Eyes Flashcards
anterior segment
conjunctiva cornea sclera anterior chamber iris posterior chamber lens
posterior segment
uvea
retina
optic nerve
blood supply
uvea
iris
ciliary body
choroid
retina
fovea
macula
what is the lens
focus light onto the retina
what is the cornea
tough, clear covering over the iris and the pupil that helps protect the eye
light ends as it passes through the cornea
first step in making imagine on the retina
cornea begins bending light to make an image, the lens finished the job
what is the pupil
dark circle in the center of your iris
hole that lets light into the inner eye
what is the shape of the cow’s pupil
oval
what is the aqueous humor
clear fluid that helps the cornea keep its rounded shape
what is the iris
muscle that controls the pupil size
functions like the diaphragm of a camera as it controls how much light enters the eye
suspended between the cornea and the lens
what is a lens
a clear, flexible structure that makes an image on the eye’s retina
flexible so that it can change shape, focusing on objects that are close up and objects that are far away
what is vitreous humor
thick, clear jelly that helps give the eyeball its shape
what is the limbus
junction between sclera and cornea
what is the sclera
white of the eyeball
thick, tough, white outer covering of the eyeball
extends from cornea to optic nerve
what is the tapetum
colorful, shiny material located behind the retina
reflects light back through the retina
what is the optic nerve
bundle of nerve fibers that carry information from the retina to the brain
cranial nerve II (2) - transmits accommodation reflex and light reflex to the brain
what is the blind spot
place where the optic nerve leaves the retina
what is the aqueous humor
fluid in the anterior chamber that helps the cornea keeps it shape
what does the ciliary body secrete?
aqueous fluid
what is the conjunctiva
Clear, thin membrane that covers part of the front surface of the eye and inner surface of the eye ball.
T/F: bulbar covers the cornea NOT the sclera
FALSE - Covers the Sclera, NOT the cornea
T/F: Palpebral covers the inner surface of the upper and lower lids
TRUE
cornea functions
Keep front part of eye moist
Keep inner surface of eyelids moist and lubricated so no friction
Protect the eye from dust, debris
no blood supply, cleaned and nourished by tears and aqueous humor
T/F: sclera has large blood supply
FALSE - sclera has limited blood supply
parts of the sclera
epislera
choroid
what is the epislera
Thin, loose connective tissue layer that lies on top of the sclera and under the conjunctiva
how is the sclera nourished
blood vessels from the epislera and choroid
what is the choroid
vascular layer of the eyeball between the sclera and retina
muscles of the eye
Muscles only work by contracting: CN III(all muscles, except); IV(sup oblique); VI (lateral rectus)
Look right – LR for right eye; MR for left eye
Look left – LR left eye; MR right eye
what is blepharitis?
eyelid margin inflammation
tools
Slit lamp
Wood’s lamp and fluorescein
Tono-pen (nml pressure 8-21mmHg)
Proparacaine/Tetracaine - anesthetic
treatment of anterior blepharitis
Cleanliness of lids
Baby shampoo
what is anterior blepharitis?
Inflammation at base of eyelashes
“red-rimmed” eyes with scales on lashes
what causes anterior blepharitis?
Bacterial (STAPH) or seborrheic
what is posterior blepharitis?
most common
inflammation of inner eyelid at the Meibomian gland
what does posterior blepharitis look like
Hyperemic lids with telangiectasia and abnormal secretions
what are the causes of posterior blepharitis?
Bacterial (STAPH), acne rosacea, seborrheic dermatitis
treatment of posterior blepharitis
Cleanliness of lids
Daily meibomian gland expression
May need long-term low dose antibiotics (topical vs oral)
entropion
inward turning of lower eyelid
T/F: ectropion cause conjunctival scarring
FALSE - entropion can
ectropian
outward turning of the lower eyelid
T/F: Ectropion can cause excessive tearing or exposure keratitis (corneal irritation)
TRUE
What is ptosis?
drooping of the eyelid (common upper)
what causes ptosis?
Dehiscence of the levator muscle from its insertion on the tarsus (Age, trauma, eye surgery)
Poorly formed levator muscle
Diseases (Horner’s syndrome, myasthenia gravis, 3rd nerve palsy)
what makes ptosis worse?
being awake for long periods of time, alcohol, and drugs
treatment of ptosis
Surgery can correct congenital or acquired ptosis
Treatment of specific disease will generally correct
Hordeolum is also called?
Stye
What is a hordeolum?
Abscess of eyelid
what is the cause of hordeolums?
staph
treatment of hordeolum
Warm compresses
Refer to Ophth. for I&D if no improvement in 10-14 days
+/-antibiotic ointment
what is a chalazion
Granulomatous inflammation of Meibomian gland
May follow an internal hordeolum
morphology of chalazions
hard, pain-less, swelling of eyelid (possible mild ertyhema)
treatment of chalazions
Small resolve on own
Warm Compress
I&D by Ophth. if persists
NO antibiotics
Injection w/ Steroids can help
what is dacryoadenitis?
Inflammation within the lacrimal drainage system
causes of acute dacryoadenitis
S. aureus
β-hemolytic streptococci
symptoms of acute dacryoadenitis
Pain, swelling, and purulent drainage
treatment of acute dacryoadenitis
antibiotics - topical and systemic
causes of chronic dacryoadenitis
S. epidermidis
C. albicans
treatment of chronic dacryoadenitis
Dacryocystorhinostomy- usually occurs after obstruction of the lacrimal system
symptoms of chronic dacryoadenitis
Swelling with chronic discharge and tearing
what is keratoconjunctivitis sicca?
dry eyes - hypofunctioning lacrimal glands
causes of keratoconjunctivitis sicca
Aging, hereditary, systemic disease, medications, climate
keratoconjunctivitis sicca is most common in _________:
women
signs and symptoms of keratoconjunctivitis sicca
Dryness, redness, foreign body sensation
Pain with EOM
Can Cause Corneal abrasion
how do you test for keratoconjunctivitis sicca
Schirmer test < 15mm of wetting then +
treatment for keratoconjunctivitis sicca
Artificial tears
Severe Cases – tear puncta plugged to prevent lacrimal outflow
what is conjunctivitis?
Red eye with Discharge
Mode of transmission is direct contact with drainage
One of the differentials in the “Red Eye Work-up”
what is the most common eye disease
conjunctivitis
causes of conjunctivitis
Infectious (Viral vs Bacterial)
Non-infectious (Allergic vs Non-Allergic)
Most common virus for viral conjunctivitis
Adenovirus
how long does viral conjunctivitis last
May last for 10-21 days - symptoms peak and are highly contagious for 5-7 days
signs and symptoms of viral conjunctivitis
Bilateral, copious watery discharge 2nd eye involved with in 24-28 hours Conjunctival injection \+/- foreign body sensation May have systemic complaints
treatments of viral conjunctivitis
no treatment needed - self limiting (total course of disease 2-3 weeks)
May prescribe antibiotic drops to prevent secondary bacterial infection (itching and cause an abrasion) but not recommended
common pathogens for bacterial conjunctivitis
Staphylococci
Streptococci
Haemophilus
Moraxella
signs and symptoms for bacterial conjunctivitis
Erythematous conjunctiva
Copious, mucopurulent discharge
No vision disturbance
Mild discomfort
treatment for bacterial conjunctivitis
Lasts 10-14 days untreated Culture reserved for severe cases Lasts 2-3 days with antibiotic drops or ointments Erythromycin ophthalmic ointment Trimethoprim-polymyxin B drops
what population is more at risk for pseudomonas bacterial conjunctivitis?
contact lens wearer
how do you treat bacterial conjunctivitis in contact lens wearer?
tx with Fluoroquinolone such as Cipro
what is gonococcocal bacterial conjunctivitis
Ophthalmologic emergency - can lead to perforation
Hyper-purulent discharge with in 12 hours of exposure and chemosis, lid swelling
what is chlamydial keratoconjunctivitis?
Bacterial Conjunctivitis
Chronic keratoconjunctivitis caused by recurrent infection
how do you treat gonococcal
Admission for Treatment
1g ceftriaxone IM
+/- antibiotic drops
testing for gonococcal
Gram-stain discharge
Gram negative Diplococci
testing for chlamydial keratoconjunctivitis
NAAT (nucleic acid amplification test)
C. trachomatis
treatment for chlamydial keratoconjunctivitis
20 mg/kg Azithromycin x 1
max 1gram
Most common infectious cause of blindness worldwide
Chlamydial Keratoconjunctivitis (Trachoma)
allergic conjunctivitis
Associated with asthma, atopic dermatitis, allergic rhinitis
Need to rule-out bacterial infection
Most common in spring and summer months
signs and symptoms of allergic conjunctivitis
Itching, redness, “stringy” discharge
Bilateral
Palpebral Conjuctiva may be hypertrophic w/ cobblestone papillae
Treatment of Allergic Conjunctivitis
Mild
Cold Compress
Topical H1-receptor antagonists - Zaditor
Topical mast-cell stabilizers - Cromolyn
Severe
Topical corticosteroids
Limited use…not long-term
Topical application of anesthetic drops the eye?
Topical anesthetic does not work on the deeper structures of the eye. Therefore, if pt has pain with consensual constriction then problem is iritis, not conjunctivitis…more to come.
Pinguecula
Yellow conjunctival nodule
Rarely grows larger, but can become inflamed (pingueculitis)
where is the pinguecula
at Nasal Limbus
treatment for pinguecula
Artificial tears
Topical anti-inflammatories
WEAR SUNGLASSES!
Pterygium
Fleshy, triangular encroachment of conjunctiva
Can grow and obstruct vision – crosses iris
treatment of pterygium
Excision
Recurrence is common and more aggressive
what is sclera icterus
yellowing of the eyes
liver disease
episcleritis
DDx in THE RED EYE w/u
Localized patches of redness
Underlying systemic dz, ex: IBD
scleritis
DDx in THE RED EYE w/u
More painful, more diffuse redness
Underlying systemic dz, ex: RA
what is a corneal abrasion
Defect in the corneal surface epithelium caused by trauma
how can you detect corneal abrasions
drop of fluorescein, slit lamp, and cobalt-blue light
Signs and Symptoms of Corneal Abrasions
Inability to open eye from pain
photophobia
watery drainage
Foreign body sensation
Physical Exam findings of corneal abrasions
Complete exam of eye before staining
Evert upper and lower lids
Fluorescein stain
treatment for corneal abrasions in non contact wearers
Antibiotic ointment/drop (e.g. Erythromycin)
Cycloplegic (ex: cyclogyl bid)
May consider Pressure Patch, if large abrasion
treatment for corneal abrasions for contact wearers
Topical fluoroquinolone
Cycloplegic
DO NOT PATCH
NO contact lens wear – get new lenses
follow up for corneal abrasions
Follow-up Ophthalmology – Same Day
Large/central abrasion / opacity
Foreign Body not removable
Hypopyon (pus in ant. Chamber)
CTL wearer
Follow-up urgently
Peripheral/small-moderate abrasion
Drop in vision two lines on Snellen chart
No healing with in 2-3 days
Child that will not cooperate with exam
what is a corneal ulcer
Loss of corneal tissue
what is corneal ulcers mainly caused by
infection ***Most are contact lens wearers Bacterial (Pseudomonas, Staph, Strep, etc) Viral (Herpes, Varicella, etc) Fungal: post steroid use
T/F: Corneal ulcers can be caused by non-infection
TRUE – Exposure keratitis (irritated cornea): contact lens, severe dry eyes, systemic inflammatory diseases, burns, etc.
signs and symptoms of corneal ulcer
Pain, photophobia, tearing, decreased visual acuity
T/F: corneal ulcers are NOT an ophthalmologic emergency
FALSE!
Risk of permanently impairing vision
Risk of progression to perforation / open globe
Superficial foreign body
Most often corresponds with a specific event
Patient will complain of “something in eye”
physical exam on superficial foreign body
Evaluate for an open globe
Examine with tangential light
Evert eye lids – UPPER & LOWER and sweep with cotton swab
treatment with superficial foreign body
Removable with cotton swab or irrigate Should be removed within 24 hours Topical antibiotics Specialists evaluation if can’t remove Abx in meantime
strabismus
Eyes are not able to focus in the same direction, at the same point, at the same time
Lack of coordination between extraoccular muscles
Can present with double vision
what population is commonly affected with strabismus
children
types of strabismus
Esotropia - Affected eye is turned inward
Exotropia - Affected eye is turned outward
Hypertropia - where one eye turns upward, or more elevated than the other
Hypotropia - where one eye looks downward compared to the other
causes of strabismus
Unknown
Correlation with stroke, thyroid disease, CNS tumors
testing for strabismus
Hirschberg light reflex test
Cover/Uncover test
Why do we treat strabismus?
Amblyopia - the brain ignores
the input from the deviated eye
leading to blindness.
strabismus treatment
If visual acuity is not altered:
Patch the good eye, special glasses
Force the affected eye to ”work”
Eye exercises
If visual acuity is altered:
Surgery
Botox injections
nystagmus
Repetitive, involuntary eye movements
This affects vision and depth perception
Usually a symptom of another eye or medical problem.
Congenital Eye Problem, ex: eye muscle disorder
Inner ear inflammation, ex: Labyrinthitis
CNS Disease, ex: Stroke (common in elderly)
Medication Side Effect, ex: Anti-seizure medications
absent red reflex
Leukocoria – abnormal white reflection from the retina
Common presenting sign of Retinoblastoma
Retinoblastoma is caused by a mutation in a single gene that does tumor suppression
T/F: Most common malignant cancer of the eye in children.
TRUE
PERRLA
pupils, equal, round, reactive, light, accommodation
anisocoria
> 1mm difference between pupil size
Need to determine which pupil is abnormal
CN III function
Levator Muscle of the Upper Eyelid
Constricts the pupil
Changes lens shape
Movement of Four Eye Muscles medial rectus (medially) superior rectus (up) inferior rectus (down) inferior oblique (up/out)
CN III Palsy
Acquired Acutely
Diplopia, Ptosis, Enl Pupil
Eye sits down and out if full CN III palsy – can have partial
CN III Causes
Mid-Brain Aneurysm, SAH, Tumor; Trauma; Cavernous sinus lesion; Orbital lesions
superior oblique (IV) movement
moves eye down and out
inferior oblique movement
moves eye up and out
medial rectus movement
medially
lateral rectus (VI) movement
away from the midline
adie’s (tonic) pupil
No reaction to light
Very little reaction to accommodation
Unilateral
The affected pupil is larger than the unaffected
causes of adie’s (tonic)
Unknown or trauma, surgery, infection, ischemia
Argyll-Robertson Pupil
No reaction to light
Reaction to accommodation is normal.
Bilateral
Smaller than normal pupils
causes of Argyll-Robertson Pupil
Unknown but can be associated with Syphilis or Diabetic Neuropathy
Marcus Gunn Pupil
relative afferent pupillary defect (RAPD)
how to test for marcus gunn pupil
Swinging light test – pupils constrict less when light swung from unaffected to affected eye therefore appear to dilate
cause of macrus gunn pupil
Damage to posterior optic nerve or retinal disease
horner’s syndrome
Injury somewhere along the sympathetic autonomic nervous system to the face
Caused by interruption somewhere along the sympathetic chain
On the ipsilateral side
signs and symptoms of horner’s syndrome
Ptosis, miosis, anhydrosis
causes of horner’s syndrome
Carotid or aortic dissection, lung tumor, thyroid tumor, chest tubes
First-order neuron disorder
Central lesions that involve the hypothalamic trac
Second-order neuron disorder
Preganglionic lesions
Third-order neuron disorder
Postganglionic lesions
horner’s syndrome tests
Confirmation
Localization
Drugs that Affect Pupil Size
Narcotics (Opiates, Opiods) and Benzo w/ Overdose Constrict Pupils (Miosis)
ETOH – no pupil size change…just double or blurry vision because constriction and dilation is slowed
Cocaine, Marijuana, Amphetamines (Adrenergic) Enlarge Pupil (Mydriasis)
cataract
Opacity of the crystalline lens
Bilateral
leading cause of visual impairment worldwide
cataract
cataract causes
Aging is the most common causes
Congenital, traumatic, secondary to chronic disease, chronic corticosteroid use, smoking
cataract signs and symptoms
Progressive blurring of vision
Increased glaring from lights
physical exam cataracts
Progressive cloudiness on fundoscopic exam
treatment of cataract
Surgery to replace lens
Cataract surgery is most common surgery of the elderly
> 95% have improved vision
emmetropia
normal vision
hyperopia
farsighted (globe is too short)
Unable to see close up
Fixed with convex lenses
myopia
nearsighted (globe is too long)
Unable to see far away
Fixed with concave lenses
presbyopia
age associated loss of vision
Eye becomes unable to increase its refractive power to accommodate on near objects
Completely normal, occurs around 45 years old
Refractive errors
nearsightedness,farsightedness andastigmatics
Most are due to a less-than-optimal curvature or symmetry of the cornea.
treatment of Presbyopia
due to an aging change in the crystalline lens
what is preseptal cellulitis
Inflammation/infection confined to the eyelids and periorbital structures ANTERIOR to the orbital septum
signs and symptoms of preseptal cellulitis
Pain around the eye, periorbital swelling and erythema
physical exam of preseptal cellulitis
Tenderness, warmth
No proptosis, NO restriction of EOM or pain with EOM
Globe is uninvolved
tests for preseptal cellulitis
+/- CBC, +/- CT scan, +/- blood cultures
treatment for preseptal cellulitis
Warm compresses
Antibiotics x 7-10d (presumed Staph/Strep and/or anaerobes)
what is Orbital Cellulitis?
Infection of orbital soft tissues POSTERIOR to the orbital septum
signs and symptoms of orbital cellulitis
Red, painful eye
Blurry vision, diplopia
Physical Exam of Orbital Cellulitis
Eyelid edema, erythema, warmth, tenderness
Proptosis, restricted EOM and pain with EOM
orbital cellulitis work up
CBC, blood cultures, CT, +/- LP (risk spread)
most common cause of orbital cellulitis
spread from a sinus infection
most common complication of orbital cellulitis
menningitis
treatment of orbital cellulitis
Admission, IV antibiotics, Ophth/ENT consult
retrobulbar hemorrhage causes
Trauma, Post-op, Vascular problem
retrobulbar hemorrhage signs and symptoms
Pain
Decreased Visual Acuity
Decreased Color Vision
retrobulbar hemorrhage physical exam
Acute Proptosis
Elevated IOP – tight eyelids: Resistance to push globe into orbit
T/F: you can see a retrobulbar hemorrhage on a CT
TRUE but only maybe not always
treatment of retrobulbar hemorrhage
Immediate Ophth. Consultation / Canthothomy
chemical burns
Irrigate immediately before anything else
alkaline (bases)
Fertilizers Cleaning products (ammonia) Drain cleaners (lye) Oven cleaners Bleach (sodium hydroxide) Fireworks (magnesium hydroxide) Cement (lime)
alkaline (bases) eyes
High pH > 7.4
Especially damaging – will denature proteins and lyse cell membranes which enhances penetration
Liquefaction necrosis
acids
Battery acid (sulfuric acid)
Glass polish/etching (hydrofluoric acid)
Vinegar (acetic acid)
acids eyes
Low pH < 7.4
Depth of penetration usually less due to precipitation of proteins
Coagulation Necrosis
Hydrofluoric acid is the exception as it acts more like a base with liquefaction necrosis
chemical burns treatment
Apply topical anesthesia Copious irrigation, preferably with saline or lactated Ringer’s for at least 30 minutes May use Morgan lens or IV tubing Lid speculum may be helpful Check pH Antibiotic ophthalmic ointment Oral pain meds Refer to ophthalmology Get visual acuity if possible but irrigation is the most important!
***IRRIGATE – MOST IMPORTANT!!!
thermal burn
Most common – cigarettes and curling iron
Usually superficial burns
May need debridement of burned tissue
Refer to Ophtho
Treat like chemical burn except no irrigation needed
Cyclogyl 1% to dilate
Antibiotic Ointment
Topical Anesthetic
UV burn
Welding or sun lamps without eye protection
Produces small, diffuse epithelial defects which stain with fluorescein
Becomes severely painful several hours after exposure
Treat with Cyclogyl, topical anesthetic and antibiotic ointment, follow-up
Subconjunctival Hemorrhage
Superficial blood vessels broken
Contained b/c involves conjuctiva
May occur spontaneously
Coumadin, aspirin, valsalva
treatment for Subconjunctival Hemorrhage
Usually self-limited
Treat with artificial tears and reassurance
May be suggestive of ruptured globe if associated with trauma – Get Full History!
orbital hematoma treatment
If mild, treat with cool compresses
If large amount of hemorrhage, especially behind the globe (Retrobulbar hemorrhage), may require emergency surgery to reduce intraocular pressure and protect corneal surface
orbital fractures
Common in high impact / high energy
signs and symptoms of orbital fractures
Diploplia, epistaxis, decreased facial sensation
crepitus
physical exam of orbital fractures
Ecchymosis, sunken eye, Fixed gaze with superior eye movement
Inferior rectus entrapment
testing for orbital fractures
Maxillofacial CT scan
treatment of orbital fractures
Nasal decongestants, antibiotics, ice packs
Consult Ophtho if visual changes, abn EOM, Or increased IOP
Surgery not required unless persistent diplopia or poor cosmetic appearance
Surgery is usually delayed for 7-14 days to allow for resolution of swelling
blowout fractures
May involve the Orbit, Zygomatic Arch, Le Fort Type, or any combo
Inferior Rectus Entrap. w/ orbital floor fracture – no upward gaze
Visual Acuity
Sensation – Infraorb. Nerve
Blowout Fracture Treatment
If no eye injury then no admission
outpatient follow up with Maxillofacial and/or Ophth.
+/- Surgery
Tetanus
Avoid valsalva or nose blowing
Decongestants x 3-5 days
Prophylactic antibiotics
Eye Injury = Immediate Consult / Admission
Surgical Repair
Intraorbital/Intraocular Foreign Body
Ophthalmology consult for complete examination
Need to rule out injury to globe or intraocular FB
Ruptured or Lacerated Globe
Be suspicious with blunt trauma, projectile injury, contact with sharp object, or trauma from hammering metal on metal
Ruptured or Lacerated Globe physical exam findings
Bloody chemosis Hemorrhagic swelling of conjunctiva Uveal prolapse Brown spot on the sclera or cornea Irregularly shaped pupil Hyphema Lowered intraocular pressure
Ruptured or Lacerated Globe treatment
IMMEDIATE OPHTH. CONSULTATION!!
CT scan of orbits (thin cuts – axial and coronal) to rule out intraocular foreign body – No MRI (in case of metallic FB)
NEVER try to remove a penetrating Foreign Body
If rupture or laceration is suspected, stop the examination immediately and place a hard shield (NOT A PATCH bc don’t want to inc. press.)
Get Visual Acuity if possible but do not press on globe
Hyphema
Blood in the anterior chamber
Posterior to cornea and anterior to lens
Often after head or eye trauma
Can be diffuse or layered
Must know sickle cell status
hyphema treatment
Shield and immediate referral to ophthalmologist
High risk of ruptured globe
eyelid lacerations
Should always be concerned about underlying open globe
Eyelid Lacerations treatment
Refer to ophthalmologist for Full-thickness laceration Laceration involving medial ⅓ of lid Deep lacerations with or without fat prolapse Lacerations with significant tissue loss
seidel’s test
fluorescein dye washed away by leaking aqueous humour from the anterior chamber
Age-Related Macular Degeneration types
Atrophic/Dry (nonexudative) - more common
Neovascular/Wet (exudative)
Age-Related Macular Degeneration signs and symptoms
Gradually progressive bilateral central vision loss
Atrophic - slower
Neovascular – faster, more severe
Drusen on funduscopic exam
Extracellular deposits under retinal pigment
Eventually retinal pigment becomes detached
Then vision loss / drusen is not blocking
Peripheral fields are maintained
Age-Related Macular Degeneration treatment
Prevention
GET A DILATED EYE EXAM!!!
Vitamin A, C, E, zinc, copper supplementation
Vascular Endothelial Growth Factors (VEGF)
Monthly intravitreal injections for 2 years
what circulations does hypertensive retinopathy affect?
retinal and choroidal circulations
what is the severity of hypertensive retinopathy?
degree and rapidity of HTN
Chronic HTN accelerates atherosclerosis
Fundoscopic exam of hypertensive retinopathy
Tortuous and narrow arterioles
Silver/copper-wiring
Increased venous compression at A-V crossing
AV nicking
Flame-shaped hemorrhages, cotton-wool spots
T/F: retina has neve endings
FALSE: The retina has NO nerve endings, thus, retinal disease, including diabetic retinopathy and macular degeneration don’t hurt because…it can’t. You can’t even feel a retinal tear or retinal detachment.
Amaurosis Fugax
Transient Ischemic Attack of the Retina
Brief interruption of blood flow = monocular blindness
Pt state: Rapidly, fading of vision like a curtain descending
T/F: Amaurosis Fugax is caused by embolus in the retinal artery
TRUE
signs and symptoms of Retinal Artery Occlusion (RAO)
Sudden, painless, monocular vision loss
If pain: Headache, scalp tenderness
physical exam of Retinal Artery Occlusion (RAO)
Visual fields restricted to temporal island
Fundoscopic exam
Cherry red spot- peri-foveal atrophy from lack of blood
“Box car” look is the arteriolar narrowing because of lack of blood flow.
May See Emboli
Chronic or old occlusion
Pale optic disc
Causes of RAO
Carotid or cardiac emboli sources
DM, hyperlipidemia, HTN
Patients > 55 years, must rule out giant cell arteritis (ESR / Biopsy)
lab findings of RAO
Elevated ESR and CRP if giant cell arteritis
DM screen, hyperlipidemia screen
imaging of RAO
Carotid ultrasound
Echocardiography
treatment of RAO
Emboli
Supine, high O2, acetazolamide
+/- thrombolysis
Giant Cell Arteritis
High dose corticosteroids
signs and symptoms of Retinal Vein Occlusion (RVO)
Sudden, painless, monocular vision loss
If pain, it is severe b/c increases IOP bc venous obstruction
what must you screen for RVO
DM, HTN, hyperlipidemia, glaucoma, and hypercoagulable states
Fundoscopic exam of RVO
Retinal hemorrhages, macular edema which is called Blood and Thunder appearance
treatment Retinal Vein Occlusion (RVO)
Photocoagulation to reduce edema and prevent future glaucoma (IOP)
Optic Neuritis
Strongly associated with demyelinating diseases
Multiple sclerosis, encephalomyelitis
Can also be caused by viral infections and autoimmune disorders
Measles, mumps, influenza, varicella, SLE
Inflammation of the Optic Nerve
Optic Neuritis signs and symptoms
Unilateral loss of vision over 1-3 days, transient
PAIN with eye movements
Color blindness
Optic Neuritis physical examination
Variable visual field defects
T/F: Papilledema is AWAYS present in optic neuritis
FALSE: Can have papilledema but not always!!
Treatment for optic neuritis
3 days of 1000mg IV methylprednisolone
what is papilledema
condition in which increased pressure in or around the brain (intracranial pressure) causes swelling of the part of the optic nerve inside the eye (optic disc)
