med surg vision

Question 1

anatomy of the eye

Answer 1

pupil: lets light in
lens & cornae : helps w/ accommodation
retina: covers back of eye

Question 2

visual acuity testing is testing for what

Answer 2

near & far vision
-snellen for far sight
-miniature eye chart/pocket chart for near vision

Question 3

ophthalmoscopy

Answer 3

-allows view into fundus of the eye
-dark room to dilate pupil
-move in from 12-15in away & to the side of pts line of vision
-routine in physical exam but also used to look for glaucoma (looking for optic disc cupping)

Question 4

size of optic disc cup in a pt w/ glaucoma

Answer 4

larger than normal

Question 5

glare testing

Answer 5

quantifies vision loss associated w/ light scatter
used for patients w/ cataracts to assess ability for night driving

Question 6

slit lamp test

Answer 6

magnifies the anterior eye w/ a low powered microscope
used for people w/ cataracts, retinal detachment, distinguish between the glaucomas, and macular degeneration

Question 7

what measures IOP

Answer 7

tonometer
important to measure in pts w/ glaucoma

Question 8

testing guidelines for IOP

Answer 8

-indicated for all pts >40 yr
-if fam hx of glaucoma, once or twice per year

Question 9

gonioscopy

Answer 9

performed when high IOP is found & determines whether open or closed angle glaucoma is present
allows visualization where iris meets cornea

Question 10

vision w/ cataracts looks like

Answer 10

everything is fuzzy & will have flood glare d/t light scatter caused by the opacities

Question 11

what anatomical structure is mainly affected w/ cataracts & what happens

Answer 11

the lens - changes shape as needed to help focus the image
w/ age lens becomes cloudy & stiffer causing decreased visual acuity and decreased accommodation

Question 12

cataracts treatment

Answer 12

initially: watch & adjust glasses, add light & day driving
advanced or diabetics d/t need to monitor retina: surgery

Question 13

pre op care for cataract surgery

Answer 13

-mydriatic (dilating) drops -> need to apply punctal occlusion to avoid systemic effects bc can lead to cardiac issues
-cycloplegic drops to paralyze the eyeball
-NSAID drop + possible anti anxiety med
-decrease room lights
-topical abx prophylactically

Question 14

cataract surgery facts

Answer 14

-outpatient procedure
-need good medical history
-patient is awake
-NPO 6 to 8 hrs prior

Question 15

post op care for cataract surgery

Answer 15

-topical abx & steroids given
-eye patch & shield until initial post op visit (within 24 hrs)
-eyes drops (abx & corticosteroid), decrease slowly
-possible activity restriction
-nighttime eye patch
-avoid bending, stooping, lifting, coughing (anything that increases IOP)

Question 16

post op cataract surgery teaching for pt

Answer 16

-directly following cataract surgery pt may experience improved or decreased visual acuity which is normal
-proper hygiene & eye care techniques
-S/s of infection
-use the meds
-follow up

Question 17

what gets monitored after cataract surgery

Answer 17

-IOP
-visual acuity
-anterior chamber depth
-corneal clarity

Question 18

what is retinopathy typically caused by

Answer 18

DM & HTN
prevention & treatment directed towards keeping disease in control

Question 19

vision w/ retinopathy looks like

Answer 19

splotchy haziness (black hazy dots)

Question 20

what type of situation is a retinal detachment

Answer 20

urgent

Question 21

clinical presentation of retinal detachment: while detaching

Answer 21

sudden onset of multiple small floaters &/or light flashes

Question 22

clinical presentation of retinal detachment: once detached

Answer 22

a painless black curtain comes across field of vision

Question 23

repair of retinal detachment

Answer 23

four major methods
1) laser photocoagulation
2) cryopexy (creates inflammatory reaction that causes adhesion/scarring)
3) scleral buckle procedure
4) pneumatic retinopexy
time matters

Question 24

scleral buckle procedure

Answer 24

-extraocular procedure
-a buckle is placed around the outside of the eyeball
-silicone patch wrapped around the eye and then indents the eyeball so it moves towards the retina
-outpatient until local anesthesia

Question 25

scleral buckle post procedure care

Answer 25

-possible bedrest
-keep HOB elevated at all times to keep IOP down
-topical eye ointments: abx, anti inflams, possible dilating agents
-restrict activity (vigorous exercise should be avoided for 3-4 wks)
-avoid constipation so they dont bear down

Question 26

scleral buckle discharge teaching

Answer 26

-proper hygiene & eye care
-S/s of infection
-importance of complying w/ activity restrictions
-proper instillation of topical meds
-pain control
-follow ups

Question 27

pneumatic retinopexy

Answer 27

-intraocular procedure
-a gas bubble is injected into the vitreous cavity
-pt needs to be positioned so that the bubble can apply maximal pressure on the retina by the force of gravity (head down & to one side)
seen in position for several days to weeks

Question 28

retinal detachment surgery outcomes

Answer 28

-successful 90% of the time
-visual prognosis varies based on extent, length & area of detachment

Question 29

vision w/ AMD looks like

Answer 29

loss of central vision (block or blurred dot in middle of the eye)
periphery is intact

Question 30

AMD: dry

Answer 30

-close (central) vision tasks become more difficult
-macular cells start to atrophy leading to progressive, painless vision loss
-less threatening to vision loss
-smoking may increase risk of progression
-no proven effective treatment
-can develop into wet

Question 31

AMD: wet

Answer 31

-more severe form
-accounts for 90% of cases of AMD related blindness
-rapid onset
-characterized by the development of abnormal blood vessels in or near macula

Question 32

AMD care (both types)

Answer 32

-antioxidant vitamins & zinc may help slow progression
-smoking cessation

Question 33

vision w/ glaucoma looks like

Answer 33

central vision is intact but peripheral vision is lost
can go unnoticed for long time d/t slow onset

Question 34

what is glaucoma

Answer 34

an eye disorder that increases IOP and is a major cause of blindness (2nd behind cataracts)

Question 35

open angle glaucoma

Answer 35

-faulty “pumper station” , blockage of trabecular meshwork which slows drainage
-problem of reabsorption of aqueous humor
-usually asym

Question 36

closed angle glaucoma

Answer 36

-a structural problem
-narrow angle between cornea and iris prevents aqueous humor from being reabsorbed
-presents as a painful red eye and must be treated w/n 24hrs or blindness may be permanent
emergency

Question 37

chronic open angle treatment

Answer 37

first line therapy is medications
-meds decrease AH production causing miosis/opening of trabecular meshwork

Question 38

biggest barrier to open angle treatment

Answer 38

compliance can be an issue d/t asym disease and frequency of drops

Question 39

treatment if medications do not work for open agnle

Answer 39

argon laser trabeculoplasty
-outpatient
-topical anesthetic
-laser hits damaged trabecular meshwork and opens outflow channels

Question 40

what is the gold standard to dx closed angle

Answer 40

gonioscopy

Question 41

treatment for closed angle: unstable

Answer 41

need to get immediate relief
-beta blocker topical agent
-carbonic anhydrase inhibitor PO
-constrict pupil to lower IOP w/ a miotic eye drop
-treat pain & nausea aggressively bc it will increase IOP
-keep calm
-place patch on affect eye

Question 42

treatment once close angle is stabilized

Answer 42

prepare for iridotomy -> punches holes in the iris
or
iridectomy
creates pathway for AH to escape

Question 43

glaucoma screening guidelines

Answer 43

-every 3-5 yrs @ 40 to 60 yr
-every 1-2 yrs >60yr
-AA: periodic exam ages 20-39

Question 44

precautions when given miotic drop

Answer 44

give before turning off lights bc the dark w/ make the eyes dilate

Question 45

environment for closed angle

Answer 45

-darken room after constriction
-cool compress to the forehead
-quiet/private
-educate