Ophthalmology Clinical

Question 1

Age related, any time after age 50, usually greater than 70. Presents with decreased central vision. What are the two types?

Answer 1

• Dry macular degeneration (Nutritional recommendations, AREDS supplements; antioxidants, luteine)
• Wet macular degeneration (growth of blood vessels under/in retina, edema and hemorrhage, eventual fibrosis and scarring; anti-vegf drugs and lasers)

Question 2

Increased ocular pressure causes optic nerve loss. What are the two main types?

Answer 2

Glaucoma

• Open angle (trabecular meshwork goes bad)
• Narrow angle (acute/closed angle); medical emergency! Pilocarpine 15 minutes and azetazolamide and then laser iridotomy

*treatment is to lower eye pressure (medical, surgical, laser). Check the cup/disc ratio! Larger cup over time can indicate worsening of glaucoma, asymmetry is common in glaucoma.

Question 3

How does diabetic retinopathy occur?

Answer 3

Increased glucose damages blood vessel walls, causing VEGF to be released. Fluid leaks into retina, causing visual damage.

Question 4

What are the three clinical stages of diabetic retinopathy?

Answer 4

• Nonproliferative diabetic retinopathy (NPDR): blot hemorrhages, cotton wool spots, micro aneurysms, macular edema, hard exudates
• Preproliferative diabetic retinopathy: more significant; intraretinal vascular abnormalities and venous beading
• Proliferative diabetic retinopathy (PDR): neovascular vitreoretinopathy, vitreous hemorrhage

*treat with pan-retinal photocoagulation (laser)

Question 5

How often do diabetics need eye exams?

Answer 5

• Type II at diagnosis and annually thereafter

- Type I annually after 5 yrs of disease duration, more freq if develop retinopathy.

Question 6

Narrowing and sclerosis of arterioles, flame hemorrhages, cotton wool spots, optic nerve edema in severe cases.

Answer 6

Hypertensive retinopathy. Treat by keeping BP down.

Question 7

• Sudden loss of vision in one eye
• Generally lasts only minutes
• Painless
• Embolic material within retinal arteriole (Hollenhorst plaque)

Answer 7

Amaurosis fugax. Usually temporary vascular insufficiency, req cardio workup first and optho eval second.

Question 8

Hallmark is scintillating scotoma

• painless and temporary
• involves both eyes causing temporary hemianopsia
• Lasts 20-30 minutes
• kind of looks like heat waves

Answer 8

Opthalmic migraine: spasm of arteriole in the occipital cortex.

Question 9

• Sudden partial vision loss in one eye
• Painless
• May be progressive, always sustained (does not resolve spontaneously)
• Often accompanied by floaters and photopsias (flashes)
• Higher frequency in myopia
• Usually spontaneous

Answer 9

Retinal detachment. Refer to optho for surgery.

Question 10

• Sudden severe loss of vision in one eye
• Painless
• Vision loss usually perm, may recover if treated rapidly
• Cherry red spot

Answer 10

Retinal arterial occlusion. Can breathe into paper bag to inhale carbon dioxide and dilate vessels.

Question 11

Squashed tomato look

Answer 11

Central retinal vein occlusion