Lecture IV Flashcards
What are the two subgroups of optic neuritis?
- Papillitis
- Retrobulbar neuritis
How do you diagnose papillitis? (2)
Relative afferent pupillary defect
Disc edema
What is papillitis?
Subgroup of optic neuritis involving optic nerve, therefore swollen optic nerve
Who usually gets retrobulbar neuritis?
Young adult with a progressive loss of vision over hours to days
What are the s/sx of retrobulbar neuritis? Why?
Progressive loss of vision and Pain on ocular movement d/t movement of the optic nerve
What is the difference between papillitis and retrobulbar neuritis?
Papillitis is inflammation of the head of the optic nerve
Retrobulbar neuritis is when the posterior part of the optic nerve is inflamed
What cause optic neuritis?
Anything that causes inflammation of the optic nerve–(e.g. viral or MS)
What differentiates optic neuritis and retrobulbar neuritis on fundoscopic exam?
Papillitis will reveal disc swelling, whilst optic neuritis will not
Are there vision problems or pupillary reflex abnormalities with acute papilledema? Chronic?
No, but if left untreated may progress to vision loss
Compare papillitis and papilledema in terms of the presence of hemorrhages.
Both have
Compare papillitis and papilledema in terms of etiology.
Papillitis is 2/2 inflammation
Papilledema is 2/2 increased ICP
Compare papillitis and papilledema in terms of optic nerve swelling
Both have
Compare papillitis and papilledema in terms of vision
Reduced with papillitis but normal with papilledema
Compare papillitis and papilledema in terms of pupillary responses.
RAPD in papillitis
Normal with papilledema
What is ischemic optic neuropathy?
Infarction of the optic disk, which may be 2/2
Who usually gets ischemic neuropathy (age)? Is it more commonly unilateral or bilateral?
Over age 55, usually unilateral
What are the s/sx of ischemic optic neuropathy? (4)
- rapid vision loss
- Cephalalgia/scalp TTP
- jaw claudication
- Arthralgias
What is the prognosis for ischemic neuropathy?
There is no effective treatment for the arteritic variety, and most lost vision is not recovered
What is giant cell arteritis?
vasculitis of large arteries, usually involving the aorta or its branches (e.g. ophthalmic artery). May result in blindness if the ophthalmic artery is occluded
What are the s/sx of giant cell arteritis? (3)
- HA
- TTP over the temporal artery
- Polymyalgia rheumatica
What is polymyalgia rheumatica?
Diffuse muscle pain that usually appears in the morning, and is caused by idiopathic diffuse inflammation, and WBCs affecting the joints.
What are the labs that are sensitive for giant cell arteritis (but not specific)?
CRP and ESR
What is the treatment for giant cell arteritis?
ASA and high dose corticosteroids
What age group usually gets giant cell arteritis?
Around age 70
What is the only way to definitively diagnose giant cell arteritis? What is the problem with this test?
Bx of the artery–if do not bx the correct part, may not diagnose it
What are the exam findings of anterior ischemic optic neuropathy?
- RAPD
- Pale, swollen optic nerve and altitudinal VF defect
What level of ESR is suggestive of anterior ischemic optic neuropathy?
More than 60 mm/hr
What is the common exam finding of a avulsion of the optic nerve?
RAPD
What is the usual defect with vascular occlusion of the CNS?
Homonymous hemianopia or quadrantanopia
Cherry red spot = ?
CRAO
In which ethnicity is glaucoma particularly prevalent in?
African Americans
What is the insidious symptom of glaucoma?
Slow, progressive loss of peripheral vision
What is the normal range of pressure in the eye?
10-21 mmHg
What causes the increased pressure with glaucoma?
Continuous production and drainage of aqueous fluid
What are the primary and secondary causes of open angle glaucoma?
Primary = unclear
Secondary =Blocked trabecular meshwork from WBCs, RBCs, or retinal elements
What causes primary closed angle glaucoma?
Enlargement or forward movement of lens against the central iris leading to obstruction or normal aqueous flow through pupil
What causes secondary closed angle glaucoma?
hypoxia from retinal disease induces vasoproliferation in iris that contracts angle
What are the s/sx of acute angle glaucoma?
Red, painful eye with decreased vision and markedly increased intraocular pressure
What causes the cupping of the optic disc with glaucoma?
Increased ocular pressure is exerted through the vitreous humor back onto the optic disc
A cup to disc ratio greater than what is concerning?
0.5
What fraction of all glaucoma cases are primary open angle glaucoma?
2/3
True or false: primary open angle glaucoma tends to be familial
True
Is primary open angle glaucoma usually bilateral or unilateral? Symmetric or asymmetric?
Bilateral, but can be asymmetric
What are the risk factors for primary open angle glaucoma?
- greater than 50 yo
- FH
- AA
- Myopic
What is the most common and effective drug for glaucoma?
Prostaglandin analogs
What is the major cholinergic compound that is used to treat glaucoma?
Pilocarpine
What are the adrenergic compounds that are used to treat glaucoma?
Propine
Iodine
Alphagan
Which is common: angle closure or open angle glaucoma?
Open angle
Which has an acute nd which has a chronic onset: angle closure or open angle glaucoma?
Acute = angle closure
Open angle = chronic
Which has severe ocular pain: angle closure or open angle glaucoma?
Pain = acute angle closure
What are the pupil characteristics of angle closure and open angle glaucoma?
Closed = Mid-dilated fixed pupil Open = normal
What happens to vision with angle closure and open angle glaucoma?
Acute= blurred vision, halos around lights
Chronic = insidious loss of vision, without halos
What are the extraocular s/sx of angle closure and open angle glaucoma?
Open = HA, n/v Closed = none
What can cause acute angle closure glaucoma? (3)
Dilating drops
Stress
Sympathomimetic drugs
What type of glaucoma is a contraindication to sympathomimetics or other drugs that dilate the eyes?
Closed angle
What are the 4 drugs that should be started immediately for acute, closed angle glaucoma?
Pilocarpine
acetazolamide
Oral glycerine
Mannitol
What is the MOA of pilocarpine?
Cholinergic drug that causes ciliary muscle contraction and mydriasis
What is an iridotomy?
Hole punch through the iris to allow flow through the iris and into the trabecular meshwork
True or false: miotics are a substitute for an iridotomy
False
Child with a clouded eye = ?
Glaucoma until proven otherwise
Increase IOP greater than what is an indication for referral to an ophthalmologist?
21 mmHg
If there is a greater than (__) difference in pressure between eyes, you should refer them to an ophthalmologist.
5 mmHg
If there is a cup:disc ratio of what value is an indication to refer to an ophthalmologist?
0.5
If there is a difference in cup:disc ratio between eyes is an indication to refer to an ophthalmologist?
0.2
True or false: cataracts are a normal part of the aging process
True
What is the most successful operation in all of surgery
Cataract correction
What is the second sight that patients with cataracts can get?
Increased myopia causes an increased ability to read close up
What are the first few s/sx of cataracts? (3)
slight blur
Decreased colors
Diplopia
True or false: there is NEVER a RAPD with cataracts
True
What is the first step in assessing cataracts?
Visual acuity test
What type of device should be used to assess the eye with cataracts?
Slit-lamp
What causes the halos around lights with cataracts?
Scattering of lights from the cataract
When should you refer a patient for cataracts?
If interferes with ADLs or causes falls/MVAs
What are the early complications that can arise from cataract surgery?
Hemorrhage
Infection
What are the late complications that can arise from cataract surgery?
Corneal/retinal problems
retinal detachment
true or false: you have to control DM or other relevant comorbidities prior to treating cataracts
True
What is the leading cause of blindness in patients over 50?
Macular degeneration
What is the possible treatment for macular degeneration?
laser surgery
True or false: often, there is not effective treatment for macular degeneration
True
What is the natural h/o macular degeneration?
Progressive deterioration of vision
What is the hallmark finding of macular degeneration?
Drusen–hyaline nodules in Bruch’s membrane
Which type of macular degeneration is there an effective treatment for: wet or dry
Wet
What is metamorphopsia?
a type of distorted vision in which a grid of straight lines appears wavy and parts of the grid may appear blank
What are the s/sx of macular degeneration?
- Sudden loss of vision
- metamorphopsia
- Central blind spot if advanced
True or false: the amount of drusen correlates well with the vision changes
False
What is the geographic form of macular degeneration?
Progressive loss of pigmentation of the retina
What causes the metamorphopsia with macular degeneration?
Usually caused by neovascularization beneath the retina, which lifts it up and distorts vision
True or false: the peripheral vision is usually greatly affected with macular degeneration?
False–Usually remains good
What are the risk factors for macular degeneration? (5)
- Age
- Smoking
- hyperopia
- Blue eyes
- FH
