Optometric Practice 2 Flashcards
FUNDUDS ANOMALIES
Diseases of the:
OPTIC NERVE
CHOROID
RETINA
MACULA
3 Diseases of the Optic Nerve
A. Optic Neuritis
B. Papilledema
C. Optic Atrophy
3 Diseases of the Choroid
A. Choroiditis
B. Posterior Uveities
C. Malignant Melanoma of the Choroid
8 Diseases of the Retina
- Retinal Tear
- Retinal Detachment
- Hypertensive Retinopathy
- Diabetic Retinopathy
- Circinate Retinopathy
- Retinal Hemorrhages
- Retinitis Pigmentosa
- Retinoblastoma
8 Diseases of the Macula
- Senile or Age-related Macular Degeneration
- Angioid Streaks
- Hole in the Macula
- Glaucomatous Cupping
- Myopic Degeneration
- Fundus in Leukemia
- Toxoplasmosis
- Fundus in AIDs
2 Types of Optic Neuritis
Papillitis and Retrobulbar Neuritis
Degeneration, demyelinization, inflammation or infection of the optic nerve
Optic Neuritis
Papillitis is also known as:
Intraocular Optic Neuritis
Optic Nerve Head is involved and there are visible changes in the disk
Papillitis
Inflammation occurs behind eyeball therefore disk changes are slight or even absent, diagnosis based on symptoms
Retrobulbar Neuritis
SYMPTOMS OF PAPILLITIS
great disturbance of vision & usually unilateral
pain around the eye or on movement of the eyeball
globe tender to palpation
PAPILLITIS OPHTHALMIC SIGNS
Very Early Stage:
The optic disc shows signs of congestion.
The disc’s edges blurry or have (stripes).
Fairly Established Condition:
The optic disc becomes swollen and takes on a whitish or grayish color.
The center of the disc may appear reddish.
Striations and white spots are often present.
Hemorrhages (bleeding) may occur.
Arteries look thin, while veins appear distended and twisted (tortuous).
surrounding retina involved & edema may accumulate in the macula to produce radiating streaks, described as
MACULAR STAR
most common cause of papillitis
SYPHILIS
Less frequent causes:
(LOVEUMMF)
Lead poisoning
Orbital Inflammation
Vascular disease
Encephalitis
Uveities
Meningitis
Multiple Sclerosis
Focal Infection
Prognosis of Papillitis
if unchecked, vision is finally much impaired or lost
TREATMENT OF PAPILLITIS
Directed against the cause and LOCALLY, rest the eye and from light
Involves the orbital or intracranial portion of the optic nerve
RETROBULBAR NEURITIS
SYMPTOMS OF RETROBULBAR NEURITIS
VETH
Headache on one side of the head.
Eye pain that gets worse when moving the eye or pressing it backward.
Vision problems that are getting worse quickly.
The pupil (the black part in the center of the eye) may not react quickly to light.
OPHTHALMIC SIGNS OF RETRO
first none, later slight hyperemia, disk margins haziness and sometimes, diminishsed caliber of retinal vessels
most common cause of Retro
MULTIPLE SCLEROSIS
less frquent causes:
syphilis, rheumatism or diabetes
acute infectious diseases (influenza
septic foci/poisons
PROGNOSIS OF RETRO
In multiple sclerosis, involvement of optic nerve rarely leasds to COMPLETE BLINDNESS
TREATMENT OF RETRO
cause should be attacked
large doses if VITAMIN B COMPLEX
A noninflammatory swelling of the optic nerve head resulting from increased intracranial pressure of some interference of the optic nerve circulation, particularly venous drainage
PAPILLEDEMA
SYMPTOMS OF PAPILLEDEMA
Early stages - nothing
ENLARGED BLINDSPOT
Later - reduction in vision to blindness IF INTRACRANIAL PRESSURE IS NOT REDUCED
OPHTHALMOSCOPIC SIGNS OF PAPILLEDEMA
in early stages, slight edema of the disk
later examination shows great swelling & protrusion of the disk
distortion & tortuosity of the retinal veins
hemorrhages upon & near the edematous papilla
Most frequent cause of Papilledema:
BRAIN TUMOR
LESS FREQUENT CAUSE:
BMIS
Brain abcess
Meningitis
Intracranial hemmorhage
Syphilis & malignant hypertension
PROGNOSIS OF PAPILLEDEMA
more or less permanent loss of vision associated with secondary optic atrophy
TREATMENT OF PAPILLEDEMA
vision restored if intracranial pressure is reduced in time removal or treatment of lesion
2 CLASSIFICATION OF OPTIC ATROPHY
- Simple or Primary Atrophy
- Secondary or Postneuritic or Secondary Inflammatory Atrophy
SYMPTOMS OF OA
reduction in the acuteness of vision
diminution in the light sense
color blindness
when atrophy is complete, pupils are dilated & immobile
OPHTHALMOSCOPIC SIGNS (SIMPLE ATROPHY)
disk is white, grayish or bluish white
edges of the disk are sharply defined and regular
size of disk is diminished & presents saucer- shaped excavation
minute vessels have disappeared
arteries are diminished in caliber
OPHTHALMOSCOPIC SIGNS (SECONDARY ATROPHY)
disk is dense white or grayish in color
margins are irregular & hazy
minute vessels are lost retinal arteries are narrow
arteries & veins enclosed by white lines
CAUSE OF SIMPLE ATROPHY
cerebrospinal diseases multiple sclerosis systemic syphilis malaria
diabetes
excessive hemorrhage
arteriosclerosis
certain poisons(arsenic, wood alcohol)
choroiditis retinitis glaucoma
CAUSE OF SECONDARY ATROPHY
papilledema
optic neuritis
tumors of the optic nerve
PROGNOSIS OF OA
simple atrophy occurs in middle life; the course is slow extending over many months & prognosis is unfavorable, the condition progessses to absolute blindness
secondary atrophy, prognosis is better & depends upon extent optic nerve has escaped from destructive influences
TREATMENT OF OA
control the cause
scleral or extraocular muscle surgical transplantation have been tried to initiate scleral vascularization which may induce choroidal & retinal neovascularization
inflammation of the choroid classified as ACUTE OR CHRONIC
CHOROIDITIS
Under Acute Choroiditis:
exogenous and endogenous
due to perforating wounds of the eyeball
EXO Acute Choroiditis
caused by infection localized elsewhere in the body
ENDOGENOUS ACUTE CHOROIDITIS
Occurs as an ocular manifestation of some internal disease such as syphilis or tuberculosis
CHRONIC CHOROIDITIS
6 CLINICAL VARIETIES OF POSTERIOR UVEITIES
(DDCJAC)
Diffuse Choroiditis
Disseminated Choroiditis
Circumscribed Choroiditis
Juxtapapillary Choroiditis
Anterior Choroiditis
Central Choroiditis
patches of exudation, each gradually shading into the surrounding portions of the choroid
DIFFUSE CHOROIDITIS
numerous round or irregular yellowish spots with fluffy borders scattered over the fundus
DISSEMINATED CHOROIDITIS
single patch of yellowish color with fading edges is seen near the macula
CIRCUMSCRIBED CHOROIDITIS
form of circumscribed choroiditis which is adjacent to the disk, its shape is usually oval
JUXTAPAPILLARY CHOROIDITIS
presents foci of exudation similar to those found in disseminated choroiditis but limited to the periphery of the choroid
ANTERIOR CHOROIDITIS
A form of circumscribed choroiditis situated in the macular region
CENTRAL CHOROIDITIS
SYMPTOMS OF CENTRAL CHOROIDITIS
severe reduction or loss of central vision but peripheral vision is preserved
seeing a black spot & distortion of
objects
flashes of light, sparks of bright circles before the eyes
OPTHALMOSCOPIC SIGNS
gray or white spot, usually about half the size of the disk, either mottled or uniform in color, with
more or less pigmentation scattered in irregular deposits or forming a border
choroidal vessels seen on surface
lesion found in the macular area
CAUSES OF CENTRAL CHOROIDITIS
tuberculosis - most common cause
syphilis
Infection resulting from a perforating injury
acute infectious diseases of childhood
PROGNOSIS OF CENTRAL CHOROIDITIS
dependent upon position of patches of exudation with subsequent atrophy
a single patch involving the macular region will seriously impair vision
TREATMENT OF CENTRAL CHOROIDITIS
removal of etiologic factor
atropine may be indicated to rest the eyes
always primary and involves ONE EYE ONLY - occurs in adults between 40-60
MALIGNANT MELANOMA OF THE CHOROID
SYMPTOMS OF MALIGNANT MELANOMA of the CHOROIDITIS
- Insidious Stage - no symptoms & only sign may be discovered by chance; a brown or black, flat or slightly elevated, circumscribed mass in the choroid which slowly increases in size; tumor may exist for a long time without causing symptoms
- Stage of Clinical Symptoms
defect in visual field or diminution in vision is the initial symptom, depending upon the location of the tumor
definite elevation of the tumor but remains circumscribed, yellowish brown, brown or black
area around tumor becomes detached - Stage of Secondary Glaucoma tumor continues to increase in size
& produce inflammatory signs as a result of glaucoma & of release of irritating necrotic products - Stage of Extraocular Extension or Metastasis - tumor grows out of the globe; metastasis frequently occurs in the liver
OPHTHALMOSCOPIC SIGNS OF MALIGNANT MELANOMA
Round or spindle-shaped cells, usually pigmented
Begins as a flat disk-shaped mass in the outer layers of the choroid
Later, it perforates the lamina vitrea(Bruch’s membrane) & forms mushroom-shaped mass pushing the retina forward & drusen
cause of malignant melanoma
unknown although found in 10% of eyes blind from injury of inflammation
PROGNOSIS OF MALIGNANT MELANOMA
when enucleated early, cure results in about 1/2 of the cases;even after removal , death results from metastasis
TREATMENT OF MALIGNANT MELANOMA
enucleation is indicated as soon as diagnosis is established, cutting the optic nerve back, but it is necessary to remove the entire contents of the orbit if the growth has broken through the globe
tumors located in anterior portion may be removed by a resection of the sclera
Torn by mechanical force, usually vitreous traction
RETINAL TEAR
A separation of the retina occuring between the layer of pigment epithelium and the layer of rods and cones. DARK CLOUD BEFORE THE EYE
RETINAL DETACHMMENT
A disease of the retina associated with essential or malignant hypertension (where blood pressure is severely high)
HYPERTENISVE RETINOPATHY
4 CLASSIFICATIONS OF HYPERTENSIVE RETINOPATHY
GRADE 1, 2 ,3 AND 4.
arterioles are reduced from ¾ to
½ of the corresponding vein & no hemorrhages, patches or edema are seen
GRADE 1
further reduction of arteries from
½ to 1/3 of the corresponding vein & no hemorrhages or patches seen
GRADE 2
aside from arteriole constriction, there are flame-shaped hemorrhages and/or cotton-wool patches & edema residues
GRADE 3
onset of papilledema with partial or complete star-shaped figure of edema residues at the macula(macular star)
GRADE 4
5yr. Survival rate of patients in group 1 is 70%; group 4 is 1%
Adequate control of hypertension improves the prognosis
PROGNOSIS:
Associated with diabetes mellitus(where tissues are unable to utilize the available or deficient insulin coming from the pancreas which results in the inability to utilize glucose)
It is always bilateral
DIABETIC RETINOPATHY
OPHTHALMIC SIGNS OF DM
Earliest sign is venous dilatation (because of obstruction of venous drainage)
Numerous small round red spots are seen which are small hemorrhages in the deeper layer of the retina
Small clusters of red dots at end of vascular twigs
CIRCLE AROUND THE MACULAR
circinate retinopathy or retinitis circinata
