Ophthalmology Key Points Flashcards
What are cataracts?
Opacity of the normally clear lens caused by age, metabolic disorder, trauma, or heredity
What are the indications for cataract surgery?
- severity of vision loss
- functional needs of patient
- need to improve view of posterior segment of the eye to care for ocular pathology
When does macular degeneration usually occur?
Anytime after age 50, usually >70 years old
What type of vision loss is present first in macular degeneration?
Central vision
What does eye exam show in minor Dry Macular Degeneration?
- drusen
- pigmentary changes
- vision probably fine
What does eye exam show in more significant Dry Macular Degeneration?
- drusen
- pigmentary retinopathy
- atrophy of the retina
- vision probably diminished
What is the treatment for Dry Macular Degeneration?
- Quit smoking
- nutritional changes (dark, green vegetables)
- manage systemic diseases (DM, HTN)
- AREDS supplements - antioxidant vitamins (beta carotene, vitC, vitE), minerals (zinc, copper)
What does eye exam show in Wet Macular Degeneration?
- Defects develop in deep retinal layers
- Growth of blood vessels under/in retina
- Edema
- Hemorrhage
- Eventual fibrosis/scarring
- Serious loss of vision
What are the treatment options for Wet Macular Degeneration?
- Dry recommendations
- Conventional laser
- Photodynamic therapy
- Anti-VEGF drugs (Avastin, Eyelea, Lucentis, Macugen) injected intravitreally can dry up exudative changes
What is Glaucoma?
Increased ocular pressure causing optic nerve loss.
What causes blockage in Open Angle Glaucoma?
- The trabecular meshwork is normally the main blockage
- Aqueous humor cannot drain out as well
What are the symptoms of Narrow (Acute/Closed) Angle Glaucoma?
- Acute onset
- Severe pain with loss of vision
- +/- nausea
- red eye
- cloudy cornea
- photophobia
- halo around lights
- fixed/mid dilated pupil
- extremely high IOP >40 mmHg
How do glaucoma medications decrease intraocular pressure?
- Decreasing aqueous production
- Increasing outflow
What three medications are suggested in the treatment of Acute Glaucoma?
- Pilocarpine (Q15min)
- Acetazolamid (Diamox IV/PO)
- Glycerine OR Isosorbide (PO)
What procedure do ophthalmologists perform to treat Acute Glaucoma?
Surgical or Lasor Peripheral Iridotomy
What are key eye exam findings in Nonproliferative Diabetic Retinopathy?
- Blot Hemorrhages
- Cotton Wool Spots
- Microaneurysms
- Macular Edema
- Hard Exudates
What is the treatment for Diabetic Retinopathy?
Panretinal Photocoagulaton (PRP)
- ablate supporting retina
- stops release of VEGF
What are the 7 things that should be on your differential diagnosis for a patient with sudden visual loss?
- Amaurosis Fugax
- Migraine Scotoma
- Retinal Detachment
- Retinal Artery Occlusion
- Retinal Vein Occlusion
- Temporal Arteritis (Giant Cell Arteritis)
- Stroke
What is the hallmark of Amaurosis Fugax?
Quick loss of vision in one eye
(lasts minutes)
Who do you refer a patient with Amaurosis Fugax to?
Cardiology!
(Impending stroke until proven otherwise!)
What is a Retinal Cholesterol Emboli a warning sign of?
Future disaster in vascular system.
(need Carotid US & Echocardiogram)
What causes an Ophthalmic Migraine (aura w/ or w/o headache)?
Spasm of arteriole in occitpital cortex
What are the clinical hallmarks of Retinal Detachment?
- Sudden partial vision loss in one eye
- Painless
- Sustained, may be progressive
What is the clinical hallmark on eye exam for Retinal Arterial Occlusion?
Cherry Red Spot
(indicates acute central retinal artery occlusion)
What is the treatment for Acute Arterial Occlusion?
- Rebreathing CO2
- Timolol
- Acetazolamide
What is the clinical hallmark on exam for Central Retinal Vein Occlusion?
Squashed Tomato
What are the clinical hallmarks for Temporal Arteritis (Giant Cell Arteritis)?
- Headache (actually scalp tenderness)
- Fever
- Weightloss
- Jaw claudication (spasm/cramp)
- Vision loss
What can Temporal Arteritis also present as?
Central Retinal Artery Occlusion
(cherry red spot)
What do you do immediately after you suspect Temporal Arteritis?
- Order STAT Sed rate and CRP
- Start high dose systemic steroids immediately
What should you not give when treating corneal abrasions? Why?
Topical anesthetics –> slows healing
