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Clinical Medicine II > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

T or F

The Physiological cup in the eye sits inside of the Optic Disk ?

A
  • True
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2
Q

Hypertensive Retinopathy is caused by ?

A
  • Hypertension
  • Due to
    1) Vascular changes
    2) Damage to retina
    3) Choroid
    4) Optic nerve
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3
Q

Hypertensive Retinopathy depends on the degree/type of damage, what are the two types?

A

1) Acute hypertension: can cause Vasospasm

2) Chronic hypertension: leads to Arteriosclerosis

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4
Q

Hypertensive Retinopathy risk factors include?

A
  • Lipid levels
  • Smoking
  • Weight
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5
Q

What are the three visual signs of Hypertensive Retinopathy ?

A
  • AV Nicking
  • Copper Wiring
  • Silver Wiring
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6
Q

Mild retinopathy includes (1 or more) ?

A
  • Gen Arteriolar narrowing
  • Focal arteriolar narrowing
  • Arteriovenous nicking
  • Arteriolar wall opacity (silver wiring)
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7
Q

Moderate retinopathy includes (1 or more) ?

A
  • Microaneurysm
  • Cotton wool spot
  • Hard exudates
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8
Q

Malignant retinopathy includes?

A
  • Moderate retinopathy

plus

  • Optic disc swelling
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9
Q

Retinal Venous Occlusive Disease symptoms?

A
  • Acute
  • Painless loss of vision in one eye
  • Only part of vision decreased (Superior/inferior)
  • Branch retinal vein occlusion (BRVO)

or

  • Central retinal vein occlusion (CRVO)
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10
Q

Retinal Venous Occlusive Disease Fundus exam reveals?

A
  • Dilated, tortuous vein with retinal hemorrhages

- Cotton wool spots and retinal edema

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11
Q

Treatment of Retinal Venous Occlusive Disease ?

A
  • ASAP referral
  • Anti-VEGF injections (Bevacizumab)

1) Decreases macular edema
2) Improves long term prognosis

  • Younger patients without above risk factors: workup for hypercoagulable state = Systemic disease
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12
Q

Retinal Artery Occlusions ?

A
  • Branch retinal artery occlusion or Central artery occlusions (Cherry Spot)
  • Caused from an Emboli
  • Cholesterol
  • Calcific
  • Atherosclerotic plaque
  • Hollenhorst plaque
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13
Q

Retinal Artery Occlusions symptoms include?

A
  • Sudden painless vision loss in area affected

- Edematous opacification of the inner retina in distribution of affected vessel

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14
Q

Central artery occlusion will show ?

A

– Appearance of cherry red spot

  • Will show dull red color due to ischemia
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15
Q

If Retinal Artery Occlusions pt presents to ophtho within 4 hrs of vision loss what can you attempt?

A
  • Attempt measures to try to dislodge emboli

- Typically vision loss is permanent due to irreversible ischemia

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16
Q

Diabetic Retinopathy is the leading cause of vision loss for what ages?

A
  • 20 thru 74
  • Risk factors
    DM onset and Age
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17
Q

Pathogenesis of diabetic retinopathy ?

A
  • Hyperglycemia over time leads to
  • Microvascular endothelial cell damage
  • Capillary occlusion/retinal ischemia
  • Dysfunction of endothelial barrier
  • Leakage of serum and retinal edema
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18
Q

What causes the vision loss in Diabetic Retinopathy?

A
  • Macular edema (capillary leakage)
  • Macular ischemia (capillary occlusion)
  • Sequlae from ischemia-induced neovascularization
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19
Q

Two forms of Diabetic Retinopathy?

A

1) Non Proliferative

2) Proliferative

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20
Q

Non Proliferative diabetic retinopathy includes what signs during a visual exam?

A
  • Retinal microvascular changes
  • Microaneurysms
  • Cotton wool spots
  • Intraretinal hemorrhages
  • Hard exudate
  • Retinal edema
  • Arteriolar and venous abnormalities
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21
Q

Proliferative Diabetic Retinopathy has ?

A
  • Extraretinal neovascularization
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22
Q

Proliferative Diabetic Retinopathy Extraretinal neovascularization includes ?

A
  • Retinal ischemia
  • Neovascularization
    Vascular Endothelial Growth Factor (VEGF)
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23
Q

Complications of proliferative diabetic retinal neovascularization includes ?

A

1) Vitreous hemorrhage

2) Retinal detachment

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24
Q

Treatment of Diabetic proliferative retiopathy includes?

A
  • Panretinal photocoagulation to peripheral ischemic retina
  • Anti-VEGF intravitreal injections
  • Surgery
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25
Q

What is the major cause of vision loss in both Proliferative and Non proliferative Diabetic Retinopathy vision loss?

A
  • Vascular permeability (Macular Edema)
  • Cystic pockets of fluid build up in the central part of the Retina
  • Retinal detachment
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26
Q

Treatment for macular edema in both Proliferative and Non proliferative Diabetic Retinopathy ?

A
  • Anti-VEGF intravitreal injections

- Laser therapy on leaking microaneurysms

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27
Q

Goal in treatment of diabetic retinopathy?

A
  • Delay & Prevention of complications
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28
Q

T or F

Pregnancy associated with worsening or Diabetic Retinopathy ?

A
  • True

- Speeds up progression

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29
Q

Schedule for diabetic pts to have eye exams?

A
  • DM I
    Within 5 years of Dx
    Annual check ups after
  • DM II
    Upon Dx
    Annual check ups after
  • Pregnancy
    Before conception / or Early 1st trimester
    Check ups 1 to 3 months during
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30
Q

Age-Related Macular Degeneration (ARMD) is the leading cause of what blindness? What age group?

A
  • Severe central visual acuity loss

- > 50 y/o

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31
Q

What are the two categories of Age-Related Macular Degeneration (ARMD)?

A

1) Dry ARMD

or

2) Wet ARMD

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32
Q

Risk factors for ARMD ?

A

1) Age & Cigarette MC
2) Caucasian

4) Family history
5) Female
6) Hyperopia
7) Light colored eyes

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33
Q

Dry Age-Related Macular Degeneration (ARMD) causes ?

A
  • Slow

- Progressive central vision loss

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34
Q

Dry Age-Related Macular Degeneration (ARMD) findings?

A
  • Drusen
  • large density of macular drusen increase risk of ARMD
  • Retinal atrophy
  • Retinal hyperpigmentation
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35
Q

T or F

Small hard amount of Drusen may be associated with normal aging

A
  • True
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36
Q

Treatment of Dry Age-Related Macular Degeneration (ARMD)?

A
  • AREDS2 eye vitamins
    Vitamin E, C & Zinc
  • Decrease progression to late stage ARMD
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37
Q

Wet Age-Related Macular Degeneration (ARMD)

A
  • Choridal neovascularization
  • Subretinal fluid or hemorrhage
  • Eventual fibrosis/scarring
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38
Q

Wet Age-Related Macular Degeneration (ARMD) causes ?

A
  • Quick decrease in central acuity

plus

  • Metamorphopsia Distorted vision in which a grid of straight lines appears wavy

and/or

  • Central scotoma
    Grey, black or blind spot in the middle of one’s vision
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39
Q

Wet Age-Related Macular Degeneration (ARMD) treatment includes?

A
  • Anti-VEGF therapy can be effective if initiated BEFORE fibrotic changes
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40
Q

Age Related Macular Degeneration (AMD)

A
  • Breakdown of light-sensitive cells of the macula
  • Progressive loss of central vision
  • Spares peripheral vision
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41
Q

Retinal Detachments classified as ?

A

1) Rhegmatogenous
(most common)

2) Tractional
(associated with neovascularization)

3) Exudative
(associated with neoplasia or inflammation)

42
Q

Rhegmatogenous Retinal Detachment causes?

A
  • Full thickness retinal break
  • Secondary to posterior vitreous detachment (PVD)
  • Vitreoretinal traction can lead to retinal tears Horseshoe tears
43
Q

Rhegmatogenous Retinal Detachment (MOST COMMON) symptoms?

A
  • Sudden floater
  • Flashes
  • “curtain” across vision
44
Q

Rhegmatogenous Retinal Detachment prognosis ?

A
  • Depends if Macula was detached
  • Emergency
  • Catastrophic vision loss
45
Q

Age related Cataract ?

A
  • Pogressive clouding/opacification of crystalline lens
  • Due to proteins and lipids
  • Leading to decrease in vision
46
Q

Age related Cataract symptoms ?

A
  • Decrease in visual acuity
  • Decrease in contrast sensitivity
  • Glare (may have trouble driving at night)
  • Change in glasses prescription (myopic shift)
47
Q

Age related Cataract can be caused by excessive steroid use ?

T of F

A
  • True
48
Q

Age related Cataract treatment ?

A
  • If interfering with ADLs = Surgery

- Phacoemulsification

49
Q

Congenital Cataract

A
  • @ birth or develop within first year
  • 33% associated with systemic syndrome
  • 33% inherited
  • 33% undetermined
50
Q

Congenital Cataract may be unilateral or bilateral, but almost always bilateral in ?

A
  • Systemic disease

or

  • Familial
51
Q

Congenital Cataract must be corrected within the first 3 months after birth?

T or F

A
  • True
52
Q

Congenital Cataract workup includes?

A

Bilateral

  • If YES FH =
    No workup
- If NO FH =
Systemic workup for TORCH infections
- Toxoplasmosis
- Other (syphilis, varicella-zoster, parvovirus B19)
- Rubella
- Cytomegalovirus (CMV)
- Herpes infections

Unilateral

  • Typically not warranted
53
Q

Congenital Cataract timing of surgery important because if Cataracts present prior to development of the fixation reflex (at 2-3 months) it increases the chances of more impact on child’s visual development ?

T or F

A
  • True
  • Bilateral cataracts
    sensory deprivation nystagmus develops at age 2-3 months, at which point visual potential decreases markedly
54
Q

Congenital Cataract surgery timing?

A
  • Between months 1-3

- With 1 week interval if bilateral

55
Q

Glaucoma

A
  • Group of diseases with a characteristic optic neuropathy
  • IOP a risk factor BUT not a requirement
  • Progressing “Cupping” of the optic nerve, cup gets larger
  • Peripheral vision loss
56
Q

Two types of glaucoma include?

A
  • Open angle
  • Closed (Narrow) angle
    Acute or Chronic
57
Q

Eye Aqueous is produced in the ciliary body and then drains where?

A
  • Trabecular meshwork
58
Q

What is the second leading causes of blindness?

A
  • Glaucoma
59
Q

Open angle glaucoma risk factors include?

A
  • Most common
  • Age
  • Vision loss is irreversible
  • First periphery and progresses
  • Most patients do not appreciate vision loss until central vision is affected
  • Family history
  • Myopia (nearsightedness)
  • Race (African Caribbean)
60
Q

Acute closed angle glaucoma risk factors include?

A
  • Age
  • Female
  • Hyperopia (farsightedness)
  • Certain medications
  • Race (Asian)
61
Q

Open angle glaucoma is associated with decreased ?

A
  • Efficiency of the trabecular meshwork

- Clogged drain

62
Q

Closed angle glaucoma is associated with decreased ?

A
  • Access to the trabecular meshwork
  • Closed drain
  • Chronic form
63
Q

Acute angle closure glaucoma ?

A
  • Sudden extreme elevation of IOP
  • Acute blockage of trabecular meshwork by
    iris (anatomically predisposed eye)
  • Precipitated by dilation/low light conditions
64
Q

Acute angle closure glaucoma symptoms include?

A
  • Emergency !!!
  • Intense pain
  • Headache
  • Nausea/vomiting
  • Decreased vision
  • Halos
  • Emergent IOP lowering required to prevent
    permanent vision loss.
65
Q

Acute angle closure glaucoma PE findings?

A
  • Red Eye
  • Dilated Pupil
  • Cloudy cornea
66
Q

Clinical Presentation of Acute Angle Closure Glaucoma includes?

A
  • Rapidity and Degree of IOP determine the onset and severity of symptoms
  • Eye pain
  • Decreased vision
  • Nausea / vomiting
  • Halo around lights
  • Headache
67
Q

Symptoms that suggest a rapid rise in IOP causing acute angle closure ?

A
  • Conjunctiva redness
  • Corneal edema or Corneal cloudiness
  • Mild dilated pupil that reacts poorly to light
68
Q

Why is the pupillary sidebar test important?

A
  • Differentiates whether a patient is complaining of
    1) Decreased vision from an ocular problem (Cataract)

or

2) Defect of the optic nerve

69
Q

The ‘swinging light test’ is used to detect ?

A
  • Relative Afferent Pupil Defect (RAPD)
  • A means of detecting differences between the two eyes in how they respond to a light shone in one eye at a time.
  • The test can be very useful for detecting unilateral or asymmetrical disease of the retina or optic nerve
70
Q

How do you evaluate for glaucoma ?

A
  • Visual Acuity
  • Evaluation of the pupils
  • Measure IOP
  • Slit lamp examination
    of the anterior segments
  • Visual field testing
71
Q

How do you evaluate for Specifically Angle-closure Glaucoma if you don’t have a tonometer ?

A
  • Test anterior chamber depth
  • By shining a light from the side of the eye
  • Darkness on the nasal side = decreased anterior chamber
72
Q

Management for acute angle closure glaucoma < 1 hour from symptoms?

A
  • Ophthalmologist referral if availability is within 1 hour
73
Q

Management for acute angle closure glaucoma > 1 hour from symptoms?

A
  • Emperic treatment if availability is greater than 1 hour
  • Laser or Surgical iridotomy (GOLD STANDARD)
  • IV acetazolamide (carbonic anhydrase inhibitor)
  • Topical B blocker
  • Mannitol for diuresis
    Ultimately
74
Q

What is the only modifiable risk factor in glaucoma?

A
  • Managing IOP
  • lowered via
    1) Laser
    2) Surgery
    3) Medications
75
Q

Papilledema

A
  • (bilateral) optic disc swelling

- Results from increased intracranial pressure (ICP)

76
Q

Papilledema causes?

A
  • Tumors / Lesions in CNS
  • Idiopathic intracranial hypertension
    (aka pseudotumor cerebri)
  • Decreased CSF resorption
    (Venous sinus thrombosis, inflammatory processes, meningitis, subarachnoid hemorrhage)
  • Increased CSF production (tumors)
  • Cerebral edema/encephalitis
  • Medications
    1) Tetracycline
    2) Minocycline
    3) Lithium
    4) Accutane
    5) Nalidixic acid
    6) Corticosteroids (both use and withdrawal)
77
Q

Papilledema symptoms include?

A
  • Transient visual obscurations: “Grayouts” of vision (Orthostatic changes)
  • Pulsatile tinnitus
  • Diplopia from 6th nerve palsy
  • Decreased vision
  • Headache
  • Nausea, vomiting
78
Q

Papilledema treatment includes?

A
  • Treat underlining cause
  • Neuro and Ophtho consults
  • MRI/MRV brain/orbits
  • Visual acuity
  • Visual fields
  • Color vision
  • Possible LP with opening pressure
79
Q

Amblyopia

A
  • Diminished vision occurring during the years of cortical visual development (8 - 10y/o)
  • Secondary to abnormal visual stimulation
  • Unilateral MC
80
Q

Amblyopia classifications?

A

1) Refractive
2) Deprivation
3) Strabismus

81
Q

Amblyopia Dx can be difficult in children?

T or F

A
  • True

- Children do not complain about baseline vision

82
Q

Amblyopia screening ?

A
  • PreK visual acuity screening
  • Red reflex
  • Cover testing
83
Q

Amblyopia management ?

A
  • Prompt referral and treatment are critical
  • If not identified prior to completion of cortical visual development (8 to 10)
  • Vision will not improve with any treatment
84
Q

Amblyopia treatment ?

A

1) Address underlying cause of amblyopia

2) Force fixation with amblyopic eye via
- Patching
or
- Pharmacologic therapy

85
Q

Strabismus

A
  • Ocular misalignment
  • Due to eye muscle issues
  • Children or Adults
86
Q

Strabismus causes?

A
  • Trauma
  • Inflammation
  • Infection
  • Thyroid/Graves eye disease
    Autoimmune / Inflammation
    Hypertrophy
  • Myasthenia Gravis
    (Eye muscle neuromuscular junction)
- Dysfunction of cranial nerve 3, 4, or 6
Ischemic
Compressive (tumor/aneurysm)
Inflammatory
Demyelinating (MS)
87
Q

Strabismus Dx test ?

A
  • Abnormal corneal light reflex

- Cover and Uncover test

88
Q

Horizontal Strabismus include?

A

1) Esotropia (ET)
“crossed inward eyes”

2) Exotropia (XT)
“wandering/drifting outward eye”

89
Q

Vertical strabismus include?

A

1) Left hypertropia (LHT)
Describe the hypertropic eye

2) Right hypotropia

90
Q

Child Strabismus treatment?

A
  • Before the ages of 8 - 10
  • Eye exercises with patch therapy or surgery
  • Patch good eye
91
Q

Adult Strabismus

A
  • Emergency
  • > 50
  • F > M
  • 3rd nerve palsy
  • Giant cell arteritis (temporal arteritis)
92
Q

Adult Strabismus presentation ?

A
  • Limitation of Supraduction
    Infraduction and Adduction

As well as
1) Ptosis and Pupillary dysfunction
&
2) Dilated pupil (10% of pts)

93
Q

Adult Strabismus can be partial or complete ?

A
  • True
94
Q

Complete adult strabismus presents?

A
  • Upper Eye lid down

- Eye down and out

95
Q

Causes of Adult strabismus ?

A
  • Aneurysm MC
  • Microvascular disease
  • Infarct
  • Tumor
  • Inflammation
  • Infection
  • Infiltration
  • Trauma
96
Q

T or F

Adult strabismus - 3rd nerve palsy can be the first sign of expanding or rupturing aneurysm located at junction of posterior communicating artery and internal carotid artery?

A
  • True

- Therefore, emergent consultation and imaging (MRA or CTA) are warranted

97
Q

Giant cell arteritis (temporal arteritis) can be a cause of adult strabismus?

T or F

A
  • True
  • Transient or Constant binocular strabismus
  • Tender temporal artery = Bx
98
Q

Adult Strabismus - Giant cell arteritis (temporal arteritis S&S?

A
  • Emergency
  • Tender temporal artery
  • Malaise
  • Fever
  • Jaw claudication
  • HA
  • Anorexia
  • Wt loss
  • Joint/muscle pain
99
Q

Adult Strabismus - Giant cell arteritis (temporal arteritis work up includes?

A
  • ESR (elevated)
  • CRP (elevated)
  • CBC (thrombocytosis, normaochromic normocytic anemia)

+/- temporal artery biopsy

100
Q

Adult Strabismus - Giant cell arteritis (temporal arteritis treatment includes?

A
  • High dose steroids

- Slow taper x 1-2 years

101
Q

Adult Strabismus Dx includes?

A
  • Abnormal corneal light reflex (Red Reflex) Test

- Cover and uncover test

Clinical Medicine II (9 decks)

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