ocular diease Flashcards
most common CN palsy
Why?
CN6
- usually due to micveovascular infact
Complete CN3 palsy is characterized by:
complete external opthalmoplegia - all of the muscles that CN3 controls are dead
Adie’s
- diagnose with .125% pilo - will constrict due to up regulation of receptors on iris sphincter
decreased deep tendon reflects
young female
veriform eye movements
slow constriction to near but not to light
what is used to diagnose a pupil involved CN3 palsy
1% pilo will cause constriction
Cause of post ganglionic horners
-Cavernous sinus issues (sympathetics travel on the ICA in the Cav sinus)
- CA Dissection
- Internal Carotid Artery Aneurysm
what does internal ophthalmoplegia mean
paralysis of the pupil
Abnormal pupil is large:
- what are in the differentials?
- Adies
- CN3 palsy
- Iris Sphincter trauma
- pharm dilation
causes of APD?
what would never cause an APD?
CAUSES OF APD
- dense vitreous heme
- extensive retinal damage
- optic nerve damage (only when unsymmetrical b/t eyes)
NEVER CAUSING AN APD
- cornea
-iris
- lens
- optic tract
- optic radiations
- occipital lobe
(anything posterior to chiasm)
optic nerve colobomas are located
Inferior nasal
early signs of Leber’s Optic neuropathy
optic disc hyperemia that progresses to optic disc pallor in late stages.
Most common type of functional pituitary tumor
macroadenoma PROLACTIN SECRETING tumor
(amenorrhea, galactorrhea, infertility)
PIGS ON ACID (acid cells)
Retrograde degneration example
How does it affect the ON
pituitary tumor is a cause of RETROGRADE DEGENERATION.
BOW TIE PALLOR of the ON (remember that fibers that are b/t the macula and the ON are NASAL) – this is reason for the bow tie pallor… all of those fibers cross and are compressed by the tumor
why is CN6 affected in IIH
CN6 travels along the Pretrous ridge of the temporal bone. Can be compressed when ICP is high
is an MRI or a lumbar puncture done first?
MRI - make sure there are no space occupying lesions
What is the only way to diagnose papilledema
spinal tap
What is the acuity in the third decade of StARgardts patient
Usually around 20/200 in the pts 30s and doesn’t get worse after that.
Rapid vision loss and color vision abnormalities
StARgarts
Fish tail flecks
RPE mottling
Beaten Bronze - bullseye
Salt and pepper
Most common macular dystrophy, inheritance
Stargardt’s
AR inheritance
stARgardt’s = AR
In early stages of RP, what test is abnormal
Scotopic ERG
RP triad
Can you name 4 other things seen ?
Waxy ON (pallor)
Bone Spicules
Artery Attentuation
PSC
Optic disc Drusen
Macular changes
Keratoconnus
Symptoms for RP, vision by 30?
Night blindness - the Cones and rods are both affected by rods are more affected than cones
Peripheral vision loss.
75% of RP patients at age 30 are asymptomatic
Ushers syndrome inheritance
RP + Hearing loss
AR
Average age of diagnosis for RP
9-19yo
Albinism may be associated with severe systemic conditions including :
Hermansky Pudluk
Chediak Higashi
Severity of vision loss in albinism is due to:
Degree of iris/ fundus hypopigmentation and foveal hypoplasia
Albinism is caused by a decrease in melanin or melanocytes
albinism = decrease in MELANIN
Normal recovery for a macular photostress test
<60 seconds
Macular holes:
Stage 1
Stage 2
Stage 3
Stage 4
Stage 1 - loss of foveal depression - yellow spot on fovea
Stage 2 - Round small full thickness hole with a PSEUDO-OPERCULUM – looks like the top of a can
Stage 3 - full thickness with a true operculum. Positive Watze Allen
Stage 4 - stage 3 + PVD
Positive Watze Allen is seen in stage 3 and 4 - complete break in the middle of the thin line projected within the macula
Cause of macular hole
Sex that gets macular holes more common
Macular hole results from posterior vitreous traction on the macula.
MC in female and most common cause is aging
Are males are females more likely to get ERMs.
What causes ERMS?
Females
- increases with age
- idiopathic but may also be caused by PVDs and retinal breaks
- think: GLIAL CELLS on the ILM
Most patients with ERMs have a PVD
Signs seen in pathological myopia
- posterior staphaloma
- oblique insertion of ON
- fuchs spots
- laquer cracks
- Premature cats (NS and PSC)
- PVD
- Peripheral retinal degeneration so (paving stone, snail tracks)
- Retinal detachments
Hallmark for pathological myopia
Posterior staphaloma = posterior bulging of a weak sclera
Refractive error associated with myopic degeneration/pathological myopia ?
What is the axial length associated?
> -6.00
26.5mm - measured with A scan
Triad for histo
Is the vitreous clear?
Punched out spots
Peripapillary atrophy
CNVM Maculopathy (CHBALA)
VITREOUS IS ALWAYS CLEAR IN HISTOPLASMOSIS
Is histo a retinitis or a choroiditis
Histoplasmosis is a choroiditis
What is the FA sign seen in CSCR
10% - smoke stack
90% PED
CSCR
Middle aged Man
Type A
Steroid use of any kind
Hypochondriac
HTN
Unilateral
- also associated with pregnancy
- caused by RPE and choroid
- serous fluid under the macula - fluid above the RPE
-relative scotoma
Classic vs Occult CNVM
Classic: well defined membrane that fills with dye during the early phases of FA
Occult: poor defined membrane with late appearing and less intense leakage
Causes of CNVM
CHBALA
Choroidal rupture
Histo
Best
Angioid streaks
Laquer cracks
Amd
can PEDs occur in dry ARMD?
Yes - called drusenoid PED
due to build up of conclude that soft Drusen on Bruchs membrane
4 outcomes from CNVM in wet ARMD
- Subretinal heme
- Sub RPE heme
- Sub retinal detachment - AKA Serous retinal detachment (plasma)
- RPE detachment - AKA: PED - (plasma)
PLASMA = Detachment
BLOOD = HEMORRHAGE
According to the macular photo coagulation study group: what are the four main risk factors that increase the risk of progression from dry to wet AMD
- Multiple soft Drusen
- Focal hyperpigmentation
- Smoking
- HTN
What is dry AMD characterized by ?
What is the end stage of dry AMD
Drusen, RPE abornalities, PED
Geographic atrophy - this can cause severe vision loss (defined as >6lines of vision loss)
Symptoms of wet AMD
- central scotoma
- metamorphopsia
- RAPID vision loss (not seen in dry AMD)
Is dry or wet AMD more common.
Does Dry or wet AMD make up the greatest amount of vision loss?
Dry - 85-90% of AMD
Even though Dry AMD makes up 85%, 88% of legal blindness caused by AMD is caused by the WET form.
Risk factors for ARMD
Smokers (2.5x)
Hyperopia
>75 yo
Family Hx
Light toxicity
Obesity
NOT: APHAKIA
MC primary intraocular malignancy
Choroidal melanoma
the choroid has a TON of melanin
Pneumonic for transformation into malignant melanomas
TO FIND SMALL OCULAR MELANOMAS USE HELPFUL HINTS
T- thickness >2mm
F - Fluid (sub retinal)
S - symptoms - blurred vision/floaters
O - orange pigment - Lipofuscin
M - Margins are irregular (remember that CHRPE have REGULAR borders)
UH- ultrasonography can hollowness - low internal reflectivity ** WILL LOOK LIKE ONE SPIKE, A FLAT LINE, THEN ANOTHER SPIKE. THE CENTER IS HOLLOW
H - halo absence (remember CHRPE can have halos)
A nevus should also be suspicious if >4DD and close to the disc
What percent of choroidal nevus progress to malignant melanoma of the choroid?
10%
Bilateral multifocal CHRPE are associated with:
Gardners Syndrome
FAP –>
(Colon CANCER)
Do Colonoscopy
Differentials for leukocoria
RB
Coats’
ROP
Toxocariasis
Heritable retinoblastoma will be unilateral or bilateral
BILATERAL = HERITABLE – 50% chance of passing it on
UNILATERAL = SPORATIC
Signs/symptoms: leukocoria, strabismus, inflammation, decreased vision
Most common intraocular malignancy in children
Most common intraorbital malignancy in children
RB - intraocular - retinoblastoma
RMS - intraorbital - Rhabdomyosarcoma
Which part of the retina is most likely to have a Tractional RD in ROP
Anterior Temporal –> the temporal retinal is the last to receive vasculature in the 9th month gestation
Who gets ROP?
Out comes of ROP
Babies born <32 weeks (definition of premature <37weeks)
Or: birthweight <1500grams in babies who received oxygen treatment
SIGNS:
Pre-retinal Heme/Vitreous heme
Tractional RD
Neo
Coats’ dz
Unilateral, telangeictatic dilated vessels that display a lightbulb appearance. Progression can lead to marked hard exudates, exudative RD, neo glc, — results in red, painful, blind eye
- 8yo boy with UNILATERAL hard exudates with exudative RD.
What are the most common causes of vascular sheathing and periplebitis
Sarcoidosis
Syph
Pars Planitis
Sickle Cell
Talc Retinopathy presents in what kind of patients
IV drug users
Interferon Retinopathy is seen _________ many months after the interferon is started,
3-5 months
Interferon is given with Ribavirin (tons of SE) to treat Hep C (MC way to contract: sharing needles)
Most common ocular manifestation of HIV/AIDS patients.
HIV retinopathy - signs include CWS, retinal hemes, similar to DR and early CMV retinitis