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Ocular Disease II > Glaucoma: OPTIC NEUROPATHIES: Dr. Tina Lecture > Flashcards

Glaucoma: OPTIC NEUROPATHIES: Dr. Tina Lecture Flashcards

1
Q

Optic Disc Neuropathies (3 main things seen)

A

(Swelling, Pallor, Cupping)

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2
Q
  1. What is Optic Disc Edema?
  2. What is Papilledema?
    a. How do you check or Diagnose it?
A
  1. Swelling, Pallor, Cupping
  2. Bilateral Optic Disc Edema w/Addition of ELEVATED ICP
    a. w/a CSF Spinal Tap
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3
Q
  1. Optic Disc Dysplasia
A
  1. Deformed Optic Disc; Can’t be classified into any specific Diagnostic Category
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4
Q

Classifications of Optic Neuropathies

  1. Congenital Disc Anomalies
  2. Optic Neuritis
  3. Ischemic
  4. Papilledema
  5. Compressive
  6. Infiltrative
  7. Traumatic
  8. Nutritional
  9. Toxic
  10. Hereditary
  11. Glaucoma (we know this…)
A
  1. Something you’re born with
  2. Inflammation of neuron
  3. Loss of BF to the nerve
  4. Bilateral Disc Edema w/INCREASED ICP
  5. Tumor or Mass that pushes on nerve (causes SWELLING or Paleness)
  6. Cancer/Sarcoidosis/Wegeners
  7. Hit in the eye…Optic Nerve will swell if hit hard enough and get paleness of nerve
  8. Not enough vitamin B12: Pale nerve
  9. Energy Drinks: Nerve Goes Pale
  10. something passed down…. (Lebers …??)
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5
Q

Congenital Disc Anomalies Optic Disc Coloboma

  1. What is it?
  2. Uni or Bi?
  3. Visual Loss?
  4. What is THIN or ABSENT?
  5. Complications?
  6. Systemic?
A
  1. INCOMPLETE or ABNORMAL APPOSITION of the Proximal End of the Embryonic Fissure
  2. Either
  3. Varies
  4. Inferior Neuroretinal Rim (NRR)
  5. SERIOUS MACULAR DETACHMENT
  6. Multisystem Congenital Syndromes
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6
Q

Congenital Disc Anomalies Optic Nerve Hypoplasia

  1. MAJOR SIGN?
  2. What is it?
  3. MOST COMMON TYPE of OPTIC NEUROPATHY?
  4. COMMON CAUSE of what blindness?
  5. Uni/Bi?
  6. Vision?
  7. Dx?
  8. Systemic?
A
  1. DOUBLE RING SIGN! (Seeing mainly Scleral tissue)
  2. Abnormal Small Optic Nerve HEAD
  3. Most Common CONGENITAL DISC ANOMALY!
  4. of CONGENITAL BLINDNESS
  5. Either
  6. 20/20 to NLP
  7. small ONH, NLP or reduced VA, abnormal OCT and/or VF
  8. CNS malformations & Endocrine Abnormalities
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7
Q

Congenital Disc Anomalies Megalopapilla

  1. What is it?
  2. Bi or Uni more common?
  3. VA?
  4. VF?
  5. RARELY: Associated with what 2 things?
  6. What does it MIMIC?
A
  1. Abnormal Large ONH (>2.1 mm diameter)
  2. BILATERAL
  3. NL or MILDLY DECREASED (variable)
  4. ENLARGED BLINDSPOT!
  5. Basal Encephalocele & Midline Facial Anomalies
  6. Glaucomatous Cupping
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8
Q

Congenital Disc Anomalies Tilted Discs

  1. It’s a Form of what?
  2. SUPERIOR RIM APPEARS to be what?
  3. Where is Neural tissue concentrated?
  4. Where is tissue deficient of Axons?
  5. Complications? (4)
  6. What can it MIMIC?
  7. MOST COMMON VF DEFECTS?
A
  1. COLOBOMA
  2. Dislocated to the SUPERONASAL QUADRANT
  3. at SUPERIOR and SUPEROTEMPORAL ASPECT
  4. Inferior and INFERONASAL ASPECT is deficient (SUPERIOR Temporal VF DEFECT)
  5. CNVM, Staphyloma, Lacquer Cracks, VF LOSS
  6. Can Mimic GLAUCOMA
  7. Superior BITEMPORAL DEFECTS!
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9
Q

Congenital Disc Anomalies Morning Glory Disc Anomaly

  1. Form of what?
    a. Associated with what 4 things?
  2. Uni/Bi?
  3. Male/Female?
  4. VA?
  5. Complications?
  6. Neurologic Associations: Order what DDx Tests?
A
  1. Coloboma
    a. Retinal Vascular Anomalies, Glial Proliferation and Metaplasia, Peripapillary Pigmentary Changes
  2. UNI
  3. FEMALE
  4. USUALLY POOR
    • SEROUS RD, CNVM (Chorioneovascular membrane)
  6. Order MRI and MRA Brain
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10
Q

Congenital Disc Anomalies Peripapillary Staphyloma

  1. What is it?
  2. Vasculature: normal/Abnormal?
  3. VA?
  4. VF?
A
  1. DEEP, Cup-shaped Excavation w/a Relatively Normal, Well-formed Optic Disc; Some temporal pallor may be present
  2. Normal
  3. usually markedly reduced
  4. Centrocecal Scotoma
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11
Q

Congenital Disc Anomalies Optic Disc Pit (Coloboma in bottom part of optic nerve; Optic Disc Pit usually upper area)

  1. What is it?
  2. UNI/BI?
  3. Occurs in locations UNRELATED to what?
  4. VA?
  5. VF defects?
  6. Complications?
A
  1. Gray, White, or yellow Oval or round depression in Optic Nerve
  2. UNI
  3. to Embryonic Fissure
  4. Usually NL
  5. varies. 50% of patients
  6. Serous Macular Detachment, Macular Edema, Macular Hole
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12
Q

Congenital Disc Anomalies Optic Disc Drusen

  1. What is it?
  2. BI/UNI?
  3. Inherited?
  4. Appearance of Drusen change with what?
  5. Dx?
  6. Complications?
A
  1. contains CALCIUM
  2. Bilateral > Uni
  3. Yes
  4. with age
  5. Clinical, B-Scan, CT Scan, FA, OCT, FAF
  6. Transient Visual Obscurations (TVO), Slow Progressive VF Defects, NAION, CRAO, CRVO, CNVM
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13
Q

Congenital Disc Anomalies Hyaloid Remnants

  1. What 2 do we see?
A
  1. Epipapillary Glial Tissue and Bergmeister Papilla
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14
Q

Congenital Disc Anomalies: Situs Inversus: Vasculature Emerges where?

A
  1. Temporal to Nasal; Benign anomaly
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15
Q

Congenital Disc Anomalies: Myelinated Nerve Fiber

  1. What does it look like?
  2. Myelination extends beyond what?
  3. Inherited?
  4. UNI/BI?
  5. VA?
  6. SEVERE MYELINATION: associations?
  7. Common?
A
  1. Whitish, Feathery appearance
  2. the Posterior Portion of Lamina Cribrosa
  3. Yes
  4. UNI
  5. Usually normal
  6. Amblyopia, Strabismus, Nystagmus, Myopia, Enlarged BS, and Relative Scotomas
  7. RARE, Systemic Associations
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16
Q

Optic Neuritis:

  1. Where is the Inflammation: It will be one of 2 scenarios?
  2. What does the eye look like when the inflammation Resolves?
A
  1. Anterior Optic Neuritis
  2. Posterior (Retrobulbar) Optic Neuritis (RBON) (*When SYMPTOMS START, the EYE LOOKS NORMAL!!!!!)
  3. The Nerve will LOOK PALE (regardless of which type it is): It usually develops PALLOR at about 1 MONTH after.
17
Q

Optic Neuritis: (2)

  1. Who does it affect the most?
  2. Adults?
  3. Children?
A
  1. Young to middle-aged adults (16-55) (FEMALES more than MALES)
  2. UNILATERAL, DEMYELINATING
  3. BILATERAL, POST-VIRAL or Vaccination! (usually benign and usually goes away)
18
Q

Optic Neuritis: (3)

  1. Symptoms (7)
A
  1. Loss of CENTRAL VISION
  2. Mild orbital PAIN
  3. Pain w/Eye MOVEMENT
  4. DYSCHROMATOPSIA (Loss of Color Vision)
  5. Reduced CONTRAST
  6. PHOTOPSIA
  7. POOR DEPTH PERCEPTION
19
Q

Optic Neuritis: (4): Signs

  1. VA?
  2. Pupils?
  3. VF?
  4. Color vision?
  5. Contrast?
  6. Stereopsis?
  7. Optic Nerve?
A
  1. varies 20/20 to NLP
  2. APD
  3. Defects: CENTRAL SCOTOMA
  4. REDUCED
  5. DECREASED
  6. DECREASED
  7. Optic Nerve Papillitis or NORMAL
20
Q

Optic Neuritis:(5)

  1. ETIOLOGY of OPTIC NEURITIS in an Adult is MOST OFTEN WHAT?
A
  1. Demyelinating in NATURE: ALWAYS LOOK FOR MS!! (Age: 20-40, Female)
    * Can develop Periventricular White Matter Lesions! (Classic in MS)
21
Q

Optic Neuritis: Treatment

  1. Option 1?
  2. Option 2?
A
  1. DO NOTHING

2. IV Methylprednisolone 1g x3days then oral Prednisone taper at 1 mg/kg/day for 11 DAYS

22
Q

Ischemic Optic Neuropathy

  1. 3 Types: What are they?
A
  1. NAION (non-arteritic Anterio Ischemic Optic Neuropathy)
  2. AION (Arteritic Anterior Ischemic Optic Neuropathy)
  3. PION (Posterior Ischemic Optic Neuropathy)
23
Q

Ischemic Optic Neuropathy: NAION

  1. Usually seen OVER WHAT AGE?
  2. Male/Female?
  3. Ethnicity?
  4. AKA?
A
  1. OVER 50
  2. Same
  3. WHITE peeps
  4. DISC at RISK
24
Q

Ischemic Optic Neuropathy: NAION

  1. What is it?
  2. Pain involved?
  3. APD?
  4. VF Defect typically where?
  5. Disc what?
  6. Types of Hemmorhages?
  7. What else?
A
  1. ACUTE VISION LOSS; USUALLY upon AWAKENING!!!
  2. Painless
  3. +
  4. INFERIOR NASAL or INFERIOR ALTITUDINAL but all defects are possible
  5. Disc Edema
  6. Flame-Shaped Hemes
  7. Dyschromatopsia
25
Q

Ischemic Optic Neuropathy: NAION

  1. 5 MAJOR RISK FACTORS?
A
  1. HYPERTENSION, Dyslipidemia, DIABETES, TOBACCO USE, NOCTURNAL HYPOTENSION
26
Q

Ischemic Optic Neuropathy: NAION: Tx

  1. What Tx is there?
  2. Be sure to rule out AION caused by WHAT?
    a. What test?
A
  1. NONE PROVEN: Q/O Aspirin Use to Prevent FELLOW Eye INVOLVEMENT
  2. GIANT CELL ARTERITIS (GCA)
    a. CBC w/diff; CRP; Westergren ESR
27
Q

Ischemic Optic Neuropathy: AION

  1. Ethnicity?
  2. Male/Female?
  3. VA?
  4. Uni/Bi?
A
  1. Whites
  2. Female
  3. SEVERELY REDUCED VA (count fingers to NLP)!!
  4. UNI then Bilateral w/in DAYS
28
Q

Ischemic Optic Neuropathy: AION

  1. Most COMMON ETIOLOGY of AION is WHAT?
    a. What is it?
A
  1. GIANT CELL ARTERITIS (GCA)

a. Systemic Vasculitis of Medium to LARGE BVs.

29
Q

Ischemic Optic Neuropathy: AION: GCA

  1. 2 Main issues?
    a. What main artery on head?
  2. Visual Loss in Arteritic AION MAY OCCUR how?
  3. DDx for Suspected GCA?
  4. GOLD STANDARD for GCA Diagnosis?
    a. When should it be done?
A
  1. HEADACHE and Jaw Claudication
    a. Superficial Temporal Artery (get Temporal Arteritis)
  2. Sudden or can be preceded by Transient Monocular or Binocular Visual Loss or Transient Diplopia
  3. CBC w/Diff; Westergren ESR; CRP
  4. TEMPORAL ARTERY BIOPSY
    a. w/in 1-2 weeks of CORTICOSTEROID TREATMENT
30
Q

GCA

  1. Dx Criteria of 3 or more of the following?
A
  1. Over Age 50; New onset localized HA; Temporal Artery Tenderness or Decreased Temp a. Pulse

Increased Westergren ERS > 50 mm/hr

Positive TAB

*Vision when out then slowly came back over a few minutes/hours; developing double vision (think GCA!!)

31
Q

Ischemic Optic Neuropathy: GCA

  1. Uncomplicated GCA
    a. What is it?
    b. Tx?
  2. Evolving Visual Loss
    a. What is it?
    b. Tx?
  3. Established Visual Loss
    a. What is it?
    b. Tx?
  4. What other things are you going to give the patient?
  5. PREDNISONE can be SLOWLY be TAPERED over what?
A
  1. a. No jaw claudication or visual disturbance
    b. 40-60 mg oral Prednisone DAILY
  2. a. Recent onset visual symptoms over 6-12 hrs OR transient visual loss
    b. IV Methylprednisolone 500-1000 mg/d x3DAYS then Oral Pred 1mg/kg/day
  3. a. It’s established
    b. AT LEAST 60 mg Prednisone DAILY to Protect fellow
  4. Calcium (1200 mg/d); Vit D (800 IU/d); Bone density test, then +/- on Aspirin (not sure if it helps but we think it might)…most peeps give a baby aspirin
  5. Over the next 12-18 months w/monitoring of Symptoms, ESR, and CRP
32
Q

Ischemic Optic Neuropathy: PION

  1. Common/Rare?
  2. 2 Types?
  3. APD?
  4. VF defect?
  5. Dyschromatopsia?
  6. At onset, what does the Optic Disc appear as?
  7. 4-6 wks later, what develops?
  8. Dx of Exclusion: Order what?
  9. Tx?
A
  1. RARE
  2. Arteritic vs. Perioperative
  3. +
  4. Yes
  5. Yes
  6. Appear NL
  7. Pallor Develops
  8. Order Neuroimaging
  9. Arteritic: Treat Underlying Cause:

Perioperative: No known Tx

33
Q

Ischemic Optic Neuropathy: Perioperative PION

  1. Get Hypotension from what?
A
  1. From Anemia or from any disease in BF to the IPSILATERAL common or ICA (internal carotid artery) during surgery may LEAD to LOSS of BF to the EYE!
34
Q

Papilledema (Whooshing sound in brain)

  1. normal CSF Pressure?
    a. Dx?
    b. What is always done before this?
A
  1. 100 mmH2O - 250 mmH2O
    a. Lumbar Puncture
    b. MRI or CT ALWAYS done BEFORE an LP
35
Q

Papilledema: Signs

  1. What happens to the disc?
  2. Hemorhages?
  3. Paton’s LINES?
  4. What 3 other things?
A
  1. Disc Edema
  2. Retinal Splinter Hemes
  3. Choroidal Folds
  4. Retinal Vessel Engorgement; Macular Edema; Increased CSF Pressure
36
Q

Papilledema: Symptoms

  1. Headache that WORSENS with what?
  2. What else?
A
  1. with VALSALVA Maneuver

2. Nuchal Rigidity; Nausea; Emesis; Transient Visual Obscurations; Pulsatile Tinnitus; Blurred Vision

37
Q

Papilledema: Causes

  1. HIGHLIGHTED ONE?
  2. What other 4?
A
  1. IDIOPATHIC!! MOST COMMON

2. Cerebral Venous Sinus Thrombosis; Endocrine and Metabolic Dysfunction; Exogenous Agents (drugs); Systemic Disorders

38
Q

Idiopathic Intracranial Hypertension

  1. AKA?
  2. Symptoms?
  3. Who gets it?
  4. Most SIGNIFICANT COMPLICATION?
  5. Tx?
  6. Sx Tx?
A
  1. Pseudotumor Cerebri
  2. HA, TVO’s, Pulsatile Tinnitus, Diplopia, Blurred vision or loss of visual field
  3. FAT, FERTILE, FEMALE

4, BLINDNESS or Permanent VISUAL impairment form chronic Papilledema resulting in Optic Atrophy

  1. Wt Loss, ORAL Acetazolamide (DIAMOX)
  2. Optic Nerve Sheath Fenestration (ONSF) or Lumboperitoneal (LP) Shunt
39
Q
  1. Optic Neuropathies may present as what?
  2. For MANY of the CONGENITAL OPTIC DISC ANOMALIES: you have to LOOK for what?
  3. What can MIMIC GLAUCOMA?
  4. Many Congenital ONH anomalies may be associated with what?
  5. most common Etiology of Optic Neuritis is what?
  6. Patients w/Small Optic Nerves are at a HIGHER RISK for what?
A
  1. Pallor, Edema, Cupping, or Dysplasia
  2. other Associations
  3. Tilted Discs
  4. CNVM or RD
  5. Demyelination; Evaluate for MS
  6. for Ischemic Optic Neuropathy

Ocular Disease II (15 decks)

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