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Foundations II (Jess) > Ophtho 4 > Flashcards

Ophtho 4 Flashcards

1
Q

What is optic neuritis?

A

an inflammatory demyelinating condition that results in acute vision loss in one eye

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2
Q

What disease is optic neuritis strongly a/w? Occurs most commonly in?

A

MS
-may also occur w/ viral infections (measles, mumps, influenza)

Women ages 20-40

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3
Q

You are concerned your patient has optic neuritis based on their story. What are some of their presenting complaints?

A
  • acute onset (hrs to days)
  • monocular vision loss
  • eye pain, worse with EOM’s
  • visual field defect, usually central scotoma
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4
Q

In optic neuritis, what is the same of the most common visual field defect?

A

Central scotoma

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5
Q

What would you see on PE of a pt with optic neuritis?

A
  • loss of color vision
  • visual acuity decreased (variable)
  • relative afferent pupillary defect (APD)
  • optic nerve changes may be seen
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6
Q

2/3 of optic neuritis are ____, showing ______ in the fundus.

In 1/3, the optic nerve is ____ w/ ______ and occasionally has ____.

A

retro-bulbar
no changes

swollen w/ pallor
flame-shaped peri-papillary hemorrhages

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7
Q

How do you confirm diagnosis of optic neuritis?

A

MRI of brain and orbits

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8
Q

Tx of optic neuritis?

A

refer urgently to optho/neuro

IV methylprednisolone for 3 days, then oral taper to accelerate vision recovery

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9
Q

Visual acuity usually returns after tx of optic neuritis, how long?
If it doesn’t return, what do you need to rule-out?

A

2-3 weeks

compressive lesion or tumor

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10
Q

What is papilledema? Usually a/w what?

A

swelling of the optic nerve head

usually a/w elevated intracranial pressure

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11
Q

What would you see on PE of a pt with papilledema?

optic disc, margins, cup, venules

A
  • optic disk is swollen, w/ blurred margins, cup may be obscured due to swelling
  • venules are dilated and tortuous
  • there may be flame hemorrhages and infarctions (white, indistinct “cotton wool spots) in the nerve finger layer, and edema in the surrounding retina
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12
Q

Pt’s with papilledema often 1st complain of other signs/symptoms of ______ before papilledema.

Like what?

A

increased intracranial pressure

HA
Transient vision changes

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13
Q

Ddx for papilledema

A
  • intracranial mass/lesion (tumor)
  • cerebral edema (encephalopathy, TBI)
  • disorders of the CSF
  • obstructive hydrocephalus
  • idiopathic intracranial hypertension (aka pseudotumor cerebri)
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14
Q

What do you do if papilledema is found?

A

Urgent ophthalmology referral and complete workup

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15
Q

What is the leading cause of adult blindness in industrialized countries?

A

Age-related macular degeneration

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16
Q

What is age-related macular degeneration?

A

a degenerative dz of the macula (central retina) that results primarily in loss of central vision

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17
Q

What are risk factors for age-related macular degeneration?

A
  • Age (over 50 increased incidence)
  • female
  • smoking hx
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18
Q

Symptoms of a pt with age-related macular degeneration?

What would you see on PE?

A
  • gradual or acute painless vision loss
  • metamorphopsia (wavy/distorted vision)
  • central scotoma

PE:
+/- decreased vision
Amsler grid distortion

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19
Q

Characteristics of dry AMD

A
  • retinal drusen (lipids) appear as discrete yellow deposits
  • retinal pigment epithelium atrophies decreasing central vision
  • Dry AMD has better prognosis than wet
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20
Q

Characteristics of wet AMD

A
  • growth of abnormal vessel into the sub retinal space

- new vessels leak

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21
Q

Is wet or dry AMD more likely to cause blindness?

A

Wet AMD accounts for 80-90% of causes of blindness due to AMD

22
Q

Tx of AMD

A
  • ophthalmology referral
  • vitamins (antioxidants/zinc)
  • smoking cessation
  • daily Amsler grid
  • photocoagulation, photodynamic therapy, intravitreal steroid/anti-angigenic injections
  • low vision aids
23
Q

Most common cause of retinal detachment?

A

a tear in the retina- vitreous fluid can then work its way under the retina, causing detachment

24
Q

Most common site of retinal detachment?

A

superior temporal retinal area

25
Q

Risk factors of retinal detachment

A
  • age > 50 yo
  • extreme myopia
  • previous ocular surgery
  • fam hx
  • diabetes
26
Q

What might a pt with retinal detachment complain of?

A
  • acute onset of monocular, decrease vision and may describe a “curtain coming down” over their eye
  • cloudy or smoky vision, “floaters”, “flashes of light”
  • no pain or redness
27
Q

What would you expect to see on PE of a pt with a retinal detachment?

A
  • afferent pupillary defect
  • fundoscopic exam may reveal a billowing or tent-like elevation of the rugose retina
  • the elevated retinal often appears out-of-focus and gray
  • may also notice virtuous hemorrhage
28
Q

Tx of retinal detachment

A
  • immediate referral to ophthalmology
  • during transport pt should remain supine and with head turned to ipsilateral side to help the retina fall back into place w/ the aid of gravity
  • closing tears using cryosurgery or laser surgery
29
Q

Meaning of Amaurosis Fugax? What is it usually caused by?

A

fleeting blindness

caused by retinal emboli from ipsilateral carotid disease

30
Q

how is the visual loss in Amaurosis Fugax usually described?

A

a curtain passing vertically across the visual field with complete monocular visual loss lasting a few minutes, and a similar curtain effect as the episode passes

31
Q

What diagnostic testing can you do in a pt with Amaurosis Fugax?

A

noninvasive evaluation of the carotids can be done using ultrasound and MRA

emboli fro cardiac sources may also be responsible, so EKG and echo may be indicated

32
Q

Describe what happen in central retinal artery occlusion

A

occlusion of retinal arteries by emboli results in decrease blood flow and hypoxia to retina

33
Q

Pt symptoms central retinal artery occlusion

A

sudden painless, total monocular vision loss

no pain or redness

34
Q

PE findings in central retinal artery occlusion

including 1 very important one

A

Pale retina w/ “cherry red spot”!

often no light perception
afferent pupillary defect

35
Q

Treatment and preventing further emboli in central retinal artery occlusion

A

emergent referral to ophthalmology
tx not effective unless started within a few hrs of onset

prevention= evaluate:

  • carotid plaques
  • cardiac emboli
  • r/o temoral arteritis is pt > 55
36
Q

Symptoms of central retinal VEIN occlusion

A

often noticed 1st thing upon waking

  • acute painless unilateral vision loss
  • no pain or redness
37
Q

Sings of central retinal VEIN occlusion

including 1 distinct one!

A

“Blood and Thunder” fundus!

variable vision
+/- APD
multiple hemorrhages
venous dilation and tortuosity

38
Q

Tx of central retinal VEIN occlusion

A

Urgent referral to ophthalmology
aspirin
obs

39
Q

Which has a worse prognosis, central retinal vein occlusion or central retinal artery occlusion?

A

Artery!

40
Q

1 cause of blindness in the Western world in pts < 50 yo

A

Diabetic retinopathy

41
Q

How common is retinopathy in diabetic pts?

A

present in about 40%

42
Q

Acute increases in serum glucose can cause what?

A

blurred vision due to acute increases in serum glucose, causing lens swelling and a refractive shift

43
Q

Characteristics of non-proliferative diabetic retinopathy

A

microaneurysms (earliest sign)
dot-blot hemorrhages
cotton-wool spots

44
Q

Characteristics of proliferative diabetic retinopathy

A

All features of non-proliferative diabetic retinopathy +:
neovascularization
vitreous hemorrhage
traction RD

45
Q

Diabetic retinopathy: macular edema

when can it occur? Fundoscopic findings?

A

can occur at any stage

retinal thickening
microaneurysms
hard exudates

46
Q

What is the earliest sign of non-proliferative diabetic retinopathy?

A

microaneurysms

47
Q

Tx of diabetic retinopathy

A

blood sugar control
-glucose < 120
HbA1C < 7

reduce comorbidity
Ophthalmology referral

48
Q

What is hypertensive retinopathy? Sx?

A

retinal vascular changes due to systemic HTN

Asymptomatic!

49
Q

Explain the Keith-Wegener-Baker Classification

A

Group 1:

  • Arteriolar narrowing (copper wiring)
  • arteriolar sclerosis (silver wiring)

Group 2: (group 1, plus)
-A:V crossing changes (A:V nicking)

Group 3: (group 2, plus)

  • cotton-wool spots
  • retinal hemorrhages
  • retinal edema/exudates (macular star)

Group 4: (group 3, plus)
-disk edema (papilledema)

50
Q

Tx of hypertensive retinopathy

A 
Systemic BP control
Ophthalmology referral (if severe HTN, associated vision loss)

Foundations II (Jess) (8 decks)

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