OPTH Lec02 Flashcards
When assessing for history, what are things you should focus on?
Is the visual loss transient or persistent? Monocular or binocular? Did the visual loss occur abruptly, or over hours, days, or weeks? Age, race and any medical conditions? Was there pain associated with the loss?
When performing an examination, what things do you look at?
1) Visual acuity 2) Confrontational visual fields (because homonymous hemianopia can still have normal VA) 3) Pupils - Marcus Gunn pupil (positive for APD) 4) Corneal assessment 5) Ophthalmoscopy (look for media opacities and fundus)
What are media opacities?
Irregularities of the clear, refractive media. Look at the cornea, anterior chamber, lens and vitreous. These do not cause afferent pupillary (sensory) defects but may physically alter the pupil
What is this?
Iris Synechia - when the iris adheres to the cornea and mis-shapes the pupil
What is corneal edema?
Dulling of the reflection of incident light off the cornea. Ground glass appearance.
What causes corneal edema?
increased IOP, acute infections, corneal inflammation, damage to the corneal tissue by dystrophies, trauma or surgery. Can also be due to glaucoma *acute angle closure).
How will a patient with acute angle glaucoma present?
With INTENSE PAIN, fixed pupil, very very red eye, corneal damage, high IOP
How do you treat a patient with acute angle glaucoma?
laser iridotomy
What is this?
Corneal edema - ground glass appearance
What is this?
Acute angle closure
What is hyphema?
Blood in the anterior chamber due to trauma. This can be spontaneous in rubeosis (neovascularization of the iris caused by diabetes, tumors, surgery or chronic inflammation)
What is this?
hypema
What is hypopion?
WBCs forming pus in the anterior chamber usually because of an infection
What is this?
hypopion
What are lenticular changes?
Changes in lens edema, or shift in refractive error.
What can cause lenticular changes?
1) Cataracts usually develop slowly and everyone will eventually get cataracts. Patient may say that they have sudden vision loss if they never close one of their eyes. If cataracts is advanced it may cause inflammation or glaucoma. 2) Sudden changes in blood sugar or electrolytes
What is a vitreous hemorrhage? How can you diagnosis? What causes it?
Reduction in visions from opaque blood blocking the light. Will have poor red reflex. Caused by: trauma or conditions causing neovascularization. Associated with subarachnoid hemorrhage.
What is this?
Vitreous hemorrhage - fuzzy image because looking through RBS suspended in vitreous
What is this?
Image of lenticular changes
What are the different kinds of retinal diseases?
1) Retinal detachment 2) Macular disease 3) Retinal vascular occlusions 4) Inflammatory processes such as: infections chorioretinitis, vasculitides, idiopathic inflammation
How will a patient present with a retinal detachment?
Complaints of flashing lights, followed by a shower of floaters and than a curtain or cloud in their vision. This will be PAINLESS! Can cause APD, May see elevated retina with folds. Choroidal background is indistinct. Early treatment = better prognosis
What is this?
Retina is ballooned forward and there is fluid causing elevation = retinal detachment