Optho Flashcards
Exopthalmos
Bulging up that I out of orbit.
Patho- most common cause is graves disease.
Subjective data – drama that can cause complete or partial dislocation of the eye
Objective data – apparent I protrusion, lids do not reach the iris.
Episcleritis
Inflammation of the superficial layers of the sclera anterior to the insertion of the rectus muscles.
Patho- poorly understood. Most cases are idiopathic. May have an underlying systemic condition.
Subj- acute onset of mild to moderate discomfort or photophobia. Painless injection and/or watery discharge without questing.
Obj- diffuse or localized injection of the bulbar conjunctiva, purpleish elevation of a few millimeters, watery discharge.
Band keratopathy
Deposition of calcium in the superficial cornea
Patho- most commonly in patients with chronic corneal disease.
Subj-decrease in vision as deposition progresses, foreign body sensation and irritation.
Obj- line just below the people, passes over the cornea rather than around the iris.
Corneal ulcer
Disruption of a corneal epithelium and stroma
Patho- rheumatological disorder, infection, extreme dryness.
Subj- pain, photophobia, history of wearing contact lenses, blurry vision, feeling that something is in the eye.
Obj- Visual acuity affected variably, depending on also location. Inflammation and erythema of the lids and conjunctiva. Purulent to exudate . Also often and round or oval, and the border sharply demarcated, with the base appearing ragged and gray.
Strabismus
Disorder of extra ocular muscles. Both eyes do not focus on an object simultaneously but can focus with either Eye.
Patho- paralytic caused by impairment of one or more extra ocular muscles, may be a sign of increased intracranial pressure, CN III is particularly vulnerable to damage from brain swelling.
Subj-Poor vision, sudden onset of double vision, report of eye deviation
Obj-if an extra ocular muscles has become impaired, that I will not move in the direction control by that muscle. For example of the right sixth nerve is damaged, the right eye does not move temporally. Detected by the cover – uncover test
Horner syndrome
Internal eye disease. Interruption of sympathetic nerve innervation to the eye.
Patho- can’t be congenital, acquired, or hereditary. May result from lesion of the primary neuron, stroke, trauma. Results in triad of ipsilateral meiosis, mild ptosis, and loss of hemi facial sweating.
Subj- depend on underlying cause
Obj- The ptosis is subtle and appreciated by noting the amount of Iris seen superiorly in opposite I is greater. Pupil unaffected side maybe around in constricted. Anisocoria is greater in darkness. Affected pupil dilates more slowly than the normal people. Dry skin is on the same side of face as the affected pupil.
Cataracts
Internal I disease. Opacity in lens.
Patho- most commonly from denaturation of lens protein caused by aging.
Subj- cloudy were blurry vision, faded colors, headlight lamps or sunlight me up here too bright, halo me up here around lights, poor night vision or double vision, frequent prescription changes.
Obj- cloudiness of the lens, often obvious without special viewing equipment.
Diabetic retinopathy (non-proliferative)
Hemorrhages or microaneurysms and the presence of hard and soft exudates.
Patho- hard exudates dates are the result of lipid transudation through incompetent capillaries. Soft exudates are caused by infection of the nerve layer.
Subj- in the initial stages, patients are asymptomatic. Blurred vision, distortion, or visual acuity loss in more advanced stages.
Obj- on ophthalmoscopic exam, blood vessels with balloon-like sacs (microaneurysms), lots of hemorrhages on the retina it’s self, tiny yellow patches of hard exudates.
Diabetic retinopathy (proliferative)
Development of new vessels as a result of anoxic stimulation.
Patho- vessels grow out of the retsina toward the vitreous humor. May occur in peripheral retina or an optic nerve itself. New vessels lack supporting structure of a healthy Bessel’s and are likely to hemorrhage. Bleeding from the vessels is a major cause of blindness in patients with diabetes.
Subj- General asymptomatic. Floaters, blurred vision, or progressive visual acuity lost in advanced stages.
Obj- visualization of these vessels may require a change in the lens setting of the ophthalmoscope. Vitreous hemorrhage may also be seen, which can obstruct the view of the retina.
Lipemia Retinalis
Creamy white appearance of retinal vessels that occurs with excessively high serum triglyceride levels.
Patho- occurs when the serum triglyceride level exceeds 2000. Seen in some of the hyperlipidemic states.
Subj- elevated serum triglyceride levels, no visual symptoms.
Obj- peripheral fundus changes in early stages, initially Brussels appear salmon pink. As triglyceride levels rise, they become white-ish. Abnormalities resolve as a checklist for levels return to normal.
Retinitis pigmentosa
Autosomal recessive disorder in which the genetic defects caused cell death, predominately in the ride photo receptors
Patho- genetic defect causes a pop ptosis in the photo receptors. Associated with deafness, paralysis of one or more extra healer muscles, dysphasia, intellectual delay.
Subj- earliest symptom is night blindness. Tunnel vision or reports of bumping into furniture. Loss of vision is painless and progresses over years to decades.
Obj- normal exam in the early stages. Optic atrophy with a waxy pallor, narrowing of the arterials, and peripheral “bone spicule” pigmentation are hallmarks
Glaucoma
Disease of the optic nerve where in the nerve cells die, usually due to excessively high intraocular pressure.
Patho- acute angle me a car acutely with dramatically elevated intraocular pressure if the iris blocks the exit of aqueous humor from the anterior chamber. Open angle caused by decreasing aqueous humor absorption leads to increased assistance and painless buildup of pressure in the eye.
Subj- in chronic glaucoma, which is more common, symptoms are absent except for a gradual loss of peripheral vision over a period of years. Acute glaucoma is accompanied by intense ocular pain, blurred vision, halos around lights, a red eye, and dilated pupil.
Obj- optic nerve damage can be clearly seen during a dilated eye examination and produces a characteristic appearance of the optic nerv (increased cupping). Visual field test me show loss of peripheral vision.
Chorioretinitis
Inflammatory process involving both the choroid the retina.
Patho- most common cause is laser therapy for diabetic retinopathy he may also be seen in histoplasmosis, toxoplasmosis, or congenital rubella infections.
Subj- history of cleaning cat litter box, laser surgery, or other causal agents. Pain, reduce visual acuity, floaters, photophobia.
Obj- sharply defined lesion. Generally whitish yellow and becomes stippled with dark pigmentation in later stages ending with a chorioretinal scar. Visual field defect with large lesion. Feathery martins contrasts with Myelinated retinal nerve fibers.
Visual field defects
Defective vision or blindness.
Patho- maybe consequence of the generative changes within the eye or from lesion of the optic nerve. Most common causes interruption of the vascular supply to the optic nerve. Pituitary tumor.
Subj- defective vision or blindness.
Obj- Visual field deficit’s
Retinalblastoma
Embryonic malignant tumor arising from the retina.
Patho- usually develops during the first two years of life. Transmitted either by autosomal dominant trait or by chromosomal mutation.
Subj- Family history of retinoblastoma. White reflects on photographs.
Obj- initial sign is leukocoria, a white reflex rather than the usual red reflex.
