Opthalmic disorders Flashcards
Retinal detachment
separation of the sensory retina from the pigment epithelium and underlying choroid
What is the result of a retinal detachment
ischemia and rapid progressive photoreceptor degeneration
What is the retina
mutilayer or neurons that line the back of the eye
Risk factors of retinal detachment
MYOPIA PREVIOUS OCULAR SURG -use of fluoroquinolones -trauma to eye -family history -marfan disease
Causes of retinal detachment
- retinal tears or holes
- traction on the retina caused by systemic influence
- tumors
- exudative process
SX of retinal detachment
- 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
Differentials for retinal detachment
- vitreous hemorrhage
- vitreous inflammation
- ocular lymphoma
- intraocular foreign body
What does ophthalmoscopic exam reveal in retinal detachment
retinal hydration lines
“billowing sail”
“rippling on a pond”
Treatment of retinal detachment
CONSULT
- drainage of subretinal fluid
- laser photocoagulation
- cryotherapy to sclera
- pneumoretinopexy
- scleral buckle placement
- vitrectomy surgery
What is photocoagulation
in office procedure that uses small laser to burn the eye and create adhesions for retina to become reattached
What is cryotherapy or cryoretinopexy
in office procedure that freezed through the sclera, choroid and the retina to form adhesions to reattach the retina
What is pneumoretinoplexy
in office procedure for large retinal detachments that uses a gas bubble to push the retinal back into place
What is scleral buckle placement
done in the operating room , suture an explant into the sclera and closing retinal breaks allowing adhesions to form
When is vitrectomy surgery done
if fovea is detached or appears imminently detached
Optic neuritis
common inflammatory disease of the optic nerve
What does the fundus exam initally show with optic neuritis
NOTHING
“the doctor sees nothing and the patient sees nothing”
What is optic neuritis associated with
demyelinating diseases
Causes of optic neuritis
DEMYELINATION
- sarcoidosis
- neuromyelitis optica
- herpes zoster
- systemic lupus erythematosus
Symptoms of optic neuritis
- 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
Differential diagnosis for optic neuritis
- infections involving the optic nerve
- retinal detachment
- giant cell arteritis
Management of optic neuritis
- usual gradual recovery without treatment
- consult neuro
- possible systemic steriods
What do you treat multiple demyelinating plaques with
interferon beta-1a
Papilledema
physical exam finding during fundoscopic exam, loss of definition of the optic disc due to edema of the head of the optic nerve
Causes of papilledema
-increased intracranial pressure transmitted along the optic nerve (only true cause)
Causes of increased intracranial pressure
- intracranial mass lesions
- cerebral edema
- hydrocephalus
- obstructed venous outflow
- idiopathic intracranial hypertension
What are the three stages of papilledema
- early
- fully developed
- chronic
Early papilledema
- loss of spontaneous venous pulsations
- optic cup is retained
Fully developed papilledema
- optic disc elevated
- optic cup is obliterated
- disc margins are obscured
- blood vessels burried
- engorged veins
- flame hemorrhages
- cotton wool spots
Chronic papilledema
- cup remains obliterated
- hemorrhagic and exudative components resolve
- nerve appears flat with irregular margins
- disc pallor
Diagnostic testing with papilledema
- MRI or CT
- lumbar puncture to check opening pressure
- visual field testing
What is normal opening pressure for an LP
70-180
Management of papilledema
- specific to underlying etiology
- reduce intracranial pressure
Ways to decrease intracranial pressure
- osmotic therapy and diuresis
- hypertonic saline
- glucocorticoids
- hyperventilation
- barbiturates
- shunt to remove CSF
- decompressive craniectomy
Clinical features of idiopathic intracranial hypertension
- nausea, vomiting, headaches, blurred vision
- cranial nerve VI paresis/horizontal diplopia
- bilateral papilledema
- spontaneous venous pulsations are absent
- visual field defects
Medication for treatment of idiopathic intracranial hypertension
acetazolamide
Differential diagnosis for papilledema
- hypertensive retinopathy
- pseudopapilledema
- diabetic papillopathy
What causes retinal artery occlusions
embolism or thrombus
What causes retinal vein occlusion
- HTN
- diabetes
- sickle cell anemia
- conditions that slow venous blood flow
Retinal artery occlusion
acute, painless loss of monocular vision
Two types of retinal artery occlusion
- central retinal artery occlusion
- branch retinal artery occlusion
Most common etiology of retinal artery occlusion
carotid artery atherosclerosis
Symptoms of central retinal artery occlusion
- sudden profound vision loss in one eye
- typically painless
- occasionaly preceeded by transient monocular blindness
Symptoms of branch retinal artery occlusion
monocular vision loss which may be restricted to just part of the visual field
What do you find on funduscopic exam with retinal artery occlusion
- ischemic retinal whitening
- cherry red spot in the macula
Pupillary defect in retinal artery occlusion
marcus gunn pupil
Management of acute retinal artery occlusion
- check sed rate and C reactive protein to r/o giant cell arteritis
- consult ophthalmology
Classifications of retinal vein occlusion
- branch retinal vein occlusion (small area)
- central retinal vein occlusion (entire retina)
- hemiretinal vein occlusion(superior or inferior portion)
Associated conditions of retinal vein occlusion
- DM
- HTN
- leukemia
- sickle cell disease
- multiple myeloma
Clinical presentation of retinal vein occlusion
-sudden painless loss of vision
What does fundoscopic exam show with retinal vein occlusion
varies from a few scattered retinal hemorrhages and cotton wool spots to a marked hemorrhagic appearance
Management of acute retinal vein occlusion
CONSULT
- intravitreal injections of VEGF inhibitor or triamcinolone
- retinal laser photocoagulation
- surgical techinques
- vitrectomy w/ direct injection of tPA
