Optic Nerve/Retina 1 Flashcards
- Gradual OR acute painless vision loss unilateral OR bilateral
- Metamorphopsia (wavy/distorted palm trees) - early sign of this condition
- Central scotoma
Sxs of what eye condition?
Age-Related Macular Degeneration
*Metamorphopsia is early sign of Wet AMD
Leading cause of adult blindness in “industrialized countries”
Age-Related Macular Degeneration (AMD)
- “Fleeting blindness”
- Usually caused by retinal emboli from ipsilateral carotid disease
Amaurosis Fugax
- Acute onset of monocular decreased vision
- “curtain coming down” over eye
- Cloudy/Smoky vision
- “Floaters” or “flashes of light”
- No pain/redness
Sxs of which eye condition?
Retinal Detachment
How is retinal detachment treated by the ophthomalagist?
Closing the tears w/ cryosurgery or laser surgery
In what position should a patient w/ retinal detachment be placed in during transport to ophtho for immediate referral?
Supine, w/ head turned to ipsilateral side to help retina fall back into place w/ aid of gravity
- Characterized by growth of abnormal vessel into subretinal space
- New vessels leak
- Accounts for 80 - 90 % of blindness of this eye condition
- May be acute onset
Wet AMD (age-related macular degeneration)
Venules are dilated and tortuous due to blood becoming backed up
Papilledema
Why would you obtain an EKG and echocardiography to diagnose Amaurosis Fugax?
Emboli from cardiac sources (atrial fibrillation) may be the cause
MRI of brain and orbits w/ gadolinium contrast is used to diagnose what eye condition?
Optic Neuritis, also assesses risk for MS
Which eye condition if suspected required URGENT ophtho referral / complete workup?
Papilledema
If you diagnose/suspicious of a pt w/ Optic Neuritis, who would you refer to? What must you rule in or out?
Ophtho/Neuro
MS
- What is performed to diagnose Dry or Wet AMD?
- Dx of Wet may require what?
- Dilated fundus exam w/ ophthalmology
Wet:
- Fluoroscein dye retinal angiography (to see where new vessels are created)
- Optical coherence tomography (OCT)
- Subretinal fluid or blood
- Subretinal neovascular membrane
Wet AMD
- Loss of color vision
- Decreased visual acuity
- RAPD - relative afferent pupillary defect
- Optic nerve changes
PE findings of Optic Neuritis
Optic disk is swollen, w/ blurred margins, cup may be obscured due to swelling
Papilledema
Flame hemorrhages and infarctions (white cotton wool spots) in the nerve fiber layer, edema of surrounding retina
Papilledema
What are the first signs/sxs of papilledema?
Signs/sxs of elevated intracranial pressure
- HA
- N/V
- Transient vision changes, or vision is normal
What is the most common cause of Retinal Detachment? (RD)
Tear in retina. Vitreous fluid then goes under the retina causing detachment.
- Discrete yellow deposits
- Central vision decreased due to atrophy of retinal pigment epithelium
Dry AMD, yellow spots are “retinal drusen”
- Most cases (2/3) are retro-bulbar (no changes in fundus)
- Some cases (1/3) optic nerve is swollen w/ pallor and occasional flame-shaped peri-papillary hemorrhages
Optic Neuritis
- Non-invasive evaluation of carotids w/ duplex US and magnetic resonance angiography (MRA)
Diagnostic test for Amaurosis Fugax
What is the goal of working up a patient w/ Amaurosis Fugax?
Determine cause of embolus
What is the most common site of retinal detachment?
Superior temporal retinal area
If visual acuity does not return after tx of Optic Neuritis, what must you rule out?
Compressive lesion or tumor
- +/- decreased visual acuity
- Amsler grid distortion
Signs of which eye condition?
Age-Related Macular Degeneration
What is the tx for Optic Neuritis?
IV methylprednisolone (steroids) for 3 days, then oral taper to accelerate vision recovery
- Visual loss described as, “curtain passing vertically” w/ complete monocular visual loss lasting a few minutes.
- Similar curtain effect as episode passes after a few minutes
Amaurosis Fugax
- Afferent Pupillary Defect
- Billowing or tent-like elevation of rugose retina on fundo exam
- Elevated retina appears out of focus and gray
- Vitreous hemorrhage
Signs of which eye condition
Retinal Detachment
- Drusen, pigmented mottling
- Geographic atrophy
Dry AMD (age-related macular degeneration)
- Which eye condition may occur w/ viral infections such as meales, mumps, and influenza?
- Common in women 20 - 40 yrs old
Optic neuritis
How soon does visual acuity return after tx of Optic Neuritis w/ IV methylprednisone for 3 days w/ oral taper?
2 - 3 weeks
- Acute onset (hrs to days)
- Monocular vision loss
- Eye pain worse w/ EOMs
- Visual field defects (central scotoma)
Optic Neuritis
- Causes loss of central vision
- Incidence increases w/ each decade over 50 yrs old
Age-Related Macular Degeneration
- Which AMD has a better prognosis?
Dry AMD
Swelling of optic nerve head, usually associated w/ what?
Papilledema, associated w/ elevated intracranial pressure
What eye condition is strongly associated w/ Multiple Sclerosis (MS) and is the presenting factor in as many as 20% of MS patients.
Optic Neuritis
- Vitamins
- Smoking cessation
- Intravitreal anti-angiogenic injections (VEGF inhibitor)
- Photodynamic therapy
- Low vision aids
Tx for which eye condition?
AMD
Also Daily Amsler Grid and Ophtho referral
What is the tx for Amaurosis Fugax?
Depends on the cause
Inflammatory demyelinating condition, results in acute vision loss in one eye
Optic neuritis
- Age
- Female gender
- Smoking hx
- Family hx
- Complement factor polymorphism (genetic factor)
Risk factors for which eye condition?
Age-Related Macular Degeneration
How do retinal tears occur?
- Spontaneously
- Secondary to traumatic events
Areas of infarction associated w/ papilledema
Cotton Wool Spots
- Over 50 yrs old
- Extreme myopia
- Previous ocular surgery
- Family hx
- DM
Risk factors for which eye condition?
Retinal Detachment
