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neuro exam 1 > Pathology of the Eye > Flashcards

Pathology of the Eye Flashcards

cards up to 30

1
Q

Why is retinal detachment an urgent problem?

A

loses blood supply and tissue can die

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2
Q

Where is the largest concentration of cones in the eye?

A

macula

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3
Q

What are the 3 visual fields?

A

Total visual field with both eyes: 170 degrees

Total monocular visual field: 150

Total binocular visual field: 120

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4
Q

Strabismus/Tropia

A

misalignment of eyes

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5
Q

Phoria

A

misalignment of eyes when fusion is broken

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6
Q

What is the function of the eyelids and eyelashes?

A

protection and lubrication of the cornea

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7
Q

Conjunctiva

A

Mucous membrane that lines the inside of the eyelids and some of the front of the eye

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8
Q

What is the function of the cornea? What aspect is most responsible for this?

A

Most external refractive media of the eye (it is avascular)

Curvature of the cornea contributes to amount of refractive error and astigmatism

Contact lenses are placed over the cornea

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9
Q

What are some functions of the anterior chamber and the angle?

A

Part of the refractive media

Holds the aqueous humor

Nourishes the cornea, maintains the pressure of the eye

Angle contains the structures that regulate the outflow of the eye

Affected by glaucoma, uveitis, neovasculature

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10
Q

What does the iris control? why are eye exams done in dark lighting

A

light into the eye

dilate pupils in dark room

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11
Q

Uveitis

A

Inflammation of the
uveal tissue

Etiology: idiopathic,
HLA related, arthritis,
granulomatous, many
more

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12
Q

What 2 problems can occur with the lens with aging?

A

With age, the lens naturally hardens and yellows –> cataract formation (blur, glare, distortion)

and ability to accommodate

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13
Q

What are myopia, hyperopia, astigmatism and presbyopia? how are all of these treated?

A

Myopia-nearsightedness

Hyperopia-”farsightedness”

Astigmastism-corneal shape

Presbyopia-loss of accommodation

*all corrected by lenses

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14
Q

Where is the largest concentration of the cones in the eye?

A

macula

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15
Q

Posterior Vitreous Detachment

A

Most common cause of “flashes or floaters”

Usually benign age-related

May cause retinal hemorrhage, retinal break, vitreous hemorrhage

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16
Q

What can cause poor binocular vision?

A

Poor monocular visual acuity

Poor monocular/binocular visual fields

Strabismus/Tropia

Phoria

Convergence/divergence abnormalities

Accommodation abnormalities

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17
Q

What is a common cause of viral red eye? What are the symptoms?

A

Adenovirus

Most common type of infectious red eye

Associated with upper respiratory infection

May have fever

Usually starts unilateral –> bilateral

Watery discharge

Likely have ocular irritation

Superficial punctate keratitis (SPK) on exam

Diffuse redness, “pink”

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18
Q

What eye problems can steroids cause?

A

cataracts

elevated intraocular pressure (IOP)–> glaucoma

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19
Q

What are some common causes of bacterial red eyes?

symptoms?

A

Causes: S. aureus, S. epidermidis, Strep pneumonia, H. influenza

symptoms?
Usually unilateral
Mucopurulent discharge, esp upon waking
RED eye,  red in fornices
Usually no corneal involvement except if severe
Treatment
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20
Q

What is blepharitis? What normally causes is?

A

dry, flaky eyes

usually caused by:
*Inflammation of meibomian glands

other Causes:
Limited lacrimation-Sjogrens, lacrimal gland tumor

bilateral and chronic

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21
Q

What are the causes, symptoms and treatment of Subconjunctival Hemorrhage?

A

Causes: Trauma (even mild), valsalva, HTN, bleeding disorders, antiplatelet/anticoag tx

symptoms: “Bruise” of the eye
BRIGHT RED eye, often sectoral
NO vision changes, NO pain, NO discharge

Tx: nothing for the hemorrhage but look into work up of the cause

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22
Q

What are causes, symptoms of anterior uveitis? How is it treated?

A

Causes: idiopathic, trauma, HLA-B27 associated, post operative, many more

Symptoms
Pain! Photophobia (hallmark), redness, tearing, blur

Signs
Diffuse injection, esp perilimbal
Cells and flare in the anterior chamber

tx: Refer to eye doctor!
High doses of topical steroid and cycloplegics

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23
Q

What causes Acute Angle Closure Glaucoma? Signs and symptoms?

A

closed iridocorneal angle–>Blocks outflow of aqueous humor

Symptoms
PAIN! Headache, significant blur, nausea/vomiting

Signs
*acutely high intraocular pressure (IOP), Unreactive pupil, corneal edema, closed angle

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24
Q

When do you need to refer a red eye to an eye doctor?

A 
Pain
Decreased vision
No improvement within 3 days of treatment
Needs steroid
Unsure of cause
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25
What is the leading cause of blindness globally?
cataracts
26
What is done to treat cataracts?
simple outpatient surgery --> Removal of opacified lens and insert an implant (IOL)
27
What are the 3 most common types of cataracts?
Nuclear: brownish in center Symptoms: blur, myopic shift, possible glare Age Cortical: white opacities Symptoms: glare, later blur Age, trauma ``` Posterior subcapsular (PSC): between capsule and lens Symptoms: blur usually from DM and steroids**, Age, trauma, intraocular surgery ```
28
What is the most common cataract? What are some symptoms?
Age related cataract Often a combination of lens opacities Symptoms: BLUR-usually so slowly progressive that the patient is only mildly aware Glare
29
What is the leading cause of blindness in the US for over the age of 55? what are the causes? some risk factors?
Age-related Macular Degeneration unknown cause risk: AGE, smoking, family history, vascular disease, Northern European ancestry
30
What vision is lost in Age-related Macular Degeneration?
center vision lost peripheral vision still in tact
31
what defines dry vs wet macular degeneration?
``` dry=no leakage Dysfunctional RPE (Retinal Pigment Epithelium) does not clear waste debris so the waste (drusen) clumps underneath--> RPE atrophies 90% of cases (dry normally progresses to wet) ``` wet=choroidal neovascularization present because of stress to choroidal circulation to try to get rid of waste New blood vessels develop and bleed Usually dramatic change in vision or visual distortions occur Can scar
32
What can the pinhole show?
there is a refractive component
33
What is acute vs chronic glaucoma?
damage to the structure of the optic nerve Most cases are chronic Slowly progressive, over many years ``` Acute: Angle closure-SEVERE, emergency Secondary open angle Extreme IOP increase Usually won’t cause quick damage to optic nerve head and subsequent severe loss of vision ```
34
What is the most common type of glaucoma? What are some characteristics? What is the goal in management?
Primary Open Angle Glaucoma ``` Characteristics: Usually elevated IOP Open angle Glaucomatous optic nerve Visual field loss (normally only later in the dx) ``` goal: prevent visual field loss (decrease the IOP)
35
What is more effective in treating glaucoma, topical or oral meds?
topical
36
What glaucoma could cause a red eye?
angle closure glaucoma
37
What type of glaucoma is likely to cause an acute attack?
narrow angle glaucoma suspect | steroid will take a long time to affect the eye
38
What can cause retinal hemorrhages (vascular problems) in the eye?
diabetic retinopathy, hypertensive retinopathy (or artery/vein occlusions), anemia retinopathy *focus most on DM and hypertension
39
What are the diabetic eye diseases?
``` Unstable refractive error -->Changes in water content of lens Cranial nerve palsies Glaucoma Retinopathy -Nonproliferative -Proliferative (including of the iris) -Macular edema ```
40
What are the risk factors for diabetic retinopathy?
DM for over 10 years (type I or II) Chronic hyperglycemia (HbA1c >8%) HTN Nephropathy
41
What symptoms do most people with diabetic retinopathy have?
usually no symptoms may have: blur, or flashes/floaters
42
What is the lowest state of diabetic retinopathy?
Mild Nonproliferative Diabetic Retinopathy Microvascular changes: -Loss of pericytes -Increased vascular permeability Effects: - Microaneurysms - Leakage - Hemorrhages - Exudates Tx: none
43
What happens in Moderate/Severe Nonproliferative Diabetic Retinopathy?
- capillary occlusion and non-perfusion - veins start to be affected---> venous bleeding - cotton wool spots (microvascular infarcts) - intraretinal macrovascular abnormalities--> form collateral networks also, no treatment. monitor
44
What is proliferative diabetic retinopathy? What is the treatment?
new vascularization==> BAD can cause retinal detachment of vitreous hemorrhages Tx: laser photocoagulation or vitrectomy
45
What is diabetic macular edema? What is the treatment?
Leakage of fluid and exudates in the macula Most common cause of visual impairment Treatment Laser-direct and grid Intravitreal steroid Intravitreal anti-VEGF
46
What can hypertensive retinopathy cause? Will it cause noevascularization?
Microvascular changes: - Vessel changes - Vessel leakage - Capillary non-perfusion Effects: - Vessel attenuation - ->hardening - Leakage - ->Flame shaped Hemes - ->Exudates - Cotton wool spots *will NOT cause neovascularization on its own
47
What are different types of retinal plaques?
1. Cholesterol/”Hollenhorst” Orange/refractile, non-occlusive From carotid arteries 2. Calcium White, occlusive From cardiac valves 3. Fibrin/platelet Dull white, non-occlusive From carotid arteries can cause blockage in the eye or no symptoms
48
What will happen due to artery occlusion? what can cause this?
acute vision loss significant pupil defect in the affected eye Cause: embolism from heart or carotid artery; atherosclerosis, giant cell arteritis
49
What can happen with a vein occlusion? What are the likely causes?
blood backed up==> get really ugly bloody retina caused by DM*, HTN*, blood dyscrasias
50
What is papilledema? What are the differentials?
swollen in both optic nerves coming from something behind the eye causing an increase in intracranial pressure Differentials: Malignant hypertension, tumor, pseudotumor cerebri, bilateral ischemic optic neuropathy, bilateral optic neuritis
51
What is Ischemic optic neuropathy?
Infarction in the ON, can be segmental--> rare to have in both eyes at the same time Etiology: HTN, DM, arteriosclerosis, hyperlipidemia, giant cell arteritis Permanent loss of visual function*
52
What is optic neuritis?
Inflammation of ON Etiology: idiopathic, multiple sclerosis, severe infection, inflammation Many have full return of visual function*
53
What eye condition can happen from inflammation/immune system associations? What is the most common?
-itis uveitis (anterior=most common) scleritis keratitis (conjunctivitis is NOT normally)
54
What are some ocular urgency symptoms?
Trauma (foreign body or head trauma) Sudden vision loss Flashes/floaters Pain
55
What are some conditions that are ocular urgencies?
Retinal detachment Iritis Neovascularization Corneal ulcer
56
What does transient vision loss normally indicate?
loss of blood flow cardiac problem/circulation problem --> normally a brain, not an eye issue vision normally returns within 24 hours
57
what normally causes Acute Permanent Vision Loss?
vision loss for >24 hours usually vascular but can also be optic neuropathy or retinal detachment as well
58
What normally causes flashes? What normaly causes floaters?
retinal stimulation Usually caused by objects anterior to the retina most common causes: Posterior Vitreous Detachment Migraine Retinal break Retinal detachment
59
What is a retinal break?
Retinal tear, retinal hole, retinal dialysis Defect in the retina where the retina has pulled away from the RPE Precursor to RD in many cases
60
When do you test for Retinal Detachment?
Anyone with “flashes and floaters” MUST have a dilated retinal exam to rule out Retinal Detachment ``` Causes: Lattice degenerationretinal break Trauma Neoplasm Vascular ``` tx: laser photocoagularion, scleral buckle and cryotherapy
61
What can cause ocular pain?
``` Effects of trauma Corneal abrasion, etc Corneal ulcer Uveitis Angle closure glaucoma ``` --> need to find the cause to treat
62
What is not an urgent condition caused by a tennis ball to the eye?
vertebrobaslar artery insufficiency

neuro exam 1 (21 decks)

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