Inner Eye Disorders Flashcards
1
Q
Thyroid Orbitopathy
occurs in who?
3 disorders
A
- Hyperthyroid (Graves)
- Euthryoid
- Hypothyroid
2
Q
Thyroid Orbitopathy
presentation
A
- bi or unilateral proptosis
3
Q
Uveitis
describe
A
emergency inflammation of uveal tract
4
Q
Uveitis
differentiate:
* anterior
* posterior
* intermediate
* panuveitis
A
- anterior chamber structures
- retina, choroid
- vitreous body only
- all structures involved
5
Q
Uveitis
sx
6 components
A
- blindness, distorted/blurred vision
- painful
- redness
- photophobia
- uni or bi lateral
- acute, < 3 mo, sudden onset
6
Q
Uveitis
PE Findings
6
A
- small/constricted pupil
- pupil reacts poorly to light
- iris becomes difficult to see
- redness
- WBCs settled in bottom of anterior chamber
- decreased IOP
7
Q
Uveitis
tx
3 components
A
- immediate referral to ophthalmology
- steroids
- exacerbated if give drugs for tx glaucoma
8
Q
Uveitis
complications
4
A
- visual loss
- cyst-like formations on macula
- glaucoma
- cataracts
9
Q
Episcleritis
describe
A
inflammation of the episclera which is the thin layer of vascular elastic tissue between the sclera and conjunctiva
10
Q
Episcleritis
PE Findings
3 components
A
- red, vascular injection of conjunctive w/ enlarged blood vessels beneath the conjunctiva
- mild pain/discomfort
- diffuse/nodular inflammation
11
Q
Episcleritis
Tx
4 components
A
- refer to ophthalmology
- warm compress
- steroids (topical)
- NSAIDs (drops/PO)
12
Q
Nystagmus
describe
2 components
A
- involuntary rhythmic eye motion/oscillation
- results from dysfunction in the vestibular system, brainstem, cerebellum
13
Q
Nystagmus
describe vestibular nystagmus
A
- results from dysfunction of the labryinth (Meinere’s disease), vestibular nerve, or vestibular nucleus in the brainstem
14
Q
Nystagmus
signs/sx of vestibular nystagmus
5 components
A
- nausea
- vertigo
- tinnitus
- hearing loss
- sudden head movements worsen sx
15
Q
Nystagmus
describe jerk nystagmus
A
- characterized by slow drifting off of a target followed by a quick corrective jerk
- can be downbeat, upbeat, horizontal, or torsional
16
Q
Nystagmus
signs/sx associated with jerk nystagmus
A
- some pts are unaware they have it
- others have: blurred vision, oscillopsia (environment oscillates)
17
Q
Nystagmus
describe up and downbeat nystagmus
A
- downbeat: occurs from lesions near the craniocervical junction (Chiari malformation, basilar invagination)
- Upbeat: damage to the pontine tegmentum from troke, demyelination, or tumor.
18
Q
Nystagmus
describe gaze evoked nystagmus
A
- when the eyes are help eccentrically in the orbits, they tend to drift back to primary position
- the pt will correct this, causing a quick oscillation to continue to target
- normal in many pts in extreme vision fields
19
Q
Nystagmus
what can exaggerate gaze-evoked nystagmus?
5 components
A
- drugs (sedatives, anti-convulsants, alcohol)
- muscle paresis
- myasthenia gravis
- demyelinating disease
- cerebellopontine angle, brainstem, cerebellar lesions
20
Q
Strabismus
pathophys
A
- problems w/ eye muscles, the nerves that transmit information to the muscles, or the control center in the brain that directs eye movements
21
Q
Strabismus
describe the misalignment of the eyes
A
- axis are not aligned
- misaligned may be constant or intermittent
22
Q
Strabismus
risk factors
3 components
A
- family hx
- refractive error (farsighted)
- medical conditions (down syndrome, stroke, cerebral palsy)
23
Q
Strabismus
differentiate extropia and esotropia
A
- extropia: deviating eye turns outward
- esotropia: deviating eye turns inward
24
Q
Strabismus
differentiate hypotropia from hypertropia
A
- hypotropia: deviating eye turns downward
- hypertropia: deviating eye turns upward
25
# Strabismus
asssocaited sx
| 3
* diplopia (double vision)
* suppression (diminished sensitivity within visual field of deviating eye)
* amblyopia (eyes not working together)
26
# Strabismus
describe accommodative esotropia
* due to uncorrected farsightedness causing eye to turn inward
* sx: double vision, closing/covering one eye when using nearsighted vision, tilting/turning head
27
# Strabismus
describe intermittent exotropia
* person cannot coordinate both eyes together
* sx: HA, difficulty reading, eye strain, closed eye w/ farsightedness/sunlight
28
# Strabismus
dx
| 5
* corneal light reflex
* cover/uncover test
* retinal exam
* ophthalmic exam
* visual acuity
29
# Strabismus
emergent causes?
| 5
1. orbital fractures
2. cellulitis
3. tumors
4. meningitis
5. increased IOP
30
# Strabismus
dx for emergent causes?
* orbital CT (ocular infiltrative process, tumors, abscesses, cellulitis)
* Brain MRI (evaulate CN roots + brainstem)
31
# Strabismus
tx
| 4 components
* can spontaneously resolve as muscles strengthen
* prism lenses (alter light enterance to eye to re-train them)
* vision therapy
* eye muscle surgery
32
# Amblyopia
describe generally
* lack of development of clear vision in one/both eyes that cannot be fixed with glasses
33
# Amblyopia
pathophys
* brain cannot combine the images from the eyes
34
# Amblyopia
this is a lazy eye
just FYI
35
# Amblyopia
causes
| 3
1. early strabismus
2. early myopia/presbyopia
3. visual problems (ex: congenital cataracts)
36
# Amblyopia
tx
* patching of "good eye" to force the lazy eye to work
* vision therapy
37
strabismus vs amblyopia
* strab: cross eyed
* ambl: lazy eye
38
# Glaucoma
generally describe
abnormal flow of fluid around lens that causes increases in IOP and then damages the optic nerve causing diminished vision and eye irritation
39
# Glaucoma
which type of glaucoma is usually asx?
chronic
40
# Glaucoma
epidemiology
| age, race, common
* increasing age
* AAs at largest risk
* family hx increases risk
* chronic open angle is most common
41
# Open-Angle Glaucoma
what increases IOP in open angle?
IOP is elevated due to reduced drainage of aqueous fluid through the trabecular meshwork
42
# Open-Angle Glaucoma
goal for tx of open angle?
reduce the pressure by reducing the amount of fluid present in the eye
43
# Open-Angle Glaucoma
sx/signs
| 6 components
* no sx in early stages
* progressive bilateral loss of peripheral vision
* tunel vision
* preserved visual acuities until advanced disease
* cupping of optic discs
* elevated IOP
44
# Closed-Angle Glaucoma
predisposing factors
| 3
1. shallow anterior chamber (farsightedness/short stature)
2. Asian/Inuits
3. enlarged lens
45
# Closed-Angle Glaucoma
what causes angle closure?
pupillary dilation
46
# Closed-Angle Glaucoma
associated sx
* HA
* red eye
* pain in eye
47
# Closed-Angle Glaucoma
dx
* measure IOP (elevated)
* gonioscopy (allows you to observe narrow chamber angle)
48
# Closed-Angle Glaucoma
PE findings
| 5
* red eye
* cloudy cornea
* pupil dilated, non-reactive to light
* IOP > 50mmHg
* globe firmness
49
# Closed-Angle Glaucoma
complication of acute
severe and permanent vision loss if not treated within 2-5 days of sx onset
50
# Closed-Angle Glaucoma
prophylaxis for acute
laser peripheral iridotomy to the unaffected eye
51
# Closed-Angle Glaucoma
Tx
| 4 components
* goal: reduce IOP
* Acetazolamide
* osmotic diuretics (glycerin, urea, or mannitol) if no response to acetazolamide
* Pilocarpine drops after IOP decreases
52
# Closed-Angle Glaucoma
surgical options
| 3
* laser pepheral iridotomy
* surgical peipheral iridectomy
* cataract surgery
53
# Glaucoma
which BB can be used? describe what is does?
* timolol
* reduces aqueous humor which decreases IOP
54
# Glaucoma
which topical prostaglanding agonist can be used? how?
* "prosts"
* increases outflow of aqueous humor to decrease IOP
55
# Glaucoma
which alpha-2 adrenergic agonist can be used? describe?
* brimonidine
* dilates pupil to increase aqueous humor outflow and decrease IOP
56
# Glaucoma
which carbonic anhydrase inhibitor can be used? describe?
* zolamides
* decreases aqueous humor volume to decrease IOP
57
# Glaucoma
glaucoma screening guidelines
* everyone at age 40
* age 40-60 w/out risk factors: every 3-5 yrs
* age 40-60 w/ risk factors: every 1-2 yrs
* age > 60 y/o: every 1-2 yrs
