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X Clin Med Exam 2 > L14 Vision Loss > Flashcards

L14 Vision Loss Flashcards

1
Q

Acute vision loss

A

Acute angle closure glaucoma
Retinal detachment
Central retinal artery/vein occlusion
Optic neuritis

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2
Q

Chronic vision loss

A 
Cataracts 
Open angle glaucoma
Macular degeneration
Diabetic retinopathy
Hypertensive retinopathy
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3
Q

Vision loss Hx

A 
Duration
    Acute/chronic
Quality
     Unilateral/bilateral
     Floaters, focal, metamorphopsia
Assoc Sxs
Systemic conditions
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4
Q

Vision loss exam

A 
Visual field 
Pupils
Tonometry
Pen light/slit lamp
Dilated fundus exam
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5
Q

Vision loss management

A

refer to ophthalmology…always

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6
Q

Problem focused eye exam: vision loss

A 
Visual acuity
Visual fields
Pupils PERRLA
Tonometry
Slit lamp/pen light
Dilated fundus exam
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7
Q

Visual field testing

A

One eye at a time
Count fingers
Amsler grid

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8
Q

Glaucoma

Acute angle closure

A

Acute rise of IOP due to outflow obstruction (aqueous outflow)
Rare in real life, common on boards

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9
Q

Open angle glaucoma’s

A 
Chronic narrowing of angle
Optic neuropathy
IOP not always elevated significantly
Optic nerve damage
Much more common
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10
Q

Sxs of Acute angle glaucoma

A 
Acute decreased vision
Halos around lights
Headaches
Nausea and vomiting
Severe eye pain
Feeling of pressure aka elevated IOP
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11
Q

Clinical presentation of Acute angle closure glaucoma

A 
Decreased vision
Circumlimbal injection/ciliary flush
Steamy cornea
Mid-dilated pupil
Narrow anterior chamber
Firm globe
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12
Q

Management of Acute angle closure glaucoma

A 
Ophthalmologic emergency
Topical ocular hypertension meds
    B-blockers
    Alpha-2 agonists
Oral/IV osmotic agents (mannitol)
Laser peripheral iridotomy
Surgical trabeculectomy
NO mydriatics
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13
Q

Open Angle glaucoma clinical presentation

A 
Early-asymptomatic
Late-chronic painless visual field loss
     Peripheral first
     Central later
Exam findings
  Increased intraocular pressure 
   Increased cup/disc ratio
  No AV nicking 
  No exudates
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14
Q

Open angle glaucoma management

A 
Ophthalmologic referral
Topical ocular hypertension medications
    B-blockers
    Alpha-2 agonists
Laser trabeculoplasty
Surgical trabeculectomy
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15
Q

Cataract clinical presentation

A

Lens opacity-age related, congenital, traumatic
Gradual, CHRONIC, PAINLESS loss of vision, “foggy”
Glare, esp at night
Decreased visual acuity
Clouding/opalescent changes to the lens

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16
Q

Management of cataract

A 
Ophthalmology referral if lifestyle is affected
Glasses Rx
Surgery
   Extracapsular cataract extraction
   Intraocular lens implant
Excellent prognosis
17
Q

Macular degeneration causes

A

Age-related macular degeneration (ARMD) or toxic effect of drugs

18
Q

Macular degeneration symptoms

A 
#1 cause of central legal blindness in western world
Gradual or acute blurred vision
Metamorphopsia (wavy/distorted vision)
Central scotoma (blind spot)
Might have decreased vision
Amsler grid distortion
19
Q

Dry A-R Macular degeneration clinical presentation

A

Drusen bodies (lipid deposits), pigment mottling
Geographic atrophy
Vision loss slow/gradual
One or both eyes

20
Q

Wet ARMD clinical presentation

A 
Subretinal neovascular degeneration
    Subretinal fluid or blood
Fibrosis/scarring
Rapid vision distortion, loss of central vision
More common in one eye
21
Q

Management of macular degeneration

A 
Ophthalmology referral
Vitamins (antioxidants/zinc)
Omega 3 fatty acids
Stop smoking!
Amsler grid checks daily
Photocoagulation, photodynamic therapy, intravitreal steroid/monoclonal antibodies
Low vision aids
Stop offending drugs
22
Q

Retinal Detachment (RD) definition and types

A

Separation of the retina from the underlying epithelial layer
Rhegmatogenous RD
Nonrhegmatogenous RD

23
Q

Rhegmatogenous RD

A

Posterior vitreous detachment

Traumatic RD

24
Q

Nonrhegmatogenous RD

A

Traction RD
Assoc with diabetes
Exudative (rare)

25
Q

Clinical presentation of RD

A 
Painless, can progress rapidly
Floaters
Photopsias (flashes)
Loss of vision (complete or partial)
Progressive scotoma (central vision loss)
Curtain-like vision loss (top —> bottom)
Might be peripheral only
Raised whitish retina
Bilateral 20% of the time
26
Q

Management of RD

A 
Ophthalmology referral
Medical
   Laser/cryo surgery
Surgery
   Scleral buckle 
   Vitrectomy
27
Q

Hypertensive Retinopathy presentation

A 
Retinal vascular changes due to systemic hypertension
Asymptomatic
Characteristic ophthalmic changes
   Copper wiring
   Silver wiring
   AV nicking
   Cotton wool spots 
   Retinal hemorrhages
   Retinal edema/exudates
   Disc edema
28
Q

Management of Hypertensive Retinopathy

A

Systemic blood pressure control
Ophthalmology referral
If severe
Associated visual loss

29
Q

Diabetic retinopathy classifications

A

Proliferative/nonproliferative

30
Q

Non proliferative diabetic retinopathy clinical presentation

A 
Blurred vision
Retinal hemorrhage 
Retinal edema
Macular edema
Cotton-wool spots
Venous dilation
Hard exudates (micro-aneurysms)
31
Q

Proliferative Diabetic retinopathy

A

Neovascularization
Preretinal and vitreous hemorrhage (can cause sudden blindness)
Subsequent fibrosis
Traction retinal detachment
Macular edema
Retinal thickening and edema involving the macula

32
Q

Management of diabetic retinopathy

A

Blood sugar control
Ophthalmology referral
Laser photocoagulation
Vitrectomy

33
Q

Retinal vascular occlusion

A

Central retinal artery occlusion CRAO
Embolic
Central retinal vein occlusion CRVO
Thrombotic

34
Q

CRAO

A 
Embolic
refer to ophthalmologist
no effective tx
evaluate etiology to prevent future strokes
  carotid plaques
  carotid thrombi
35
Q

CRVO

A 
thrombotic
refer to ophthalmologist
aspirin
observation
tx for retinal edema or ischemia
evaluate etiology if young 
    severe hypertension
    hyper coagulable state
36
Q

optic neuritis clinical presentation

A

acute inflammatory demyelination of the optic nerve
monocular vision loss over hours to days
central scotoma
painful
might have abnormal color vision
might have flashes of light
1/3 visible papillitis w/ disc swelling on fundoscopic exam

37
Q

management of optic neuritis

A

MRI of brain and orbits
IV methylprednisone for severe vision loss or 2 or more white matter lesions on MRI
rapid recovery does not impact long-term vision function
no treatment
improvement in 2-3 wks
typically 20/40 vision by one year
30% will develop MS at 5 years

38
Q

Who to refer to ophthalmologist

A 
all pts with vision loss
    acute: ASAP
    chronic: arrange consult
pts with known hx of glaucoma
pts with DM
chronic eye conditions
uncertain dx
worried pt
worried pa

X Clin Med Exam 2 (6 decks)

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