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Clin Med Exam II > Opthalmic disorders > Flashcards

Opthalmic disorders Flashcards

1
Q

Retinal detachment

A

separation of the sensory retina from the pigment epithelium and underlying choroid

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2
Q

What is the result of a retinal detachment

A

ischemia and rapid progressive photoreceptor degeneration

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3
Q

What is the retina

A

mutilayer or neurons that line the back of the eye

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4
Q

Risk factors of retinal detachment

A 
MYOPIA
PREVIOUS OCULAR SURG
-use of fluoroquinolones
-trauma to eye
-family history
-marfan disease
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5
Q

Causes of retinal detachment

A
  • retinal tears or holes
  • traction on the retina caused by systemic influence
  • tumors
  • exudative process
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6
Q

SX of retinal detachment

A
  • increasing number of floaters
  • flashes of light in visual field
  • shower of black spots in visual field
  • curtain spreading over visual field
  • cloudy or smoky vision
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7
Q

Differentials for retinal detachment

A
  • vitreous hemorrhage
  • vitreous inflammation
  • ocular lymphoma
  • intraocular foreign body
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8
Q

What does ophthalmoscopic exam reveal in retinal detachment

A

retinal hydration lines
“billowing sail”
“rippling on a pond”

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9
Q

Treatment of retinal detachment

A

CONSULT

  • drainage of subretinal fluid
  • laser photocoagulation
  • cryotherapy to sclera
  • pneumoretinopexy
  • scleral buckle placement
  • vitrectomy surgery
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10
Q

What is photocoagulation

A

in office procedure that uses small laser to burn the eye and create adhesions for retina to become reattached

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11
Q

What is cryotherapy or cryoretinopexy

A

in office procedure that freezed through the sclera, choroid and the retina to form adhesions to reattach the retina

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12
Q

What is pneumoretinoplexy

A

in office procedure for large retinal detachments that uses a gas bubble to push the retinal back into place

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13
Q

What is scleral buckle placement

A

done in the operating room , suture an explant into the sclera and closing retinal breaks allowing adhesions to form

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14
Q

When is vitrectomy surgery done

A

if fovea is detached or appears imminently detached

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15
Q

Optic neuritis

A

common inflammatory disease of the optic nerve

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16
Q

What does the fundus exam initally show with optic neuritis

A

NOTHING

“the doctor sees nothing and the patient sees nothing”

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17
Q

What is optic neuritis associated with

A

demyelinating diseases

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18
Q

Causes of optic neuritis

A

DEMYELINATION

  • sarcoidosis
  • neuromyelitis optica
  • herpes zoster
  • systemic lupus erythematosus
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19
Q

Symptoms of optic neuritis

A
  • unilateral vision loss that develops over a few days
  • field loss usually centrally
  • loss of color vision
  • pain behind the eyes that is exacerbated by movement
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20
Q

Differential diagnosis for optic neuritis

A
  • infections involving the optic nerve
  • retinal detachment
  • giant cell arteritis
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21
Q

Management of optic neuritis

A
  • usual gradual recovery without treatment
  • consult neuro
  • possible systemic steriods
22
Q

What do you treat multiple demyelinating plaques with

A

interferon beta-1a

23
Q

Papilledema

A

physical exam finding during fundoscopic exam, loss of definition of the optic disc due to edema of the head of the optic nerve

24
Q

Causes of papilledema

A

-increased intracranial pressure transmitted along the optic nerve (only true cause)

25
Q

Causes of increased intracranial pressure

A
  • intracranial mass lesions
  • cerebral edema
  • hydrocephalus
  • obstructed venous outflow
  • idiopathic intracranial hypertension
26
Q

What are the three stages of papilledema

A
  • early
  • fully developed
  • chronic
27
Q

Early papilledema

A
  • loss of spontaneous venous pulsations

- optic cup is retained

28
Q

Fully developed papilledema

A
  • optic disc elevated
  • optic cup is obliterated
  • disc margins are obscured
  • blood vessels burried
  • engorged veins
  • flame hemorrhages
  • cotton wool spots
29
Q

Chronic papilledema

A
  • cup remains obliterated
  • hemorrhagic and exudative components resolve
  • nerve appears flat with irregular margins
  • disc pallor
30
Q

Diagnostic testing with papilledema

A
  • MRI or CT
  • lumbar puncture to check opening pressure
  • visual field testing
31
Q

What is normal opening pressure for an LP

A

70-180

32
Q

Management of papilledema

A
  • specific to underlying etiology

- reduce intracranial pressure

33
Q

Ways to decrease intracranial pressure

A
  • osmotic therapy and diuresis
  • hypertonic saline
  • glucocorticoids
  • hyperventilation
  • barbiturates
  • shunt to remove CSF
  • decompressive craniectomy
34
Q

Clinical features of idiopathic intracranial hypertension

A
  • nausea, vomiting, headaches, blurred vision
  • cranial nerve VI paresis/horizontal diplopia
  • bilateral papilledema
  • spontaneous venous pulsations are absent
  • visual field defects
35
Q

Medication for treatment of idiopathic intracranial hypertension

A

acetazolamide

36
Q

Differential diagnosis for papilledema

A
  • hypertensive retinopathy
  • pseudopapilledema
  • diabetic papillopathy
37
Q

What causes retinal artery occlusions

A

embolism or thrombus

38
Q

What causes retinal vein occlusion

A
  • HTN
  • diabetes
  • sickle cell anemia
  • conditions that slow venous blood flow
39
Q

Retinal artery occlusion

A

acute, painless loss of monocular vision

40
Q

Two types of retinal artery occlusion

A
  • central retinal artery occlusion

- branch retinal artery occlusion

41
Q

Most common etiology of retinal artery occlusion

A

carotid artery atherosclerosis

42
Q

Symptoms of central retinal artery occlusion

A
  • sudden profound vision loss in one eye
  • typically painless
  • occasionaly preceeded by transient monocular blindness
43
Q

Symptoms of branch retinal artery occlusion

A

monocular vision loss which may be restricted to just part of the visual field

44
Q

What do you find on funduscopic exam with retinal artery occlusion

A
  • ischemic retinal whitening

- cherry red spot in the macula

45
Q

Pupillary defect in retinal artery occlusion

A

marcus gunn pupil

46
Q

Management of acute retinal artery occlusion

A
  • check sed rate and C reactive protein to r/o giant cell arteritis
  • consult ophthalmology
47
Q

Classifications of retinal vein occlusion

A
  • branch retinal vein occlusion (small area)
  • central retinal vein occlusion (entire retina)
  • hemiretinal vein occlusion(superior or inferior portion)
48
Q

Associated conditions of retinal vein occlusion

A
  • DM
  • HTN
  • leukemia
  • sickle cell disease
  • multiple myeloma
49
Q

Clinical presentation of retinal vein occlusion

A

-sudden painless loss of vision

50
Q

What does fundoscopic exam show with retinal vein occlusion

A

varies from a few scattered retinal hemorrhages and cotton wool spots to a marked hemorrhagic appearance

51
Q

Management of acute retinal vein occlusion

A

CONSULT

  • intravitreal injections of VEGF inhibitor or triamcinolone
  • retinal laser photocoagulation
  • surgical techinques
  • vitrectomy w/ direct injection of tPA

Clin Med Exam II (11 decks)

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