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Opthalmology > Gradual Vision Loss > Flashcards

Gradual Vision Loss Flashcards

0
Q

List the different types of refractive error

A
  1. Hyper-metropia ( long sight): can’t see near–> focus behind retina–> want less diverge–> CONVEX
  2. Myopia ( near sight) : can’t see far–> focus in front->diverge more- CONCAVE
  3. Presbyopia ( age associated loss of accommodation) : diverge less- CONVEX* age related myopia
  4. Astigmatism : 2 diff curvatures of cornea
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1
Q

List 7 causes of gradual vision loss

A
  1. Refractive error
  2. Cataract
  3. Corneal blindness
  4. Optic atrophy
  5. ARMD
  6. Diabetic macular edema
  7. Chronic ocular inflammation/ infection
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2
Q

How does one prove refractive error?

A

Vision improves with 1mm pin hole

Parallel rays pass through - needing no refraction to get a clear image

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3
Q

What is a cataract?

A

Cloudy / less clarity of lens

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4
Q

List 4 causes of cataract

A
  1. congenital

2. Acquired: senile, diabetes, trauma, steroid, chronic uveitis

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5
Q

Sx and Sn of cataracts

A
  1. Blindness gradual
  2. Glare
  3. Mono-ocular diplopia
  4. Refractive error
  5. Loss of red reflex
  6. Leukocoria
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6
Q

Other cause se of leukocoria

A
  1. Toxo
  2. Toxocariasis
  3. Retinoblastoma
  4. Long standing retinal detachment
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7
Q

Mx of cataracts

A
  1. Microsurgery
    ( safe, cost effective, quick)

Cataract extraction->
1. Intra capsular: remove with lens and capsule- eye is aphakic( no lens) replace with powerful glass lense +10

  1. Extra capsular : lens only removed- leave capsule so replace lens
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8
Q

Methods of Extra capsular excision

A
  1. Traditional: large limbal cut- needle make hole in capsule - remove by applying pressure
  2. Small incision : tunnel via sclera–> hydrostatic removal –>no suture
  3. Phaco-emulsification: ultrasound probe emulsify and aspirated –> no suture - short recovery time
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9
Q

What is corneal blindness?

A

Anything that causes an Opacified cornea - low Va

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10
Q

What is the difference between a cataract and cornaeal blindness (sign)

A

Visible iris in cataract

Non-visible iris behind a opaque cornea

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11
Q

Causes of corneal blindness?

A
  1. Infection :
    A. Trachoma : chlamydia, spread by housefly–> recurrent infections. Cause conj scaring-entropion-trichaisis- cornaeal scar

B. Intersistinal keratitis: congenital syphillis, TB, measels

2.UV
A. Climatic droplet keatopathy: prolonged uv light ( outdoor workers or desert land)–> looks like “bubbling cornea” - Mx patch or ointment work temp ( may have ass cataract)

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12
Q

What is optic atrophy?

A

PALE optic disc
Damage to nerve fibers at any point from the retina to LGB
1. Glaucomatous atrophy ( large optic disc cup)” cupping “
2. Non Glaucomatous atrophy/diffuse

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13
Q

Sn and Sx of optic atrophy

A
  1. Gradual vision loss
  2. Low colour vision
  3. Loss VF
  4. AFFERENT PUPIL DEFECT
  5. Pale disc
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14
Q

Causes of optic atrophy

A

Any interruption on the retina or the optic nerve including chasm
1 . Nerve compression : tumor
2. Damage nerve head : glaucoma ( pressure response) or chronic
3. Nerve ischemia : central rental artery occlusion:
4. Damage to retina : metabolic ( retinitis pigmantosa) infective ( syphillis) genetic , toxic (ethambutol. Tabbaco-ethoh amblyopia ).

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15
Q

What is Glaucoma?

A

Optic neuropathy with

  1. Optic docs cupping
  2. Chart artistic visual field loss (. Central vision maintained)

Associated with
1. Increased IOP (N 10-21 mmHg)

*can have normal cup and VA AND IOP

16
Q

What is the normal CSF opening pressure?

A

70-180 mmHg–> 7-18 cm Hg

17
Q

Classify glaucoma?

A
  1. Acute vs chronic
  2. Open vs closed angle: anterior chamber angle( gonioscopy)
  3. Primary vs secondary : other related ds?-uveitis, cataract

*primary chronic open Angle -most common

18
Q

Risk factors for glaucoma ( poag)?

A
  1. Age>45
  2. Black
  3. Myopia
  4. Dm, hpt uncontrolled
    5 genetic: TIGR MYOCILLIN gene
19
Q

Sx sn glaucoma

A
  1. ASX, no pain, normal va/low
  2. Peripheral VF lost-> follows path of recital nerve damage (out in)
    -tunnel vison
    -nasal step
    -ring scotoma
    -eventual blin
  3. Optic disc
    -pale
    ->o.6= Glaucomatous cupping = loss of nerve fibre cause bigger cup
    +disc hge
    +cup pallor> disc
    +laminar dot sign
    +vessel change : nasalization, baring, bayonetting
    +disc notching
20
Q

Mx glaucoma

A
  • lifelong: progression
    1. Medically Drop IOP: drops Bb, PG analogue
    2. Surgically drop IOP; drain - trabeculectomy ( SE:Can cause bleb on eye ; looks like cyst on conjunctiva)
21
Q

What is retinitis pigmantosa (RP)?

A

-inherited retinal atrophy–> dystrophy of photoreceptors

22
Q

Sn and Sx of RP

A
  • gradual vision loss
  • night blind
  • tunnel vison
Sn
-waxy pale disc
-bone speckle pigmentary retinopathy
-annuated bv
-
23
Q

What else should you screen for in a patient with RP?

A
  1. Deafness
  2. Heart block
  3. Cerebellar disease
24
Q

What is Papilloedema?

A

Bilateral discs swelling due to INCREASED ICP

  • cause intermittent visual disturbances that re-occurs during the day
  • chronic: vidialy acuity loss so pallor = optic atrophy
25
Q

What are the signs and Sx of ICP

A

Sx: early morning headache, nausea, intemittend visual disturbance , LOC/ personality change

Sn :
1 papilloodema
2 cushings triad : high bp, wide pp, Brady cardia (+ deep respiration )
3 cranial nerve 6 palsy : can’t ad-duct eye–> have convergent squint on distant fixation ( FALSE LOCALIZING SIGN)
* cn 6 out of the bottom of brain first affected at inc ICP / long intracranial path

26
Q

Dx?
If a pt disc is
1. Swollen
2, sudden COMPLETE vision loss

A

Papillitis causes optic neuritis

27
Q

Age related macular degeneration is diease of elderly > 65
And in light skinned.
But how does it present?

A
  1. Central vision loss( scaring , leaking or bleeding sub retinal neo-vascular membrane
  2. Distorted image/ metamorphopsia

Types:
1Loss slow/dry
2 fast/wet(due to bleeding).

Sn:

  1. Drusen : pale deposit in MACULAR (early sign)
  2. Dry–>Retinal pigment epithelial atrophy (dry)
  3. Wet –> hge and exudate from sub retinal neovascular membrane
28
Q

Mx of ARMD

A
  1. Laser
  2. Antivascular GF - intraviteral injection
  3. Visual aid of mild
29
Q

Diabetetes?

A

Macular odema

30
Q

Chronic ocular inflammation

A

H

Opthalmology (1 decks)

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