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Neuro Block 3 > Opthamology Clinical Correlates > Flashcards

Opthamology Clinical Correlates Flashcards

1
Q

What are the 8 components of a complete eye exam?

A
  1. vision
  2. external anatomy
  3. pupils
  4. ocular motility
  5. anterior segment
  6. ophthalmoscopy (dilated)
  7. IOP
  8. visual fields
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2
Q

What are the 3 most common eye issues?

A

cataracts

macular degeneration

glaucoma

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3
Q

What is a cataract?

A

an opacity of the normally clear lens, caused by age, metabolic disorder, trauma or heredity

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4
Q

Surgery for cataracts isn’t done immediately. What are the 3 indications that surgery is necessary?

A

the severity of visual loss is great

functional needs of the patient

need to improve view of the posterior segment of the eye to care for other ocular pathology

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5
Q

After what age does macular degernation start becoming very common>

A

after age 50, but over 70 in particular

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6
Q

What segment of vision is lost in macular degeneration?

A

central vision

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7
Q

What are the two types of macular degeneration?

A

dry and wet

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8
Q

What are the signs of dry macular degeneration?

A

drusen, pigmentation changes, retina atrophy

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9
Q

WHat happens in wet macular degeneration

A

the defect develps in the deep retinal layers

growth o f blood vessens under the retina - they’re are new and leaky vessels that lead to edema and hemorrhage

the hemorrhage eventually turns fibrotic as it heals, leading to scarring and serious loss of vision

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10
Q

WHat are the treatment options for dry macular degeneration?

A
  1. quite smoking
  2. take AREDs nutritional supplements
  3. manage systemic diseases like HTN
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11
Q

What are the treatments for wet macular degeneration?

A

anti-vegf drugs like avastin to disrupt formation of new blooc vessels

conventional laser treatments if those don’t work

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12
Q

What vitamins are helpful in macular degeneration?

A

antioxidant vitamins - beta carotene, vitamin C and vitamin E

minerals zinc and copper

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13
Q

Why do newer vitamin formulas omit the beta carotene?

A

in smokers, beta carotene increases risk of lung CA

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14
Q

In general, what happens in glaucoma?

A

increased ocular pressure causes optic nerve loss

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15
Q

What are the two main types of glaucoma?

A

open angle and narrow angle (acute)

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16
Q

In general, what is the treatment for glaucoma?

A

lower the eye pressure via medical or surgical (laser) means

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17
Q

Describe normal aqueous flow.

A

the aqueous humor is formed near the ciliary body and then flows through the pupil over the iris down to the trabecular meshwork where it’s absorbed thorugh schlemm’s canal into the aqueous vein

then it drains into the episcleral vein in the conjunctiva

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18
Q

WHat happens in open angle glaucoma?

A

the trabecular meshwork degrades such that the aqueous humor doesn’t drain appropriately and pressure builds up

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19
Q

How will the appearance of the optic disc look different on exam in glaucoma?

A

you’ll get optic nerve cupping = enlarged cup due to loss of rim tissue

this indicates loss of optic nerve fibers

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20
Q

What are the signs of glaucoma?

A

pressure over 30 mmHg

optic nerve cupping = optic nerve tissue loss

shrinking of visual fields/progressive blind spots

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21
Q

What technique can be used to quantify loss of optic nerve tissue?

A

optical coherence tomography (OCT)

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22
Q

What are the two basic strategies of glaucoma medications?

A

decrease IOP by decreasing aqueous production or increases outflow

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23
Q

Which form of glaucoma is an eye emergency?

A

narrow angle = acute glaucoma

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24
Q

WHat are the symptoms of acute glaucoma?

A

acute onset

severe pain with loss of vision

maybe nausea, vomiting

red eye

cloudy cornea

extremely high ocular pressure, over 40 mmHg

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25
Q

What is the cause of narrow angle glaucoma?

A

closure of the angle between the iris and the cornea

these people just have a narrower angle and if the pupil dilates too far, it will push the irish right up against the trabecular meshwork such that fluid won’t be able to leave the eye at all

this builds up pressure in the eye, which pushes the iris even further into the meshwork, making it worse

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26
Q

What is the treatment for acute glaucoma?

A
  1. pilocarpine to constrict the pupil and pull the iris away from the angle
  2. acetzolamide (diamox) - a diuretic to pull fluid off to lower pressure
  3. Immediately refer to ophthamology for peripheral iridotomy
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27
Q

What happens in diabetic retinopathy pathogenesis?

A

increase glucose chronically

damages blood vessel walls

VEGF is release in response

this causes abnormal vasoproliferation

new vessels are leaky, so fluid leaks into the retina, fibrosis occurs, causing damage and potentially complete loss of vision

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28
Q

What are the clinical stages of diabetic reitnopathy?

A

nonproliferative diabetic retinopathy

preproliferative diabetic retinopathy

proliferative diabetic retinopathy

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29
Q

What are some of the signs you’d see in nonproliferative diabetic retinopathy?

A

blot hemorrhages and microaneurysms

cotton wool spots (small infarcts)

macular edema

hard exudates (lipids that leak out with fluid and are left there when fluid is resorbed)

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30
Q

What’s the gold standard for diagnosing diabetic retinopathy?

A

fluorescein angiography

you inject a dye and then take a picture as the die is in the eye

this allows you to see areas of fluid leakage form the vessels

can also use OCT

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31
Q

How can you treat the macular edema that comes with diabetic retinopathy?

A

intravitreal injections of steroid triamcinolone

32
Q

What additional symptoms would you see in preproliferative diabetic retinopathy that aren’t present in non-proliferative?

A

intrareitnal vascular abnormalities and venous bleeding

33
Q

What symptoms will you ultimatley see in proliferative diabetic retinopathy

A

neovascular vitreoretinopathy

vitreous hemorrhage = boat hemorrhage

fibrosis

retinal traction and puckering

34
Q

What is the treatment for diabetic retinopathy?

A

panretinal photocoagulation

it’s basically laser treatments along the edges of the retina where it’s ischemic - hopes to stop the neovascularization

35
Q

How often should diabetics have dilated eye exams?

A

yearly!!

refer upon diagnosis in type 2 and within 5 years of diagnosis of type 1

36
Q

What happens in hypertensive retinopathy?

A

after continuous high arterial pressure, the arterioles will narrow and undergo sclerosis

37
Q

What are the signs of hypertensive retinopathy?

A

flame hemorrhages

cotton wool spots

optic nerve edema in severe cases

arteriovenous nicking

“silver wire arteries”

38
Q

What is the treatment for hypertensive retinopathy?

A

lower the blood pressure!

39
Q

What are the 7 potential causes of sudden visual loss?

A

amaurosis fugax

migraine scotoma

retinal detachment

retinal artery occlusion

retinal vein occlusion

temporal arteritis

stroke

40
Q

Describe amaurosis fugas

A

it’s a sudden loss of vision in ONE eye

lasts only minutes

painless

it’s usually temporary vascular insufficiency (TIA in the eye)

41
Q

What workup should be done first in amaurosis fugax? What was the cause until proven otherwise?

A

cardiovascular workup first

CAD until proven otherwise

42
Q

What would you see in the eye with amaurosis fugax>

A

embolic material within a retinal arteriole = hollenhortst plaque

43
Q

Why is a retinal cholesterol emboli (amaurosis fugax) worrisome if it’s non-occlusive?

A

It’s a warning sign of future disaster in the vascular system

they’ll need a full carido workup including carotid US and echocardiogram

44
Q

What are the characteristics of an ophthalmic migrainte?

A

often acephalgic

SCINTILLATING SCOTOMA is the hallmark

painless and temporary!

involves both eyes, causing hemianopsia

usually lasts 20-30 minutes

cause: spasm of arteriole in occipital cortex

45
Q

What happens in retinal detachment?

A

sudden painless loss of partial vision in one eye

may be progressive but ALWAYS SUSTAINED - will NOT response spontaneously like an ophthalmic migraine will

often accompanied by floaters and photopsias

often spontaneous, but can be associated with trauma

46
Q

Is retinal detachment for common in myopia or hyperopia?

A

myopia

47
Q

What is the treatment for retinal detachment?

A

surgery

they can try to use laster demarcation of the retinal tear, but if that doesn’t work they’ll do a scleral buckling procedure

this involves pushing the eye wall against the retina, thus sealing the tear

48
Q

What happens in retinal arterial occlusion?

A

sudden severe loss of vision in one eye

painless

vision loss is usually permanent, but may recover if treated rapidly

the cherry red spot indicates acute central retinal artery occlusion

49
Q

What is the goal to treat an arterial occlusion acutely?

A

you want to push the block to the periphery where the damage will be less

rebreathe CO2 (dilate vessels)

timolol to lower ocular pressure

IV acetazolamide to lower IOP

massaging the globe with lids closed

50
Q

Retinal vein occlusion can also occur. It this more serious or less serious than arterial occlusion? With what chronic conditions is it more common?

A

it’s less serious

more common with HTN and DM

51
Q

What is the risk for sequellae with retinal vein oclusion

A

neovascular glaucoma - so refer to ophthamology, but not as urgently as you would with an arterial occlusion

52
Q

What will the eye look like on examination with a central retinal vein occlusion?

A

a squashed tomato

53
Q

Why is a branched retinal vein occlusion even less serious than a central retinal vein occlusion?

A

there is less damage to the retina, so there is less risk of serious vision loss

54
Q

What is temporal arteritis?

A

it’s giant cell arteritis

an inflammatory conditions that causes HA, scalp tenderness, fever, weight loss, jaw claudicaiton, polymyalgia rheumatica, vision loss - maybe total blindness

55
Q

What are the two ways temporal arterities can affect the eye?

A

vision loss from:

  1. retinal arteriolar occlusion
  2. optic nerve infarction
56
Q

What are the potential deadly sequelae of temprla arteritis?

A

aortic aneurysms or stroke

57
Q

WHat diagnostic tests are run in a temporal arteritis workup?

A

ESR and CRP will be positive

temporal artery biopsy to look for PMNs in the arterial walls

58
Q

What is the treatment for temporal arteritis?

A

high dose systemic steroids immediately

59
Q

In a visual CVA, visual field loss occurs bilaterally on the ____ side of the cortical lesion.

A

contralateral

60
Q

What symptoms will you see in a CN3 nerve palsy?

A

ptosis

may have dilated pupil

affected eye down and out

(think of the hulk)

61
Q

What happens in a CNIV palsy?

A

paralysis of the superior oblique muscle

so VERTICAL DIPLOPIA

slight elevation of the affected eye

very subtle - refer to ophtho

62
Q

What happens in a CN6 palsy?

A

paralysis of the lateral rectus

affected eye is esotropic (turned in)

HORIZONTAL diplopia

movement of the affected eye is partially or totally limited in the lateral gaze

63
Q

What are some causes of conjunctivitis?

A

chemical injury

angle closure glaucoma

ocular foreign body

corneal abrasion

uveitis

conjunctivitis - bacterial, viral, allergic

subconjucntival hemorrhage

64
Q

What are the worst chemical injuries for the eyes?

A

alkali burns

these stick to proteins that stick to the eye and keep buring it - it will burn thorugh the cornea in an hour

rinse until pH is neutral

65
Q

What are some symptoms of a corneal abrasion?

A

sensation of foreign body present - even if gone

pain

tearing

photophobia

66
Q

HOw do you diagnose a corneal abrasion

A

you use fluorescein staining, which will stain any area of the cornea where there is an abrasion under UB light

67
Q

What 2 things do you need to be careful that you don’t miss in a corneal abrasion?

A

a corneal laceration - these WILL get infected

hyphema - blood in the anterior chamber

refer both immediately

68
Q

If you see linear abrasions of the cornea, what should you do?

A

flip the eyelid to see if there is a foreign body stuck under hte lid - rinsing won’t get it out

69
Q

How doyou remove a metallic foreign body from the cornea?

A

you scoop it out with a small gauge needle

(if a rust ring is left, if may need to be burred out)

70
Q

What do you NEVER prescribe for corneal abrasions?

A

topic anesthetics

they will NOT HEAL if they use this

71
Q

What discharge iwll be seen with the following:

bacterial conjunctivitis

viral conjunctivitis

allergic conjuncitivis

A

bacterial = purulent

viral = clear

allergic = stringy with white mucus

72
Q

What sort of injection will you see in allergic onjunctivitis?

A

diffuse = involving lids and often bilateral

longer history - little discharge, but what’s there will be ropey and mucoid

itchy eyes

73
Q

Describe anterior uveitis = iritis.

A

you get ciliary conjunctival injection

no discharge

light sensitivity

deep, achy pain

anisocoria

keratic precipitates

often associated with systemic diseases

74
Q

Describe a subconjunctival hemorrhage?

A

It’s a collection of blood on the surface of the sclera under conjunctiva

there is no inflammation, pain, or discharge

totally harmless, but patients freak out

(causes include trauma, eye rubbing, valsalva, cough/seeze, dry eyes)

75
Q
A

Neuro Block 3 (24 decks)

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