

25
Q

What are some etiologies of cataracts?

A
  1. MC age related 50% of people >65yo
  2. trauma
  3. immune mediated (corticosteriods supress immune system)
  4. infection CMV, rubella
  5. metabolic (diabetes mellitus-osmotic change)
  6. nutritional defect
  7. radiation
26
Q

what is the pathophysiology of cataracts?

A

thickening of lens, opacity in crystalline structure of the lens

  • can lead to myopia increase” 2nd sight”
  • diplopia monocular due to irregular refractory
  • image blurr
27
Q

What is the presentation of cataracts?

A 
1. painless progressive loss of vision
(slowly progressive)
2. image blur
3. myopia increase
4. monocular diplopia
28
Q

What is the treatment for cataracts?

A

surgery -cataract extraction

29
Q

How are cataracts diagnosed?

A

visual actuity
papillary response
opthalmoscopy

30
Q

What three conditions present with slow progressive loss of visual fields?

A

diabetic retinopathy and open angle glaucoma and macular degeneration
cataracts also slow progressive but more image blur and change in focus

31
Q

how can you distinguish glaucoma, diabetic retinopathy and macular degeneration?

A
  • IOP in glaucoma high normal in open angle and optic disc cup
  • spots from microaneurysms seen in diabetic retinol
  • macular degeneration will be central vision distortion and blind spots
32
Q

What is the treatment for diabetic retinopathy?

A

panretinal laser photocoagulation

33
Q

how can you diagnose diabetic retinopathy?

A

opthamopathologic exam-regular surveillance with diabetes

34
Q

what percentage of patients with diabetes for 15-25 years develop retinopathy?

A

60%

35
Q

What is the pathophysiology of diabetic neuropathy and retinopathy?

A

aldose reductase turns glucose into sorbitol
changes the osmotic potential
tissue damage
vascular insufficiency

36
Q

What are the 2 types of diabetic retinopathy?

A

proliferative: new vessels(neovascular) form (VEGF)
at risk for retinal detach and blindness
photocoagulate microaneurysms
nonproliferative: miscroaneurysms, flame hemmorhage, exudates

37
Q

How does diabetic retinopathy present?

A
  1. slow progression of visual field loss

2. tiny dots on retina from ruptured micro aneurysms and retinal exudates

38
Q

what is the treatment for diabetic retinopathy?

A

panretinal laser photocoagulation

39
Q

What is the incidence of macular degeneration from age 50?

A

.05%

11.8% after 80

40
Q

What is the etiology of macular degeneration?

A

Drusen deposits on Brush’s membrane due to degeneration of thin retina

41
Q

what is the pathophysiology of macular degeneration?

A
  1. Antioxidant damage
  2. DRY thin retina membrane
  3. hyaline nodule forms (yellow white)= Drusen deposits on layer of retina before the choroid
    - Brusch’s membrane
  4. WET vessels under retina hemmorage(subretinal neovascular change)
  5. retinal cells die
  6. pt. has blind spots or distorted central vision
42
Q

how does the patient with macular degeneration present?

A
  1. older
  2. slow progressive painless loss of vision field
    - central vision, blindspots

can be acute onset if retinal hemmorrage

43
Q

what is the treatment for macular degeneration?

A

laser therapy

44
Q

How is macular degeneration diagnosed?

A

angiography
amsler grid testing
opthalmoscopy

45
Q

what increases the risk of closed angle glaucoma?

A

elderly on multiple drugs

drugs like bupriorion (wellbutrin), spiriva, advair, fluoxetine, albuterol

46
Q

what can cause glaucoma idiopathically?

A

prescribing glucocorticoids
-pt on them for 2-6 weeks can increase IOP and cause optic nerve damage
“steriod glaucoma”

47
Q

what distinguishes open angle from closed angle glaucoma?

A

closed angle will get relief from pilocarpine and minimal optic cupping seen in closed angle
more cupping in open angle
onset is usually acute in closed angle

48
Q

what can cause open angle glaucoma?

A

progressive disc change

49
Q

what is uvetitis?

A

cause of closed angle glaucoma

cilliary flushing with cells in anterior chamber

50
Q

How does uvetitis present?

A

Head ache constant pressure and discomfort (pulsing)

blurry vision

51
Q

What is the treatment for uveitis?

A

GOAL: create an environment of zero inflammation
corticosteriods (side effects)
topical cycllopeliga (atropine)
topical or oral NSAID
noncortocsteriod oral immunosuppressant (methotrexate)
TNF alpha inhibitor

52
Q

What are some side effects for the eye in using glucocorticoids?

A

keratitis (herpes simplex or fungal) due to immune suppression. Can cause perforation of the cornea

steriod glacoma…increased IOP

53
Q

in macular degeneration which are the first retinal cells to respond to degeneration (drusen build up)?

A

retinal pigmented epithelium cells (next cell layer anterior to Brushe’s membrane-lamina vitae)

54
Q

What causes bitemporal hemionopsia?

A

optic chiasm lesion (pit tumor if onset insidious)

55
Q

An onset of 2 months (insidious) and lateral rectus palsy is most likely caused by…

A

meningeal tumor of ventral pons (if was infarct of pons would see other sensory, motor effects) (if was in cavernous sinus or superior orbital fissure would have complete opthalmopelgia)

56
Q

What is the major factor in the retina pathology of diabetic retinopathy?

A

vascular endothelial growth factor

57
Q

3rd nerve palsy with pupillary reflex intact is most likely due to what etiology?

A

vascular event in brainstem that spares medial fibers (not in 3rd nerve itself because by time it exits brainstem it carries both fibers)

special senses (3 decks)

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