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Head And Neck > Midterm - ophthalmoscopic exam of internal eye > Flashcards

Midterm - ophthalmoscopic exam of internal eye Flashcards

1
Q

What are the 4 steps of an internal eye exam?

A
  1. Check the red reflex
  2. Evaulate the optic disk
  3. Evaluate the retina/vessels
  4. Assess anterior structures
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2
Q

The red reflex is formed by reflection of illuminating light off the _________. Examination is started at ____ degrees lateral to the patient’s line of vision

A

Fundus (back of the eye)

15 degrees

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3
Q

What is a cataract?

A

Any opacity in the lens causing the lens to lose transparency or scatter light

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4
Q

____% of 65-74 yr olds, and ____% of 75+ yr olds have cataracts

A

50, 70

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5
Q

What is the most common cause of cataracts?

A

Age

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6
Q

What risks are associated with cataracts?

A

Cigarette smoking, ocular UV-B light exposure, diabetes, long-term systemic steroids

*when cataracts are due to these caucuses (rather than aging) formation is more rapid

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7
Q

What vision changes occur with cataracts?

A

Gradual loss of visual acuity, foggy vision, increased glare

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8
Q

What are three different cataract types?

A
  1. Subcapsular - at back of lens
  2. Nuclear - gradual clouding of central vision, usually bilaterally
  3. Cortical - “spoke-like” appearance, less impact on vision
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9
Q

What does a normal optic disc look like?

A

Round, yellowish-orange to creamy pink, pale central cup, distinct margins (nasal aspect is naturally slightly more blurred)

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10
Q

What does a blurred disc margin suggest? What causes it?

A
  • Swelling of the optic nerve (papilledema)

- increased intracranial pressure

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11
Q

Papilledema is usually (unilateral/bilateral), causes (early/ no early) vision loss, and (no eye pain/eye pain) ?

A
  • bilateral
  • no early vision loss
  • no eye pain
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12
Q

True or false: a pigment crescent, sclera crescent or myelinated nerve fibers are all normal variants seen?

A

True

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13
Q

The normal cup-to-disc ratio is ______

A

O.5 or 1:2

The cup diameter is half of the optic diameter

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14
Q

Increased cup:disc ratio suggests

A

Glaucomatous cupping (ex: end-stage open angle glaucoma

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15
Q

Primary open-angle glaucoma is related to abnormal function of ____________ and results in (anterior/posterior?) intraocular pressure?

A

Trabecular meshwork

Posterior

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16
Q

What is the leading cause of preventable blindness?

A

Primary open-angle glaucoma

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17
Q

What risks are associated with primary open-angle glaucoma?

A
  • African-Americans are 3-5 times more likely and the risk begins earlier
  • > 35 years old in African-Americans
  • > 50 years old in caucasians
  • family history, severe myopia (near-sightedness), diabetes, cardiovascular disease, medications are all other risks
18
Q

Why are corticosteroids dangerous for the eye?

A

They increase the risk of intraocular pressure elevation - especially if patient has other risks.

  • IOP lowers after stopping steroid treatment but vision damage may be permanent
19
Q

In primary open-angle glaucoma, IOP increase is (gradual/sudden), often (bilateral/unilateral), (painless/painful), and (symptomatic/asymptomatic)* until end-stages?

A
  • gradual
  • bilateral
  • painless
  • asymptomatic
20
Q

In primary open-angle glaucoma, why do patients turn their head to see objects?

A

They gradually lose peripheral vision

21
Q

How do you typically assess primary open-angle glaucoma?

A
  • “air-puff” tonometry screening exam
  • cup:disc ratio
  • peripheral vision testing
22
Q

How is primary open-angle glaucoma treated?

A
  • prescription eye drops
  • aerobic exercise may decrease IOP
  • trabeculoplasty
23
Q

What does the normal macula look like?

A
  • temporal to the optic disc
  • darker than the surrounding retina
  • focal absence of surrounding retinal vessels
24
Q

What does an abnormal macula look like?

A
  • drusen (yellowish-colored sub-retinal deposits)

- can be due to normal aging but may also occur with dry macular degeneration

25
Q

Macular degeneration can cause __________ in elderly patients

A

Central vision loss and blind spot (scotoma)

26
Q

What are risk factors of macular degeneration?

A
  • > 55 years old
  • female
  • Caucasian
  • family history of AMD
  • cigarette smoking
27
Q

Both dry and wet age-related macular degeneration have _________, but only wet has ________

A

Drusen

Choroidal (subretinal) neovascularization

28
Q

What is the treatment for age-related macular degeneration?

A
  1. Zinc& antioxidants (Vit C, E, lutein, &
    zeaxanthin beta-carotene):
    - Reduces the risk of worsening vision in intermediate or advanced AMD
  2. Referral to ophthalmologist to discuss laser, surgical, and/or medical injection treatment options
29
Q

What do normal arteries in the eye look like?

A
  • light red
  • smaller
  • bright central light reflection
30
Q

What do normal veins in the eye look like?

A
  • darker red
  • larger
  • minimal or absent light reflex
31
Q

What are 2 main causes of abnormal retinal vessels?

A
  • hypertensive retinopathy

- diabetic retinopathy

32
Q

What are floaters and flashers a symptom of? Is it dangerous?

A
  • Posterior vitreous detachment (associated with aging)
  • Usually harmless

Can indicate retinal tear or detachment

33
Q

Why is abnormal vitreous?

A

Hemorrhages or floaters (dark specks or strands between the fundus and the lens

34
Q

Why is proliferative diabetic retinopathy a big threat to vision?

A
  • neovascularization occurs in response to ischemic changes

- the new vessels can grow into the vitreous increasing risk of retinal detachment and vitreous hemorrhage

35
Q

How does non-proliferative diabetic retinopathy lead vision issues?

A
  • microaneurysms cause weakened vessel walls
    > vessels leak lipids and blood
    > hard exudates, hemorrhages and macular edema
  • small vessel ischemia to the superficial nerve fiber layer of the retina
    > cotton wool spots
36
Q

How does diabetes lead to vision problems?

A
  • increased risk of cataract formation
  • increased risk of glaucoma
  • diabetic retinopathy (non-proliferative and proliferative)
37
Q

Diabetic retinopathy is associated with ____ years of diabetes

A

20+

38
Q

What is the difference between cotton-wool and hard exudates? Are they white or red spots?

A
  • both are white spots (exudates) found in hypertensive retinopathy and diabetic retinopathy
  • cotton = soft exudates, fuzzy borders, irregularly shaped, caused by infractions of the nerve fiber layer of the retina
  • hard = aka lipoid or fatty exudates, more well defined borders, smaller and in deeper layer than cotton-wool spots
39
Q

What is the difference between flame shaped hemorrhages and round microaneurysms? Are they red or white spots?

A
  • both are red spots
  • flame = occur in superficial retinal layer and is a classic hypertensive retinopathy finding
  • microaneurysm = “dots and blots”, small round with smooth borders, earliest sign of diabetic retinopathy
40
Q

Chronic hypertensive retinopathy can cause ______

A
  1. Arteriovenous crossing (AV nicking and/or tapering)
    - veins appears to stop abruptly but is actually due to wide, invisible artery walls that have become thickened
  2. Copper wire deformity
    - some arteries become full, tortuous and with increased light reflex
41
Q

What are early signs of hypertensive retinopathy?

A
  • narrowing Artie’s with narrowed light reflex

- occasionally silver wire deformity (narrowed artery develops an opaque wall)

Head And Neck (18 decks)

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