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EENT Exam 1 > Ocular Disorders: Posterior > Flashcards

Ocular Disorders: Posterior Flashcards

1
Q

Most common cause of reversible blindness worldwide

A

Cataracts

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2
Q

Cataracts

A

Opacification of the intraocular lens resulting in vision changes

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3
Q

Most common cause of cataracts

A

age-related changes in crystalline lens

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4
Q

Other causes of cataracts

A
  • diabetes mellitus
  • galactosemia
  • hypocalcemia
  • Radiation
  • Trauma
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5
Q

What is attenuation?

A

(↓ force/effect) of light

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6
Q

Cataracts pathophysiology

A
  • Loss of optical clarity
  • Morphological changes
  • Building up a diffusion barrier to
    nucleus coloration/clouding of lens
  • Biochemistry
  • ↓ glutathione (antioxidant) levels
  • Formation of advanced glycolated
    end products
  • Loss of alpha-crystallin chaperone
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7
Q

Cataracts clinical presentation

A
  • Often detected during routine eye
    exam in asymptomatic patients
  • May report gradual painless loss
    of vision at distance
  • Typically bilateral, but can be
    asymmetrical
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8
Q

Diagnosis of cataracts

A
  • Most diagnosed during rouXne ophthalmoscopic exam in asymptomaXc paXents
  • Suspect in older paXents with progressive ↓ vision or other S/S
  • Diagnosis confirmed by comprehensive eye exam (Ophthalmology)
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9
Q

Cataracts management

A
  • Management of symptomatic cataract is primarily surgical
  • Nonsurgical management
  • Prescribe eyeglasses (if appropriate)
  • Counsel patients about cataract-related visual symptoms
  • Provide reassurance about cause of visual impairment
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10
Q

Age-related Macular Degeneration (AMD)

A

Progressive chronic retinal disease of aging eye(s), characterized by:
- Drusen (focal yellowish deposits of acellular, polymorphous debris)
- Geographic atrophy of retinal pigment epithelium
- Neovascularization leading to visual impairmen

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11
Q

Age-related Macular Degenera4on (AMD) Pathogenesis

A
  • Cause unknown
  • Drusen forms below retinal pigment
    epithelium & Bruch’s membrane
  • Geographic atrophy begins to
    manifest as retinal pigment
    epithelium changes
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12
Q

AMD Clinical presentation

A

Incidental finding <——-> Sudden central visual distortion
* May report ↓ vision, flashes of light (photopsia), or difficulties with light
adaptation

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13
Q

AMD diagnosis

A
  • Comprehensive exam, including visual acuity & Amsler grid
  • Dilated fundoscopic exam with stereoscopic biomicroscopic exam of the macula
  • presence of few medium (63-124 micrometers) Drusen (early AMD)
  • retinal hyperpigmentation or hypopigmentation
  • retinal atrophy
  • Optical coherence tomography
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14
Q

___ is #1 severe, irreversible vision impairment in developed countries

A

AMD

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15
Q

AMD Management

A
  • Smoking cessation (if applicable)
  • Early AMD → obervation
  • Intermidiate/Advanced AMD → antioxidant vitamin (carotenoids, vitamins C & E) & mineral supplements (selenium & zinc)
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16
Q

1st Line treatment for AMD

A

Neovascular AMD → Intravitreal injection of antivascular endotheial growth factor antibodies

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17
Q

Complications & Referral Considerations for AMD

A
  • Blindness
  • ↑ risk for depression, hip fracture, & nursing home placement
  • Charles Bonnet syndrome
  • ↑ mortality in patients aged 49-75 years
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18
Q

Glaucoma: Two types

A

Acute angle closure: Primary glaucoma in which contact of the iris with the peripheral cornea excludes aqueous humor from the
trabecular drainage meshwork.
Chronic open angle: Primary glaucoma in which the aqueous humor has free access to the trabecular meshwork.

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19
Q

Glaucoma – Angle Closure clinical presentation

A
  • Asymptomatic early
  • Symptomatic: >90% of attacks are unilateral
  • Severe ocular pain
  • Sudden vision loss
  • Blurred vision
  • Halos around lights
  • Headache
  • Eye redness
  • Nausea & vomiting (if IOP high)
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20
Q

Glaucoma – Angle Closure physical exam

A
  • Structural assessment of optic cup
  • Visual field loss in severe cases
  • More diffuse with angle-closure glaucoma
  • Slit-lamp biomicroscopy
    *** Tonometry
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21
Q

Diagnostic Criteria for Glaucoma – Angle Closure

A

≥ 2 symptoms
1. ocular or periocular pain
2. nausea &/or vomiting
3. Hx of intermittent blurring of
vision w/ haloes

22
Q

Glaucoma – Open Angle clinical presentation

A
  • Asymptomatic early
  • Symptomatic
  • Ocular burning/smarting/stinging/soreness
  • ocular tiredness
  • blurry/dim vision
  • Eye foreign body sensation
  • visual difficulty in daylight &/or darkness
  • halos around lights
  • Ask about use of steroids
23
Q

Left untreated open angle
glaucoma will lead to
_____

A

permanent blindness

24
Q

Glaucoma results in ____ as the central cup becomes enlarged

A

“cupping”

25
Q

Glaucoma – Angle Closure Management

A

Laser trabeculoplasty is the ini7al therapy in selected patients or alternative for patients who can/will not use medications reliably

26
Q

Glaucoma – Open Angle Management

A
  • Long-term medications (↓ IOP) delay
    visual progression in pts with primary
    open-angle glaucoma or ocular
    hypertension
  • Topical medications
  • Beta-blockers
  • Prostaglandin analogs
  • Parasympathomimetic agents
  • Alpha-adrenergic agonists
  • Systemic carbonic anhydrase
    inhibitors
27
Q

1 cause of preventable

blindness in US adults 20-74 yo

A

Diabetic Retinopathy

28
Q

Diabetic Retinopathy Clinical persentation

A
  • Often Asymptomatic!
  • Blurred or double vision
  • ↓ field of vision
  • Seeing dark spots
  • Pressure or pain in eyes
  • ↓ vision in dim light
  • Sudden blindness (rarre)
29
Q

Advanced Hypertensive Retinopathy findings on exam

A
  • Flame hemorrhages
  • Arteriovenous nicking [a small artery
    (arteriole) is seen crossing a small vein
    (venule), which results in the
    compression of the vein with bulging on
    either side of the crossing]
  • Cotton-wool spots
30
Q

Diagnosis of Diabetic Retinopathy

A
  • Funduscopic Exam Findings (direct ophthalmoscopy)
  • Ideally done during routine, annual, asymptomatic screening
31
Q

_____ are generally the 1st clinical sign in the early-stages of Diabetic Retinopathy

A

Microaneurysms

32
Q

Central Retinal Artery Occlusion

A

blockage of the arterial supply to the retina
leading to retinal ischemia or infarction & transient or permanent vision loss.

33
Q

Central Retinal Artery Occlusion most common cause

A

Embolism

34
Q

Central Retinal Artery Occlusion common clinical presentation

A
  • Sudden painless, monocular vision
    loss or degradation
    “a veil/curtain/shade suddenly
    coming down over my eye”
35
Q

Retinal opacity, or whitening, with cherry red spot is earliest sign for ____

A

Central Retinal Artery Occlusion

36
Q

Central Retinal Artery Occlusion Management

A
  • The prognosis for visual recovery is related directly to the promptness in
    treatment; thus…
  • Rapid transport to the ED is essential!
37
Q

____ constitute the
second most common retinal
vascular disorder.

A

CRVO & Branch Retinal Vein
Occlusion (BRVO)

38
Q

Central Retinal Vein Occlusion

A

Backup of the blood in the re?nal venous system &
increased resistance to venous blood flow 2° thromboembolism

39
Q

Leading cause of visual loss in both
ischemic & nonischemic CRVO

A
  • Ischemic damage to the retina may
    stimulate ↑ production of vascular
    endothelial growth factor (VEGF) in the
    vitreous cavity → neovascularization of
    the posterior & anterior segment
  • VEGF causes capillary leakage → macular
    edema
40
Q

Central Retinal Vein Occlusion Diagnosis

A

Visual acuity: Variable → one of the
important indicators of prognosis

  • Retinal hemorrhages may present in all 4 quadrants.
  • can be superficial, dot & blot, &/or deep.
  • may be seen in the peripheral fundus only.
  • mild to severe, covering the whole fundus
  • “Blood & Thunder” appearance
41
Q

Re&nal Detachment

A

Separation of neurosensory retina from underlying retinal pigment epithelium

42
Q

Re&nal Detachment most common cause

A

Rhegmatogenous detachment → entry
of liquid vitreous into subretinal space
through a retinal break

43
Q

Retinal Detachment - Exudative detachment

A

subretinal fluid accumulates & causes detachment without any corresponding break in the retina
* Tumor growth or inflammation

44
Q

Retinal Detachment - Traditional attachment

A

centripetal mechanical forces on retina, usually mediated by fibrotic tissue & scarring from previous disease
* Diabetic retinopathy
* sickle cell disease
* penetrating trauma

45
Q

Retinal Detachment exam findings

A
  • Marcus-Gunn pupil
  • Intraocular pressure measurement in both eyes
  • Relative hypotony of >4-5 mm Hg less tobacco dust
    (Shafer sign) than the fellow eye is common]
  • Described as a dim “shadow” or “curtain”
46
Q

Retinal Detachment is a ______

A

Surgical Emergency

47
Q

Optic Neuritis

A

occurs when inflamma?on damages the optic nerve

48
Q

Periocular pain can occur in >90% of patients who have ____

A

Optic Neuritis

49
Q

Optic Neuritis Clinical Presentation

A
  • May present with visual deteriora?on during exercise or elevated temperature
  • Uhthoff phenomena
50
Q

Anterior Ischemic Optic Neuropathy

A

Sudden loss of vision due to a decreased or interrupted blood flow to the eye’s op?c nerve

51
Q

Most common cause of acute op?c neuropathy in older age groups

A

Anterior Ischemic Op*c Neuropathy

52
Q

Amaurosis Fugax

A

Amaurosis “dark” & Fugax “flee?ng” – Transient loss of vision

EENT Exam 1 (5 decks)

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