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Neuro Week 4 > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

the big three

A

cataracts, macular degeneration, glaucoma

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2
Q

indications for cataract surgery

A

severity of visual loss, functional needs of patient, need to improve view of posterior segment of eye to care for ocular pathology

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3
Q

macular degeneration causes ______

A

decreased central vision (affects macula)

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4
Q

dry vs wet ARMD

A

dry - not as bad

wet - worse, includes hemorrhage or fluid (serum, or blood)

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5
Q

age range armd

A

50, usually >70 (75-85)

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6
Q

tx dry MD

A

quit smoking, nutritional recom., AREDS 2 supplementation, manage systemic disease

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7
Q

tx wet MD

A

quit smoking, nutritional recom., AREDS 2 supplementation, manage systemic disease
++++ anti-vegf drugs or
rarely conventional laster, photodynamic tx

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8
Q

vitamins in macular degeneration

A

high dose antioxidant vitamins (C, E) and minerals (Zinc, copper)

beta carotene –> lung cancer
use lutein/xeaxanthin now (carotenoids)

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9
Q

glaucoma

A

increased ocular pressure causes optic nerve loss

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10
Q

2 types of glaucoma

A

open angle - slow d/t trabecular meshwork

narrow angle - emergency (closure of narrow angle)

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11
Q

tx for acute glaucoma

A

pilocarpine (constrict pupil)
acetazolamide (diuretics)
oral glycerine or isosorbide (osmotic)
refer to ophthamology - laser peripheral iridotomy

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12
Q

sudden loss of vision in one eye for only minutes

A

amaurosis fugax

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13
Q

work up amaurosis fugax

A

first - see CV workup (usually temporary vascular insufficiency) - worry about stroke, etc.
then opth

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14
Q

duration ophthalmic migraine

A

20-30 minutes (HALLMARK)

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15
Q

etiology ophth migraine

A

spasm of arterioles in occipital cortex

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16
Q

____ are worse that _____ (bases acids)

A

bases worse than acids

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17
Q

test to look at nerve fiber defects before visual field loss

A

optical coherence tomorgraphy

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18
Q

_______ sighted people get angle closure more

A

far sighted (hyperopia)

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19
Q

tx diabetic retinopathy

A

prevention (manage BSL)
laser therapy
surgical - vitrectomy
anti-vegf drugs

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20
Q

diabetic retinopathy

A

increased glucose –> vegf –> increased capillary permeability/abnormal vasoproliferation

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21
Q

clinical stages diabetic retinopathy

A

nonproliferative diabetic retinopathy
preproliferative diabetic retinopathy
proliferative DR

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22
Q

NPDR

A

microaneurysms, blot hemorrhages, hard exudates, macular edema (vision), lipid deposits
eye may see fine if macula spared

23
Q

test to see vessels in eye (DR)

A

fluorescein angiogram

24
Q

tx NPDR

A

intravitreal steroids, antivegf

25
Q

preproliferative DR

A

venous bleeding, intraretinal microvascular changes, ischemic areas with cws

26
Q

proliferative DR

A

boat hemorrhage
large retinal hemorrhages
neovascularization
fibrosis, retinal traction and wrinkling

27
Q

tx PDR

A

laser pan-retinal photocoagulation to stop release of vegf

28
Q

eye exams for diabetics

A

type 1 - annually after 5 years of disease

type 2 - at diagnosis and annually

29
Q

hypertensive retinopathy signs

A

narrowing and sclerosis of arterioles –> flame hemorrhages, cotton wool spots, papilledema in severe cases
hard exudates, silver wired arterioles, disc edema in advanced

30
Q

tx hypertensive retinopathy

A

control blood pressure!

31
Q

causes of sudden visual loss

A

migraine scotoma, retinal detachment, retinal artery occlusion, retinal vein occlusion, temporal arteritis, stroke

32
Q

retinal cholesterol emboli

A

non-occlusive
warning sign for vascular disaster
w/u: carotid doppler, ECG, serum cholesterol, triglyceride levels, angiography

33
Q

sudden partial vision loss in one eye, painless, always sustained, floaters and photopsias, myopia…

A

retinal detachment

34
Q

tx retinal detachment

A

refer immediately to ophth for surgery

35
Q

sudden severe loss of vision in one eye, painless, permanent but may recover if treated quickly, cherry red spot

A

acute central retinal artery occlusion

36
Q

cherry red spot happens why

A

rest of retina is pale/swollen/opacified and fovea is not as thick so you can see intact choroidal circulation beneath retina

37
Q

tx acute arterial occlusion

A

rebreathing CO2 - arterial dilation –> go further out
timolol to lower occular pressure
IV acetazolamide
massaging of globe with lids closed

38
Q

retinal vein occlusion

A 
central or branch
more common w/ htx or dm
tx underlying diseases
refer
squashed tomatos
39
Q

temporal arteritis

A

ha and scalp tenderness
fever, weight loss
jaw claudication
vision loss d/t retinal arteriolar occlusion or optic nerve infarct

giant cell arteritis

40
Q

dx temporal arteritis

A

STAT ESR and CRP

temporal artery biopsy to look for PMNs in arterial wall

41
Q

tx temporal arteritis

A

HIGH DOSE SYSTEMIC STEROIDS ASAP (before biopsy)

42
Q

biopsy results temporal arteritis

A

inflammation of arterial wall
fragmentation/disruption of internal elastic lamina
+/- multinucleated giant cells

43
Q

visual stroke

A

sudden painless loss of vision causing hemianopsia
usually involves occipital cortex
visual field loss occurs bilaterally on contralateral side of cortical lesion

44
Q

thyroid ophthalmopathy

A 
dry eyes
proptosis
ocular injection
chemosis
lid retraction
ocular muscle restriction --> diplopia
45
Q

tx thyroid ophthalmopathy

A

tears, monitor TH, monitor ophth, corticosteroids, orbital irradiation or surgical decompression, surgery

46
Q

tx chemical injury

A

anesthetize and irrigate immediately and profusely
measure and remeasure pH until neutral
research chemical
bases worse

47
Q

corneal laceration

A

irregular pupil, cover with shield and refer immediately ( no flurescien)

48
Q

what to do with blood in anterior chambeR?

A

hyphema - refer immediately

49
Q

corneal abrasion tx

A

topical abx, pressure patch, oral analgesics, promote healing (cyclopentolate)

50
Q

topical anesthetics for eye?

A

NO - only for your exam, don’t give to the, - will get worse and scar

51
Q

preauricular lymphadenopathy signals

A

viral conjunctivitis

52
Q

ciliary injection concentrated at limbus, indicates _______

A

iritis (anterior uveitis) rather than conjunctivitis

systemic disease, large ddx

53
Q

overall issue with temporal arteritis

A

ischemia to nerve

54
Q

changes in retina in DR

A

cholesterol deposits and microaneurysms, basal proliferation and cotton wool spots

Neuro Week 4 (5 decks)

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