Eyes- Uveal tract, lens, intraocular conditions, orbit & macula/retina

Question 1

what is and where does acute uveitis occur?

Answer 1

inflamm in iris, ciliary body, choroids (uveal tract)

Question 2

how is acute uveitis anatomically classified?

Answer 2

• anterior (iritis), ciliary body (cyclitis) or both (ididocyclitis)
• intermediate (peripheral uveitis)
• posterior, rare serious condition (choroiditis, chorioretinitis)

Question 3

cause of acute uveitis?

Answer 3

• underlying systemic dz or idiopathic
• ankylosing spondylitis
• reactive arthritis
• infection
• sarcoidosis
• auto-immune

Question 4

Ssxs of acute uveitis?

Answer 4

• anterior uveitis: acute, unilater, painful ciliary flush, blurred vision, photophobia, tearing
• intermediate: painless, floaters, blurred vision
• posterior: blurred vision, eye floaters, eye pain, photophobia

Question 5

what is cataracts? 2 forms of etiology?

Answer 5

• increased opacity of lens w/painless, progressive visual loss
  1. developmental- juvenile cataracts
  2. degenerative- senile, XR, UV light, trauma, diabetes

Question 6

SSxs of cataracts?

Answer 6

• decreased visual acuity
• increased glare
• progression may lead to mild to moderate myopia
• no red reflex anymore

Question 7

what is glaucoma? two forms?

Answer 7

• increased intraocular pressue
  1. acute closed angle glaucoma
  2. chronic open angle glaucoma

Question 8

what is acute closed angle glaucoma? predisposing factor?

Answer 8

• EMERGENCY
• red eye
• mechanical blockage of canal of schlemm
• drugs predispose

Question 9

SSxs of acute closed angle glaucoma?

Answer 9

• pts elderly, hyperopic, no hx of glaucoma

- peri-orbital pain & visual deficits, pain is boring, concomitant ipsilateral H/A, blurry vision, ‘halo around objects’

Question 10

PE findings of glaucoma?

Answer 10

• blurred vision, detect hand movements but not text or numbers
• corneal & scleral injection
• pain on eye movement
• dilated non-reactive pupil
• MEDIAL CRESCENT SHADOW
• increased cup/disc ratio

Question 11

how do you tx someone w/acute closed angle glaucoma?

Answer 11

REFER IMMEDIATELY

Question 12

what is chronic open angle glaucoma? cause?

Answer 12

• no red eye
• 90% of all cases
• malfunction of canal of schlemm usu from organic changes w/aging
• decreased rate of aqueous outflow, bilateral, genetic predisposition

Question 13

SSxs of chronic open angle glaucoma?

Answer 13

• gradual loss of peripheral vision

- when uncontrolled will result in loss of vision

Question 14

what is hyphema?

Answer 14

• hermorrhage into anterior chamber from trauma

- recurrent bleeding may cause glaucoma & visual loss

Question 15

what is preseptal cellulitis? cause?

Answer 15

• inflammation/inxn of eyelid & surrounding skin anterior to orbital septum
• trauma, infxn spread from nasal sinus or tooth, insect bite, seeding from bac, eyelid injury, conj, chalazion

Question 16

what are SSxs of preseptal cellulitis? emergency?

Answer 16

• tenderness, swelling warmth, redness of eyelids
• visual acuity not affected
• typically mild condition, rarely leads to complications
• typically not an emergency

Question 17

what is orbital cellulitis? causes?

Answer 17

EMERGENCY

• infxn of orbital tissue posterior to nasal septum
• progresses rapidly can cause thrombi or increased intraocular pressure
• extension of infxn from ethmoid sinus, local trauma, infxn on face or teeth

Question 18

SSxs of orbital cellulitis?

Answer 18

• swelling & redness of eyelid & surrounding tissues, proptosis
• extreme unilateral orbital pain, pain with eye movement, dec eye motility
• conj hyperemia & chemosis
• decreased visual acuity
• depending on cause nasal d/c, sinus bleeding, tooth abscess
• fever, malaise, H/A raise suspicion of meningitis

Question 19

what do you do with a pt with orbital cellulitis?

Answer 19

-REFER out to hospital for CT, IV abs, possibly drainage

Question 20

what is exopthalomos? causes?

Answer 20

• bulging of eyes, ‘proptosis’

- orbital inflam, edema, injuries, hyperthyroid, leukemia, meingioma

Question 21

what causes retinal detachment?

Answer 21

• trauma, diabetes, inflam disorder, posterior vitreous detachment, idiopathic
• EMERGENCY

Question 22

SSxs of retinal detachment?

Answer 22

• painless
• dark or irregular floaters
• flashes of light
• blurred vision which progressively worsens
• curtain or vein in field of vision
• no redness

Question 23

what is posterior vitreous detachment? SSxs?

Answer 23

• w/age, vitrious gel can collapse & pull forward

- painless, floaters, flashes of light

Question 24

what is macular degeneration?

Answer 24

• leading cause of vision loss in elderly
• hemorrhage
• slow or sudden painless loss of central visual acuity
• see drusen bodies on opthalmoscopic exam

Question 25

what is diabetic retinopathy? who do you see it in? early vs late signs?

Answer 25

- blindness in diabetics - early signs: venous dilation & small, red well demarcated lesions then macular edema develops & affects vision - late signs: soft exudates caused by anoxia or hard white-yellow exudates from chronic edema - REFER if develop blurred vision over 2 d not associated w/elevated blood glucose, sudden loss in vision in 1 or both eyes, block spots, cobwebs or flashing lights in visual field

Question 26

what is hypersensitive reinopathy?

Answer 26

- vascular changes w/extent and persistence of hypertension - copper wire - silver wire - AV nicking - hemorrhages - soft exudates - hard exudates - papilledema

Question 27

what is copper wire in retinopathy?

Answer 27

-brightening & widening of central strip of artery, mod arteriosclerosis

Question 28

what is silver wire retinopathy?

Answer 28

-central light reflex entire width of arteriole from thickened walls

Question 29

what is AV nicking retinopathy?

Answer 29

-arteriole crossing venule

Question 30

what is retinitis pigmentosa?

Answer 30

- inherited slowly progressive bilateral retinal degeneration - loss of photoreceptors and blindness - central island of vision gradually constricts over time