Opthalmalogy - Burden Flashcards
____ error
- The need for glasses
- Due to the __ or ___ of the entire eye or its parts
•Important parts/measurements:
•___ of the eye
_____ of the cornea
- Density and shape of the ___
- Too big = ____ = ____sighted
- Too small = ____ = ___sighted
- Most children are ___opic
Refractive error
- The need for glasses
- Due to the size or shape of the entire eye or its parts
- Important parts/measurements:
•Length of the eye
•Curve of the cornea
- Density and shape of the lens
- Too big = Myopia = nearsighted
- Too small = Hyperopia = farsighted
- Most children are hyperopic
_____ = curve in 2 directions (like a football)
_____ = usually after age 40, need for reading glasses (due to loss of accommodation)
Astigmatism = curve in 2 directions (like a football)
Presbyopia = usually after age 40, need for reading glasses (due to loss of accommodation)
In____:
•___is not spherical
(i.e. shaped like a football instead of a baseball, curve in 2 directions)
- Light rays do not create a __, ___focus
- Can occur with nearsightedness or farsightedness
Astigmatism
•Cornea is not spherical
(i.e. shaped like a football instead of a baseball, curve in 2 directions)
- Light rays do not create a single, sharp focus
- Can occur with nearsightedness or farsightedness
- Shape of the eye issue, generally not a ____ of the eye issue
- Most children are _____ (have small eyes)
- Everyone develops ____ as a normal part of aging, usually around age ___
- Shape of the eye issue, generally not a health of the eye issue
- Most children are hyperopic (have small eyes)
- Everyone develops presbyopia as a normal part of aging, usually around age 40
Corneal ____ - epithelium
- Scratch of the surface of the eye
- Usually heals without treatment in __ - ___ hours
- Look for associated foreign body
- Corneal abrasion - epithelium
- Scratch of the surface of the eye
- Usually heals without treatment in 24-48 hours
- Look for associated foreign body
- Corneal ulcer – epithelium + ____
- Corneal abrasion plus an underlying suppuration of corneal ___
- Can be infectious or sterile (neurotrophic)
- Corneal ulcer – epithelium + stroma
- Corneal abrasion plus an underlying suppuration of corneal stroma
•Can be infectious or sterile (neurotrophic)
Cateract:
- Clear lens (made of crystalline protein) becomes ____
- This blocks the light from getting to the ___
- Can be___ or___
- Typically, occurs with ___ __
- Single largest line item cost for Medicare
- Treatment = Surgery
- Medications = ___
Cateract:
- Clear lens (made of crystalline protein) becomes cloudy
- This blocks the light from getting to the retina
- Can be congenital or traumatic
- Typically, occurs with NORMAL AGING
- Single largest line item cost for Medicare
- Treatment = Surgery
- Medications = none!!
There are three different types of cateract”
- __ __ has white spokes or vacuoles
(blisters of fluid).
- __ __ cataract is yellowish brown (normal one)
- ___ ___ cateract - look like grains of sugar on the back of the lens. This is associated with __ __ and __ use.
1. Cortical cataract has white spokes or vacuoles
(blisters of fluid).
2. Nuclear sclerotic cataract is yellowish brown.
- Posterior subcapsular cateract - look like grains of sugar on the back of the lens. This is associated with DM and steroid use.
Cateract: When to do surgery:
- Cataract surgery is elective!
- When poor vision is affecting activities of daily living
- Driving (especially glare at night)
- Reading
- Usually if vision is __/___ or worse
Cateract: When to do surgery:
- Cataract surgery is elective!
- When poor vision is affecting activities of daily living
- Driving (especially glare at night)
- Reading
- Usually if vision is 20/50 or worse
__ __ is the part that makes the aqueous fluid (this fluid is in the front of the eye). It is made by the __ __ behind __. It circulate in front of the lens in front of the iris into the anterior chamber and then out the trabelucar meshwork (which is where the fluid leaves the eye) which is where the cornea meets th sclera. So there is this circulation of fluid that must occur for the eye to be healthy.
Ciliary body is the part that makes the aqueous fluid (this fluid is in the front of the eye). It is made by the ciliary body behind iris. It circulate in front of the lens in front of the iris into the anterior chamber and then out the trabelucar meshwork which is where the cornea meets th sclera. So there is this circulation of fluid that must occur for the eye to be healthy.
When we think about glaucoma, we think about three places where it can occur:
- Trabecular meshwork
- Cliary body (makes fluid
- Optic nerve (place that gets damaged if pressure is too high).
Glaucoma:
- Damage to the ___ nerve
- Usually from __ eye pressure
- Usually from insufficient drainage of ___ fluid through the __ ___
- NOT from overproduction of fluid
Can cause ___ because it does damage to the optic nerve that cannot be repaired.
Can cause blindnes
Two types of Glaucoma:
“Open angle”
- Primary Open Angle Glaucoma = POAG
- __ ___ is clogged at microscopic level
“Closed angle”
- ___ is pressed against __, blocking access to __ __
- If acute, sudden spike in ___ pressure
Causing, painful, red eye, nausea and vomiting
•If chronic, pressure ____ builds over time, ___ tolerated by patient
- Damage to the optic nerve
- Usually from high eye pressure
- Usually from insufficient drainage of aqueous fluid through the trabecular meshwork
- NOT from overproduction of fluid
Can cause blindnes
Two types of Glaucoma:
“Open angle”
•Primary Open Angle Glaucoma = POAG
•Trabecular meshwork is clogged at microscopic level
“Closed angle”
- Iris is pressed against cornea, blocking access to trabecular meshwork
- If acute, suddent spike in intraocular pressure
- Painful, red eye
- Nausea and vomiting
- If chronic, pressure slowly builds over time, better tolerated by patient
A patient was sitting in a dark room for hours. They all of a sudden staretd to feel naseous and had a painful red eye. What do they have?
Closed angle glaucoma
While they were sitting in the dark room, their iris was dilated. Because of the dilation, it pushes against the cornea.
Fluid builds up while watching movie, and the pupil wants to constrict after being in bright light but it cant cuz fluid has gotten trapped.
In glaucoma, the optic cup gets ___ while the optic __ gets smaller due to death of __ fibers. This is the end result in open or closed angle glaucoma. Typically patients will lose ___ vision.
In glaucoma, the optic cup gets larger while the optic rim gets smaller due to death of nerve fibers. This is the end result in open or closed angle glaucoma. Typically patients will lose peripheral vision.
Glaucoma Treatment:
- Goal: Lower the __ __
- Medications: eye drops - first line therapy for POAG (open angle glaucoma)
- Surgery:
- In POAG, only do this if medications fail
- In Acute Angle Closure Glaucoma, l___ ___ ___y is a first line treatment
How to treat with meds?
Decrease production of aqueous fluid
use:
•____ agonist (example: ____)
___ ____ blocker (example: ____)
•__ ____ inhibitor
(example: ____)
You can also try to increase outflow of aqueous fluid using:
•Prostaglandin analogue (example: latanoprost - dilates veins)
Side Effects:
Beta blockers (such as timolol)
- Can lower __ __
- Can induce ___ (esp. in asthma or COPD)
Alpha agonists (such as brimonidine)
•Most likely to cause ___ __ ___
Dorzolamide (carbonic anhydrase inhibitor)
•Contain ___
Prostaglandin analogue (such as latanoprost)
•Can cause __ __ (cystoid macular edema)
DO SURGERY ONLY IF MED FAILS
- Increase outflow by creating a guarded ____“___ (punch a hole in the iris)” from the anterior chamber beneath the conjunctiva
- Increase outflow by placing a __ ___ from the anterior chamber to beneath the conjunctiva
- Decrease aqueous production by destroying the __ __
Glaucoma Treatment:
- Goal: Lower the intraocular pressure
- Medications: eye drops - first line therapy for POAG
Surgery
- In POAG, only if medications fail
- In Acute Angle Closure Glaucoma, laser peripheral iridotomy is a first line treatment
Glaucoma Treatment:
- Goal: Lower the intraocular pressure
- Medications: eye drops - first line therapy for POAG (open angle glaucoma)
- Surgery:
- In POAG, only do this if medications fail
- In Acute Angle Closure Glaucoma, laser peripheral iridotomy is a first line treatment
How to treat with meds?
Decrease production of aqueous fluid
use:
- Alpha agonist (example: brimonidine)
- Beta blocker (example: timolol)
- Carbonic anhydrase inhibitor
(example: dorzolamide)
You can also try to increase outflow of aqueous fluid using:
•Prostaglandin analogue (example: latanoprost)
Side Effects:
Beta blockers (such as timolol)
- Can lower heart rate (bradycardia)
- Can induce bronchospasm (don’t give to patients with asthma or COPD)
Alpha agonists (such as brimonidine)
•Most likely to cause allergic (contact) dermatitis
Dorzolamide
•Contain sulfa (some people can be alelrgic to this)
Prostaglandin analogue (such as latanoprost)
•Can cause retinal swelling (cystoid macular edema)
DO SURGERY ONLY IF MED FAILS
- Increase outflow by creating a guarded hole “trabeculectomy (remove part of trabecular meshwork)” from the anterior chamber beneath the conjunctiva
- Increase outflow by placing a tube shunt from the anterior chamber to beneath the conjunctiva
- Decrease aqueous production by destroying the ciliary body
