Midterm - ophthalmoscopic exam of internal eye

Question 1

What are the 4 steps of an internal eye exam?

Answer 1

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

Question 2

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

Answer 2

Fundus (back of the eye)

15 degrees

Question 3

What is a cataract?

Answer 3

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

Question 4

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

Answer 4

50, 70

Question 5

What is the most common cause of cataracts?

Answer 5

Age

Question 6

What risks are associated with cataracts?

Answer 6

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

Question 7

What vision changes occur with cataracts?

Answer 7

Gradual loss of visual acuity, foggy vision, increased glare

Question 8

What are three different cataract types?

Answer 8

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

Question 9

What does a normal optic disc look like?

Answer 9

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

Question 10

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

Answer 10

• Swelling of the optic nerve (papilledema)

- increased intracranial pressure

Question 11

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

Answer 11

• bilateral
• no early vision loss
• no eye pain

Question 12

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

Answer 12

True

Question 13

The normal cup-to-disc ratio is ______

Answer 13

O.5 or 1:2

The cup diameter is half of the optic diameter

Question 14

Increased cup:disc ratio suggests

Answer 14

Glaucomatous cupping (ex: end-stage open angle glaucoma

Question 15

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

Answer 15

Trabecular meshwork

Posterior

Question 16

What is the leading cause of preventable blindness?

Answer 16

Primary open-angle glaucoma

Question 17

What risks are associated with primary open-angle glaucoma?

Answer 17

• 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

Question 18

Why are corticosteroids dangerous for the eye?

Answer 18

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

Question 19

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

Answer 19

• gradual
• bilateral
• painless
• asymptomatic

Question 20

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

Answer 20

They gradually lose peripheral vision

Question 21

How do you typically assess primary open-angle glaucoma?

Answer 21

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

Question 22

How is primary open-angle glaucoma treated?

Answer 22

• prescription eye drops
• aerobic exercise may decrease IOP
• trabeculoplasty

Question 23

What does the normal macula look like?

Answer 23

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

Question 24

What does an abnormal macula look like?

Answer 24

• drusen (yellowish-colored sub-retinal deposits)

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

Question 25

Macular degeneration can cause __________ in elderly patients

Answer 25

Central vision loss and blind spot (scotoma)

Question 26

What are risk factors of macular degeneration?

Answer 26

- >55 years old - female - Caucasian - family history of AMD - cigarette smoking

Question 27

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

Answer 27

Drusen | Choroidal (subretinal) neovascularization

Question 28

What is the treatment for age-related macular degeneration?

Answer 28

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

Question 29

What do normal arteries in the eye look like?

Answer 29

- light red - smaller - bright central light reflection

Question 30

What do normal veins in the eye look like?

Answer 30

- darker red - larger - minimal or absent light reflex

Question 31

What are 2 main causes of abnormal retinal vessels?

Answer 31

- hypertensive retinopathy | - diabetic retinopathy

Question 32

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

Answer 32

- Posterior vitreous detachment (associated with aging) - Usually harmless Can indicate retinal tear or detachment

Question 33

Why is abnormal vitreous?

Answer 33

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

Question 34

Why is proliferative diabetic retinopathy a big threat to vision?

Answer 34

- neovascularization occurs in response to ischemic changes | - the new vessels can grow into the vitreous increasing risk of retinal detachment and vitreous hemorrhage

Question 35

How does non-proliferative diabetic retinopathy lead vision issues?

Answer 35

- 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

Question 36

How does diabetes lead to vision problems?

Answer 36

- increased risk of cataract formation - increased risk of glaucoma - diabetic retinopathy (non-proliferative and proliferative)

Question 37

Diabetic retinopathy is associated with ____ years of diabetes

Answer 37

20+

Question 38

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

Answer 38

- 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

Question 39

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

Answer 39

- 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

Question 40

Chronic hypertensive retinopathy can cause ______

Answer 40

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

Question 41

What are early signs of hypertensive retinopathy?

Answer 41

- narrowing Artie's with narrowed light reflex | - occasionally silver wire deformity (narrowed artery develops an opaque wall)