Internal Eye Flashcards
At what distance do we hold the ophthalmoscope when assessing the red retinal reflex?
6 inches away from patient’s eye
What does it mean when the red retinal reflex is created without any dark shadows?
No opacities of the cornea (scars), lens (cataracts), nor blood or pus in the aqueous or vitreous fluids
What are cataracts?
Abnormal progressive loss of lens transparency
What causes cataracts?
Degenerative changes usually occurring after age 50
What is the eventual appearance of cataracts?
Gray-white opacity
What is the vision like in a patient with cataracts?
Progressively blurry vision as if looking into frosted glass
What is unique about the tendency to develop cataracts?
Inherited
What should be the shape and color of the optic nerve head, and the ratio between the opt disc and the physiologic cup?
Shape = disc-shaped/round Color = yellow-orange Ratio = cup usually less than 1/2 the entire disc area
Where is a choroidal crescent located?
On the optic nerve head
Choroidal crescents are especially common among what population?
Near-sighted individuals (myopic patients)
What is unique about the vascularization of the physiologic cup?
Lack a capillary bed (appears as a small light yellow area for this reason)
What is the physiologic cup?
Small indentation of the optic nerve head from which blood vessels emerge from
What are the four layers of the eye before the retina that are assed via the red retinal reflex?
1 cornea
2 aqueous humor
3 lens
4 vitreous humor
Which are usually fatter: arteries or veins?
Veins
Which border of the optic disc is often not as sharp as the rest?
Nasal border
What should be the overall general appearance of a normal and healthy retina?
Uniform red color and texture
Describe the appearance of both the macula and fovea.
Macula - darker pigmented area in retina
Fovea - pinhole dot of light in the macula
What is the most sensitive part of the retina?
Macula/fovea
Why is the macula/fovea region difficult to inspect?
1 most sensitive part of retina
2 pupil will further constrict
3 patient won’t hold still
Where is the macula located in relation to the optic disc?
2 disc diameters lateral
If papilledema is observed, what must be ruled out as a cause?
Intracranial pressure
Is an atypical, deep, and escalating headache present in all cases of papilledema?
No, about 25%
How is visual acuity affected by papilledema?
Only affected in advanced stages
What is the most consistent funduscopic finding associated with space occupying intracranial lesions?
Papilledema
What is the funduscopic appearance of papilledema?
Distorted optic disc with blurry borders
What are the signs and symptoms of chronic glaucoma?
1 headaches originates near eyes
2 tunnel vision
3 increased physiologic cup size
What is the cause of the increased physiologic cup size seen with chronic glaucoma?
Atrophy (whitening) of nerve fibers leading to blindness
What are the general symptoms of diabetes mellitus?
Frequent urination and thirst
What is the most frequent form of diabetic neuropathy?
Bilateral sensory loss in the feet
What is the most common symptoms of neuropathy in 50-60% of males with diabetes mellitus?
Impotence with gradual firmness of erections over 6-12 months
What diagnostic test is used in suspected cases of diabetes as the “gold standard”?
Glucose tolerance test
When are funduscopic signs of diabetic retinopathy usually first detected?
5 or more years after diagnosis
Funduscopic signs of diabetic retinopathy may only be present in 50% of patients to some degree how many years post diagnosis?
10
What are the funduscoptic signs of diabetic retinopathy in order of earliest to latest stages?
1 microaneurysms
2 hard exudates
3 soft exudates
4 neovascularization
Are there any obvious signs of hypertension?
No
What kinds of funduscopic signs may be seen with hypertensive retinopathy?
1 arteriole constriction/A-V tapering
2 flame-shaped hemorrhages
3 silver-wiring
Is retinal detachment always due to trauma?
No (can be age-related)
Shrinkage of which fluid of the eye occurs in retinal detachment?
Vitreous
What population is especially at risk for retinal detachment?
Near-sighted people over 50 years old
What are symptoms of retinal detachment?
1 new vitreous floaters
2 flashing lights
3 loss of peripheral vision in the area of detachment
What kind of eye condition is associated with an adult with a narrow corneal angle?
Acute glaucoma
What is the genetic eye condition where night blindness occurs followed by progressive tunnel vision starting during youth and appears as a “bone spicule” retinopathy?
Retinitis pigmentosa
Which eye condition is often due to atherosclerosis and usually precedes a vascular event like a stroke?
Amaurosis fugax
What are the physical findings of amaurosis fugax?
Small embolus or thrombus in retinal artery, possible carotid bruit
What are the symptoms of central cataract?
Central blurred vision progressing into a central scotoma
What are the symptoms of macular degeneration?
Slowly progressive central vision loss with distorted images
What are the physical exam findings involved with macular degeneration?
Altered color and configuration of the macula/fovea
