Lecture 5 Flashcards
leukocytes in the anterior chamber is indicative of
Acute Uveitis (iritis)
epidemiology of Acute Uveitis (iritis)
associated with many infections/diseases:
Betche’s, Chrons, gout, Zoster, Reiter’s Syndrome** (triad of arthritis, urethritis and uveitus, r. arthritis, sarcoid and TB
s&s of Acute Uveitis (iritis)
pain, photophobia, redness, miosis (small pupil)
tx/management for Acute Uveitis (iritis)
emergent opthoalmogist consult
-tx based on cause
sudden monocular loss of vision with cherry-red spot* “box car segment” is indicative of
Central Artery Occlusion
risk factors for Central Artery Occlusion
> 50 y/o, r/o Giant Cell Arteritis, DM, hyperlipidemia, HTN, oral contraceptives, AFIB, emboli
diagnostic studies for Central Artery Occlusion for Giant Cell Arteritis
erythrocyte sedimentation rate ESR, C-reactive protein
diagnostic studies for Central Artery Occlusion screening for DM
fasting glucose and A1c
diagnostic studies for Central Artery Occlusion screening for hyperlipidemia
fasting lipid levels and LFTs
diagnostic studies for Central Artery Occlusion screening for Cardiac
CBC w plt
- electrolytes
- TSH/FT4
- renal fxn
- carotid arteries (U/S, EKG, echo of heart)
referral for Central Artery Occlusion
Admit to hospital
-emergent consult to optho and cardio
treatment for Central artery Occlusion with Giant Cell Arteritis
high dose of steroids and possible artery biopsy
treatment for Central Artery Occlusion with cardiac
tx underlying cause, may need anticoagulant therapy, at risk for stroke
a pt has sudden monocular loss of vision, no pain, no redness, with “blood and thunder” retinal. This is indicative of?
central vein occlusion
risk factors for central vein occlusion
DM, HTN, hyperlipidemia, OCs, smoking, glaucoma
diagnostic studies for Central Vein Occlusion
fundoscopic exam - blood and thunder retinal and neovascualrization
treatment and management for Central Vein Occlusion
refer: emergent consult to optho to prevent retinal detachment
- PCP tx underlying cause (dm etc)
pt has sudden loss of vision and floaters, this indicates….
Vitreous Hemorrhage
risk factors of Vitreous Hemorrhage
retinal tears, retinal detachment, DM, sickle cell, blood dycrasias, trauma, ARMD
referral for Vitreous Hemorrhage
emergent consult to optho
pt has an abrupt monocular (bino) loss of vision (partial or completer) that lasts only a FEW minutes, AKA: ocular transient ischemic attack (TIA); this is indicative of….
Amaurosis Fugax
risk factors or Amaurosis Fugax
DM, HTN, hyperlipidemia, Giant Cell Arteritis, migraine
epidemiology of Amaurosis Fugax
caused by an emboli if vascular
PE of Amaurosis Fugax
complete ocular exam, cardiac, and neurological exam
diagnostic studies for Amaurosis Fugax
lipid panel
-glucose, A1c, CBC, TSH/FT4, electrolytes, carotid artery U/S, EKG, echo
complications of Amaurosis Fugax
central retinal artery occlusion, stroke
treat/referral for Amaurosis Fugax
referral emergent consult to optho
tx underlying cause
pt has a reduction in VA (> 2-line differences b/w eyes) usually unilateral… this is indicative of
Vision abnl - Amblyopia
epidemiology of Amblyopia
strabismus amblyopia - misalignment
-refractive amblyopia
most common cause of pediatric visual impairment
Amblyopia
risk factors of Amblyopia
premature, small size for gestational age, 1st degree relative with amblyopia, neurodevelopment delay
tx and management for Amblyopia
pediatric optho consult
-tx based on cause
an elevated IOOP, progressive loss of VF, pathologic cupping of optic disc (>0.5) is indicative of…
Chronic Open-Angle Glaucoma
risk factors for Chronic Open-Angle Glaucoma
> 40 yo
- genetics
- DM
- Steroid use
diagnostic studies for Chronic Open-Angle Glaucoma
IOP > 22
complications for Chronic Open-Angle Glaucoma
blindness
referral and f/u for Chronic Open-Angle Glaucoma
routine consult to optho
f/u: annually/Q6m optho
sooner if sx inc
medication for Chronic Open-Angle Glaucoma
timolol 0.25% opth sol
non Pharma for Chronic Open-Angle Glaucoma
diet modification, no smoking, decrease caffeine
if pos FMHx for Chronic Open-Angle Glaucoma when should pt begin screening
at 40 yo
what should pt with Chronic Open-Angle Glaucoma avoid?
beta blocker in pt with asthma, COPD, 2nd and 3rd degree AV block
a sudden onset of severe pain, steamy cornea, fixed mid-dilated pupil, halos around lights, blurred vision with shallow anterior chamber is indicative of
Acute Closed-Angle Glaucoma
risk factors for Acute Closed-Angle Glaucoma
-drugs:
some bronchodilators, furosemide, thiazides, antidepressants, sulfonamides, cocaine, ecstasy
-trauma
diagnostic studies for Acute Closed-Angle Glaucoma
IOP > 22 (40-70mmHg)
complications of Acute Closed-Angle Glaucoma
cataract, decrease VA, repeat episodes
referral for Acute Closed-Angle Glaucoma
emergent consult to optho w/in 1 hr of pt presentation
-may go immediate to surgery
medications for Acute Closed-Angle Glaucoma
1 drop each 1 minute apart: timolol 0.5% apraclonidine 1%, pilocarpine 2%;
possible IV acetazolamide 500 mg (check eye pressure every 30 min) may be d/c PO Rx
a painful, diffuse anterior sclera - 50%, local tenderness to touch, sclera edema is indicative of
vision loss due to scleritis
epidemiology of vision loss due to scleritis
inflammatory and autoimmune process
risk factors of vision loss due to scleritis
RA and Wegeners granulomatosis
referral for scleritis
emergent consult to optho and rheumatologist
medications for Scleritis
consider NSADs- indomethacin (25-75 mg PO TID)
-consider glucocorticoids - prednisone 1 mg/kg per day maximum 80 mg (tapering regimen - for d/c prednisone)
eye deviation from anatomical position - trope (constant) is indicative of
strabismus
risk factors for Strabismus
positive FMHx, low birth weight, Downs or cerebral palsy
epidemiology of Strabismus (2 laws)
Herings law or Sherringtons law
congenital epidemiology of Strabismus
- congenital: poor central vision, retinoblastoma, trauma with CN palsies
acquired epidemiology of Strabismus
intracranial hemorrhage, abscess, encephalitis, Guillain- Barre syndrome, measles, orbital fracture, tumors, CN palsy
s&S of strabismus
diplopia, slit images, HA, n/v, fever
diagnostic studies for strabismus
MRI and CT; CBC w diff
treatment for strabismus
consult optho, tx will be based on cause
Hering’s law
agonist muscles in both eyes receive equal innervation to ensure binocular eye movement (right lateral rectus m. abducts right eye = left medial rectus m. to adduct the left eye)
Sherringtons law
agonist/antagonist muscle pairs of each eye receive reciprocal innervation (right medial rectus m. contracts adducting right eye; antagonist - right lateral rectus m relaxes)
if you have vision loss on an entire eye, a tumor is most likely blocking your …. (visual fields)
both optic nerves of eye
if your have vision loss on the inner half of an eye, a tumor could be blocking your (visual fields)
outer optic nerve
if you lose your peripheral vision, tumor is most likely blocking (visual fields)
optic chiasm
if you lose vision on one side of both eyes.. tumor is affecting …. (visual fields)
optic tract or lateral geniculate nucleus
