Ophthalmology

Question 1

Visual field defects

Answer 1

• Optic nerve: R/L anopia
• Optic chiasm: bitemporal hemianopsia
• Optic tract or visual cortex: R/L homonymous hemianopia
• Meyer loop (temporal lobe): R/L upper quadrantic anopia
• Dorsal optic radiation (parietal lobe): R/L lower quadrantic anopia
• PCA infarct: R/L hemianopsia w/ macular sparing
• Macula: central scotoma

Question 2

Glaucoma

Answer 2

Damage to optic nerve by ↑IOP by disrupt* of aqueous humor flow
Open-angle > closed-angle (in USA)

Open-angle bilateral; closed-angle unilateral

Question 3

Closed-angle glaucoma (RF, PE)

Answer 3

Disrupt flow in ant chamb → ↑P* in post chamb → angle closure

RF: fam Hx; old; asian; hyperopia; prolong pupil dilat* (dark/stress/meds); ant uveitis; lens dislocat*

Extreme, sudden eye pain; blurr vis*; headac; N/V

Question 4

Closed-angle glaucoma (dg, ttt)

Answer 4

Dg: hard red eye, fixed pupil

ttt: emerg!!! Give eyedrops (timolol/pilocarpine)
Oral/IV acetazolamide; IV mannitol
Laser periph iridotomy (cure)
!!! No meds that dilate pupil

Question 5

Open-angle glaucoma (RF, PE)

Answer 5

Ds trabec meshwork → ↓drain → ↑IOP + progr vis* loss
RF: >40yo; black; DM; myopia

Suspect in >35yo w/ fqt lens changes + mild headac, visual disturb; asympt until late ds

Question 6

Open-angle glaucoma (dg, ttt)

Answer 6

Dg: tonometry; cupping of optic disc; test visual field

ttt: eyedrops (timolol/betaxolol) ↓aq product*
Pilocarpine ↑aq outflow
Acetazolamide
If fail, laser trabeculoplasty/trabeculectomy

Question 7

Cataracts

Answer 7

Lens opacificat*
Ass w/ DM; HTN; adv age; expo to radiat*

Loss of visual acuity and night vis*
ttt: surg lens removal/replacement

Question 8

Age-related macular degeneration (PE)

Answer 8

Esp white, women, smoker, fam Hx
Painless loss of central vis; distort of lines

• Atrophic/dry: 80%; gradual vis* loss
• Exudative/neovasc/wet: rapid severe vis* loss

Question 9

Age-related macular degeneration (dg, ttt)

Answer 9

Dg: fundoscopy: Dry (drusen; pigment chang)
Wet (hge; subretinal fluid)

ttt: Dry (vit C/E/beta-carotene/zinc slow progr)
Wet (VEGF inhib = ranibizumab/bevacizumab ↑vis* or ↓loss); photodynamic coag therapy

Question 10

Central retinal artery occlusion

Answer 10

Sudden painless unilateral blindness
Cherry-red spot on fovea; retinal swell; bloodless retinal arteries

ttt: ocular massage; intra-arterial thrombolysis in 8h

Question 11

Central retinal vein occlusion

Answer 11

Rapid painless vision loss
Ass w/ HTN
Swollen optic disk w/ hge, venous stasis, retinal hge; cotton-wool spots; macular edema

ttt: laser photocoag