Neuro-opth Flashcards
What is the clinical presentation of presbyopia?
refractive error for close vision, eye strain and headaches
What are risk factors for presbyopia?
usually by 45 most people have it
What is the causation of presbyopia?
aging
How do you treat presbyopia?
corrective lenses
What was the clinical presentation of acute angle closure glaucoma?
red eyes, cloudy cornea, dilated pupil
EXTREME pain, blurred vision, unilateral , halos, headaches, nausea, abdominal pain
IOP pressure>50 (normal 10-21), hard eyes
What are risk factors for acute angle closure glaucoma?
Shallow, anterior chamber (far-sightedness (hyperopia), small eyes), enlargement of lens, genetics, disease in elderly, pupil dilation
What is the cause of acute angle closure glaucoma?
Closed angle –> optic nerve inflammation, pressure in the eye
How do you diagnose an acute angle closure glaucoma?
Look for cup and disc ratio… cup should be 30% or less
How do you treat acute angle closure glaucoma?
EMERGENCY
refer to ophthalmology
IV acetazolamide
oral acetazolamide QID
+ topical medication timolol maleate
when pressure lowers, topical pilocarpine
cataract removal or laser peripheral iridotomy
What causes secondary acute-angle closure glaucoma?
Normal structures but acute event maybe occurring from anterior uveitis, dislocation of lens, hemodialysis, medications
How do you diagnose secondary acute-angle closure glaucoma?
diagnosis is 2/3 parameters: optic disk, visual fields, intraocular pressure
What do you need to remember when treating secondary acute-angle closure glaucoma?
treat unaffected eye in case of risk
What is the presentation of chronic glaucoma?
progressive optic nerve damage, gradual “tunnel vision”, painless bilateral
What are risk factors for chronic glaucoma?
Inuit or asian ancestry, 1st degree relatives, pts with DM, older people with African or Hispanic ancestry, any corticosteroid use
What are causes of chronic glaucoma?
1) Open angle = MCC, increased aqueous production and/or decreased outflow bilateral
2) Angle closure, flow of aqueous humor is obstructed but not as fast occuring
3) normal tension (vascular issues)
How do you treat chronic glaucoma?
prostaglandin drops to reduce intraocular pressure –> latanoprost, travoprost
you can add beta blockers too
laser treatment is reserved for failure of medication trabeculoplasty, trabeculectomy, iridectomy
What is strabismus?
misalignment of eyes: esotropia or exotropia
What’s a risk for strabismus?
children
What is the cause of strabismus?
eye muscle issues, nerve transmission, control center in brain
What are diagnostic tips for strabismus?
Check medial canthus on children (pseudo?)
Hirschberg test (is the light in the same spot?)
Cover test
What is the clinical presentation of ambylopia?
brain turns off eye, so there is atrophy of eye muscles, losing visual field
Unilateral, impaired and absent fine depth perception
What are risk factors for amblyopia?
Prematurity, small size for gestational age, 1st degree relative, neurodevelopmental delay
What is the causation of amblyopia?
long-term suppression of one eye, usually visual acuity 3-5 years of age
How do you diagnose amblyopia?
Need complete eye exam by eye specialist, >2 line difference between 2 eyes
Objection to occlusion in children
Referral to ophthalmologist for many, many abnormal indications…
How do you treat amblyopia?
Patching eye or atropine (vision blurring)
What is retinoblastoma?
Retinal tumor, which can be seen in the white eye reflection
What is a risk factor for retinoblastoma?
children; rare after age 6
How is a retinoblastoma caused?
inherited or sporadic
How do you diagnose a retinoblastoma?
fundoscopic exam by eye specialist, if concerned
What is the clinical presentation of amaurosis fugax?
Sudden unilateral vision loss, which lasts a few minutes
What is the cause of amaurosis fugax?
transient emboli to retinal artery
How do you diagnose amaurosis fugax?
Usually normal on exam, but need to look at PMH, FH, reliance on patient’s description, analyze differentials
Bad headache –> most likely arteritis
CAD? Age? Onset? Duration?
How do you treat amaurosis fugax?
Ophthalmologic eval, check inflammatory mediators, carotid imaging
IF NORMAL: Cardio eval, brain MRI, EEG, hypercoagulable testing
treat like a stroke until proven otherwise, depends on cause
What is the clinical presentation of optic neuritis?
Monocular visual loss (color vision, decrease brightness), worse with low Vitamin D
Eye pain, worse with eye movement, relative afferent pupillary defect (pupil dilates to light), usually unilateral
Who are at risk for optic neuritis?
young women 20-40yrs, obesity, smoking, autoimmune
What is the causation of optic neuritis?
inflammation and demyelination of optic nerve, immune mediated
presenting sign of MS
if infection, : Lyme, Herpes, Syphilis, methanol poisoning, B12 deficency, diabetes
What does optic neuritis look like upon exam?
Bright, inflamed optic disk, almost like a firework behind a cloud on exam
How do you manage optic neuritis?
IV steroids: methylprednisolone, PO prednisolone
Refer to op
MS will develop
If no improvement, MRI of head, rule out compressive lesion
What is the clinical presentation of infantile nystagmus?
Repetitive, uncontrolled eye movements (horizontal), reduced vision and depth perception, affect of balance and coordination
What makes someone at risk for infantile nystagmus?
albinism, congenital absence of iris, underdeveloped optic nerves
When is infantile nystagmus developed/observed?
2-3 months of age
How do you diagnose infantile nystagmus?
check for other visual changes, vertigo, neurlogic symptoms, eye movements
What is the clinical presentation of papilledema?
bilateral, nonpainful optic disk swelling (raised intracranial pressure), visual field loss and acuity
What is the causation of papilledema?
Idioapathic intracranial hypertension (chronic and long term)
Space occupying lesions
Blockage of CSF, cerebral edema, meningitis
How do you diagnose papilledema?
Bulge on eye exam
How do you treat papilledema?
Reducing ICP, weight loss if obese, and acetazolamide
Reduce fluid –> reduce pressure
What is the normal IOP?
10-21
What is the IOP for glaucoma ?
> 50
