OPthalmology x2 Flashcards
Afferent nerve lesion
shine light in affected eye no pupillary reflex bilaterally
Efferent nerve lesion
shine line in either eye no pupillary constriction on affected side only.
Gluacoma primar component
Intraocular pressure increase - urgent >30mmHG
- optic nerve damge
- visual field loss
Gluacoma Angle Closure
acute rise on IO pressure du to outflow obstuction
Cause: primary (genetic) angle closure or secondary angle closure
Test: penlight test> look for cresent shadow
Angle closure glaucoma Pres
decreased vison halos around lights ciliary flsuh steamy cloudy cornea mid-dialated pupil 4-6mm - so it reacts poorly to light Narrow ant chamber Firm globe N/V severe eye pain
Angle closure glaucoma managment
- refer immediatly Gonioscopy is standard for diagnosis Tx: Beta blocker or Alpha 2 agonist ( ask opthamologist preference) - Mannitol ( osmotic agents) - laser peripheral iridotomy - surgical trabeculectomy NO dialating drops
OPen angle gluacoma
Optic neuropathy and either increase aqueous production or decreased ouflow
OPen angle glaucoma presentation
- increased intraocular pressure often
- increase cup/disc ratio
- may have afferent pupillary defect
- early asymptomatic
- later chronic vision loss - peripheral first
- vision loss cannot be recovered onece it occurs
open angle glauc Tx
OPthamologic referall topical ocular antihypertensive medication - beta blockers abd alpha 2 agonist laser trabeculoplasty surgical trabeculectomy
Cataracts
break down of clumping of eye proteins
risk: >60, poor nutrition, excessive exposure to sun, some medication, smoking, DM, HIV, trauma, congential
Cataracts pres
gradual chronic painess loss of vision
usualy bilateral symptom
usually difficulty with night driving may seem glare
decreased visual acuity
yellowing.opalescent changes of the lense
Cataracts management
Tx: Rx glasses for vision changes
no criteria for surgery> extracapsular cataract extraction and intraocular lens implant
Macular Degeneration cause/ risk
Age related
degen disease of macula
risks: > 50, smoke, heavy alch, diet, FH, Nitroglycerin, Beta blockers
Gen pres: gradual or cutley blurred vision, Metamorphopisa, central scotoma, amser grid distorsion
Dry AMrD
central scotoma, drusen deposits, pigment mottling, geographic atrophy, vison loss is gradual in one or both eyes
Wet ARMD
subretianl neovascular subsequent degeneration-leaky vessels> subretinal fluid or blodd Rapid vision distoreion - metamorphopsia - central scotoma - mor common in one eye
Macular degen Tx
VItamins (antiox/min/zinc/omega 3) stop smoking daily amsler low vision aids stop offending drigs wet: photcoagulation, photodynamic therapy, intravitreal steroid/ monoclonal antibodies
Retinal Detatchment
serparation of the retinal from epithelia and choroid and can cause ischema of the photoreceptors
Risks: history of myopia, comp of cataracts surgery, current us of flouriquinolones, FH
Rhegmatogenous RD
full thickness tear in the retina
- posterior vitreous detachment is most common cause
- with age the VH with shrink and liquifies with age
pulls away from retina resulting in tears
Traumatic RD: unccomon traumatic tear of retina followed by subretinal bleed of vitreous migration
Nonreheg
caused by vitreous traction pulling on the retina and tearing
* associated with diabetes
fibrosis from neovascularization adherent between retina and vitreous
RD presentation
painless and can rapidly progress - floaters/photopsias -loss of vision - progrssion scotoma - curtain like raised whitish retina * often bilateral rate of progression depended on size of retinal break - may have afferent pupillary defect
RD managment
without tx will progress urgent referall laser photcoagulation surgery - scleral buckle -vitrectomy. replace VH with gas o silicone oil
Hypertensive retinopathy presentation
Often asymptomatic but some mild vision changes Copper wiring silver wiring AV nicking cotton woll spots retinal hemorrhages retinal and disn edema Tx: bp contol and laser potocoagulation if retinal hemorrhage
Diabetic retinopathy non-ploiferative
blurred vision retinal hemorrhage retinal and macular edema cottom wool spots venous dialation hard exudates
Diabetic retinopathy proliferattive
neovasularization preretinal and vitreous hemorrhage tractionall retinal detatchment retinal thickening macular edema
Diabetic retinopathy tx
blood sugar control
opthalmology referal
laser phocoagulation
vitrectomy
Central Retinal Artery Occulsion
Embolic
Risks
M>F, carotic arter atherosclerosis, hypertension, smoking, hyperlipidemia, DM
Central Retinal vein Occlusion
Thrombotic older HTN DM Smoking obesity hypercoagulble glaucoma
CRAO presentation
acute total painless loss of vision unilateral no light perception afferent pupillary defect ischemic retinal whitening "cherry red spot"
CRVO pres
presentation acute varialbly painless loss of vision unilateral scotoma w/blurred vision may have visual field loss \+/- afferent pupilary defect "blood and thunder " retinal appearance
CRAO and CRVO Tx
no effective treatment
prevent future strokes
CRVO
- asprin, observation, tx for retinal edema
- evaluate eitology if young
Optic Neuritis
inflamatory demyelantation of optic nerve
age 20-40 women
monocular vision loss over 1-2 wks
- predictive MS
OPtic Neuritis Prese
PAINFUL central scotoma painful worse with EOMS \+/- abnormal vision color or photopsias optic disc edema optic nerve pale and shrunken
optic neuritis managment
MRI brain and orbit with contrast
IV methylprednisione for severe vision loss > 2 white matter lesions on MRI
- more rapid recover but similar visual acuity at year one and may delay onset of MS
No tx: imprvement in 2-3 wks and there may be recurrence
