Optho Flashcards
What muscle closes the eyelid
Orbicularis oculi
—Closes the eyelid
—Innervated by CN VII (Facial)
What muscle opens the eyelid
Levator palpebrae superioris
—Opens the upper eyelid
—Innervated by CN III (Oculomotor)
What is mullers muscles
Mueller’s muscle
—Assists in opening the eyelids (upper/lower)
—Innervated by sympathetic ANS
(Widens palpebral fissure in situations associated with fear or surprise)
What are the three tunics of the eye
Fibrous tunic
Vascular tunic
Nervous tunic
What is the role of the cornea
Front window of the eye
The MAJOR REFRACTIVE surface of the eye (2/3 of the power)
What is the limbus
Where the sclera meets the cornea
What controls the opening and closing to the pupil
Sphincter – Parasympathetic ANS
Dilator – Sympathetic ANS
What is the palpabral conjunctiva
Covers the inside of the eyelids
What is the bulbar conjunctiva
Clear membrane that covers the sclera
What part of the eye produces aqueous humor
Ciliary Body
What is the function of the ciliary muscle
Contraction changes tension on zonular fibers
The fibers that suspend the lens
Allows focus on near objects
—Accommodation
What is the choroid
Vascular, pigmented layer
Between the sclera and the retina
Provides blood supply for the outer retinal layers
What is the space between the cornea and the iris
Anterior chamber
Where does the aqueous humor drain?
Anterior chamber
Where is the posterior chamber
Small space behind iris/in front of vitreous
Filled with aqueous humor
Describe the lens
Biconvex body
Suspended by zonules
Also has refractive responsibilities (1/3 of the power)
What is the neural lining of the eye
Retina
10 layers thick
Contains the Rods and Cons
Top 9 layers are transparent
What part of the eye is responsible for fine, central vision
Macula
What is the depression in the center of the fovea called
macula
How many nerves are contained in the macula
A third of all nerves
What’s the most important part of the retina
The macula
What is the location where the nerve fibers converge and the leave the eye
Optic disk
Where is the physiologic blind spot of the eye
15 degrees temporally
What are the 4 rectum muscles
Superior rectus
Inferior rectus
Medial rectus
Lateral rectus
What are the 2 oblique muscles of the eye
Superior oblique
Inferior oblique
What are the three layers of tears in the eye
Oil (outer layer)
—Meibomian Glands
Water (middle)
—Lacrimal
—Accessory Lacrimal
Mucin (inner layer)
—Goblet cells
What are the afferent and efferent pathway of the eye
Optic - Afferent pathway
Oculomotor + Parasympathetic - Efferent pathway
Watch this :
https://www.youtube.com/watch?v=WwB2jyj2lYM
What are Mydriatics
Meds for dilation = “Mydriatics”
Adrenergic-Stimulating
—Stimulate the pupillary dilator muscle
Cholinergic-Blocking
—Paralyzing the iris sphincter
What is a normal eye pressure range
10-21mmHG
Picked up slides at Lens and Vitreous D/o
Rheumatoid Arthirits is assoc with what other condition
Scleritis
What is the tissue with the highest protein content in the body
The lens
What are the three main layers of the Lens
Capsule
Cortex
Nucleus
What is the most common cause of cataracts
Age
Cataracts can be caused by IN steroids
Just a factoid
What is nuclear sclerosis
Yellow or brown discoloration of the nucleus
Blurs distance vision more than near vision
A pt presents with opacities near the posterior aspect of the lens
(Vacuoles/ Plaque like)
With a glare and difficulty reading
Posterior sub capsular
2/2 Young (less than 50) Ocular inflammation DM High NMyopia Ionizing rads Steroids Truama
Define Cortical Catarcts
Radial like spikes on a bike
Usually asymptomatic
Glare is more common complaint
a pt presents glare, monocular diplopia, fixed spots in the visual field, with decreased color perception
Think
Cataracts
What is the tx for catarcts
Early: Specactle prescription
If its small: dilation may improve Vision
Late: Surgical removal
Does scopalamine help cataracts
Benefits are only temporary
When is surgery indicated of catarcts
Glaucoma
Diabetic retinopathy
Age-related macular degeneration
Is congenital cataracts recessive or dominant
Dominant
What is Leukocoria
White pupil
What is the tx for cataracts in children
Cataract is considered emergency
Brain learns to see with macula
First 3 to 4 months of life
Lost vision may be permanent
Need to prevent irreversible deprivational amblyopia
Refer to pediatrician to treat underlying disorders
What is the difference between subluxation and dislocation of the lens
Subluxation
Partial disruption if the zonular fibers
—The lens is decentered!! but remains partially visible in the pupillary aperture
Dislocation
Complete disruption of the zonular fibers
-The lens is displaced out!! of the natural position in posterior chamber
ie. into vitreous or into anterior chamber
What is the most common cause of Lens anomolies
Trauma
What are two conditions associated with Lens position anomaly
Marfans and Homocystinuria
What are the S/s of a Lens Position Anamoly
Decreased vision Monocular diplopia Decentered or displaced lens Quivering of the iris (iridodonesis) Quivering of the lens (phacodonesis) Marked irregular astigmatism Angle-closure glaucoma Cataract Asymmetry of the anterior chamber
Floaters and Flashes of acute onset indicate
Intermediate or posterior uveitis
Bleeding in the vitreous cavity
Diabetes
Sickle cell anemia
Posterior vitreous detachment
Retinal tear
Intraocular foreign body
Flashes in the visual field indicate/ suggest
Suggests traction of the vitreous on the peripheral retina
- Must rule out retinal detachment
- R/o Posterior vitreous detachment
With floaters – blood/pigment in the vitreous
Also can occur with a migraine
- Scintillations
- Zig-Zag lights
A pt presents with sudden appearance of balk spots/ flashing lights
With many floaters
And a vitreous opacity in the sharpe of a ring (Weiss ring) or partial ring.
Think
Vitreous Detachment
Tx with Referal
Photocoagulation/cryotherapy may be necessary if retinal break/tear/detachment occurs
Where is the macula
5.5 mm in diameter centered on the fovea
Where is the fovea
4 mm temporal/0.8 mm inferior to the optic nerve
Slightly darker and lacks vascularity
Has a Foveolar light reflex
-Small yellow reflex at center of fovea
What are the two blood supplies to the eye
The central retinal artery
—Supplies the “inner retina” (towards inside of eye)
The choroid
—Supplies the “outer retina” (towards the outer wall)
—Supplies the photo receptors
—High oxygen demand
What is the nerve fiber layer of the retina and the location of the ganglion nuclei
Inner retina
What is the difference between Branch and Central artery occlusion of the retina
Central blocks out the entire vision
Younger female with retinal artery occlusion
Think of what cause
Oral contraceptives
A pt that loses vision in the eye suddenly that is now only light perceptive that happened upon rising in the morning
Think
Central retinal artery occlusion
On fundascope you see whiting of the retina, with Gerry red spot in the center of the macula, with “box car” or segmentation in Arterioles
Think
Central renal artery occlusion
How do we retinal artery occlusions
Immediate ESR, CRP, and platelets
—Rule out giant cell arteritis if over 55 years old
REFER!! Ocular massage and transport
High dose steroids for giant cell
A pt presents with sudden, painless, unilateral vision loss
Look for
Central Retinal Vein or Artery occlusion
Vision will be more preserved with vein occlusion
A pt presents with a blood and thunder fundus
Dot, blot, and flame-shaped hemorrhage
Cotton wool spots and exudates
Think ?.
Central retinal vein occlusion
What is the tx for a Retinal Vein occlusion
Mandatory referal
D/C contraceptives
Reduce IOP
ANTI VEGF injections
With Aspirin once a day
What are the two classifications of DM retinopathy
Non proliferative and proliferative
How do we treat non prolif DM retinopathy
Tight BGL control
Referal
AntiVGEF injections
Or Pan retinal Photooag
Laser surgery
What is rhegmatogenous
A break or tear in the retina truama usually
Fluid gets between the layers and detaches it
What is a exudative retinal detachment
A leachage into the retina without a break
Typically for a tumor or source of fluid
Flashes and floaters are only seen in what type of retinal detachment
Flashes and Floaters
A pt presetns with flashes and floaters
Decreased Vision, like curtain pulled down
What kind or retinal detachment ?
Rhegmatogenous
What is the approach to a retina detachment
Refer
Treatment
Rhegmatogenous
-Pneumatic retinopexy – intravitreal gas bubble with laser
-Scleral buckle – silicone belt around the outer globe
Tractional
-Pars plana vitrectomy
What is the most common cute of blindness in pts over than 60 yo in the western world
Age related macular degeneration
What is the most common abnormality of macular degeneration
Drusen
- Foveal area (mild or extensive)
- Yellowish deposits deep in the retina
- Limits the nutritional support to outer retina (photoreceptors)
What are the risk factors for Age Realted macular Degen
Cause typically unknown
Older age Female gender Lighter pigmentation Smoking Suspected genetic predisposition
What is the differnce between wet and dry macular degen
DRY: Gradual loss of central vision
Clumps of pigment on outer retina
WET:
Distortion of straight lines
Rapid Central vision loss
+choroidal neovasc
+Subretinal Hemm.
What are the risk factors that can turn dry AMD into wet AMD
Advanced age Hyperopia Blue eyes Family history Larger, ill-defined drusen Focal pigment clumps Systemic hypertension Smoking
What is the W/u test for AMD
Ambler Grid
IV Flourescein angiography
Macular Slit lamp
And Family tracing
How do you treat DRY AMD
High dose vitamin C, E, beta-carotene, and zinc (AREDS)
Reduces risk of progression by 25%
No beta-carotene for smokers (associated risk for lung cancer)
What is the Tx for Wet AMD
Anti-vascular endothelial growth factor (Anti-VEGF) intravitreal injections
Laser photocoagulation
—Done within 72 hours of angiography
What is the hallmark of HTN retinopathy
Hallmark = diffuse arteriolar narrowing
Blood vessel walls are virtually invisible
A copper wire vessel or a yellowing of the linear light reflex
Is a sign of
HTN retinopathy
Silver wire sign in the eye is a sign of
Sclerosis of the vessel
What are the S/s of HTN retinopathy
Vision
- May be normal
- May be blurred slightly
- May suddenly decrease
Blind spot in the vision (scotoma)
Double vision
If you see a Star in the eye it is….. everytime…
HTN
A pt presents with decreased vision, abnormal color vision, and difficulty adjusting to dark light
With a bulls eye maculopahty
What drug did they just start taking
Chloroquine
Send to Opto for baseline tests
What is a NML IOP
10-21 is NML
What are the two requirements for Glaucoma
Optic nerve damage and Visual Field loss
What is the optic disc
Where optic nerve and blood vessels leave to globe
Anatomical blind spot
How many visual field test do pts in the work up of glaucoma need
3
What is the gold standard for tonometery of the eye
(Eye pressure)
Goldman Applanation
What is the only thing that can be treated in glaucoma
Eye pressures ( tonometry)
Is ocular HTN, glaucoma?
NO!!
Everything is normal except for the ocualr pressure
What is the progression of Primary open Angle glaucoma
Rarely have any complaints in early disease
—Visual field defects must overlap
Decreased vision late in disease
- Complaint of “parts of a page are missing”
- Classic “tunnel vision” is a late complaint
- Central fixation preserved until late
- Remaining visual field - temporal island
Demographics for Primary Open Angle Glaucoma
Fm HX
Age >50
African American or Hispanic
DM
HTN
How do we treat open angle glaucoma
REFERAL!!
-
What is the ADE of prostaglandin analogs for glaucoma
Conjunctival hyperemia
What are the surgical options for Primary angle glaucoma
Trabeculoplasty
- Argon laser
- Selective laser
Trabeculectomy
- Drainage implant (shunt) surgery
- Aqueous flows into subconjunctival space (filtering bleb)
Ciliary body ablation
-Destroy a portion of the ciliary epithelium
What are the S/s of acute angle closure glaucoma
Symptoms:
-Vision is blurred
—Typically in one eye
Monocular halos around lights
Intense ocular pain with photophobia
Frontal headache
Vasovagal symptoms
- Nausea
- Vomiting
A pt presents with a mid dilated no reactive pupil
With conjunctival injections a
With absent light reflex with IOP 60-80
Think
Acute angle closure
What is the treatment of choice for acute angle closure of the eye
Laser iridotomy
After the initial attack is broken
