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Opthalmology > Posterior Chamber and Retinal Disorders > Flashcards

Posterior Chamber and Retinal Disorders Flashcards

1
Q

Describe what happens with a retinal detachment

A

Primary event is a retinal tear. Fluid vitreous passes though the tear and lodges behind the sensory retina.Combined traction and pull of gravity results in progressive detachment.

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2
Q

What are predisposing factors of retinal detachment?

A

Age – 50-75. Myosis. Cataract extraction. Trauma

Family history. Advanced diabetes

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3
Q

What are signs and symptoms of a retinal detachment?

A

Blurred vision in one eye, becoming progressively worse. Floaters, sometimes described as a large horsefly (photopsias). Flashing lights- caused by the tugging on the retinal surface by the separating vitreous (significant indicator).

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4
Q

What are treatments of retinal detachment?

A

Cryotherapy (freezing). Scleral buckle. Intravitral gas. Vitrectomy

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5
Q

Describe what happens with a central retinal artery occlusion.

A

Emboli enter and occlude the retinal artery

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6
Q

What are predisposing factors to a central retinal artery occlusion?

A

Age – mean is 60-80. Carotid artery disease. Atrial fibrillation. Hypertension. Diabetes. Temporal Arteritis

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7
Q

What are signs and symptoms of a central retinal artery occlusion?

A

Sudden profound monocular visual loss, Can be preceded by amarousis fugax, Painless, Can detect hand movements but can’t count fingers

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8
Q

What does a fundascopic exam show with central retinal artery occlusion?

A

Ischemic retinal whitening. Cherry red spot on macula or fovea. Arteriole narrowing. “boxcar” segmentation of the retinal veins.Marked afferent pupillary defect

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9
Q

What is a marked afferent pupillary defect?

A

When a light is shone in the abnormal eye of a patient with an APD, the pupil of the affected eye paradoxically dilates rather than constricts

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10
Q

What is treatment of central retinal artery occlusion?

A

Ocular massage. Anterior chamber paracentesis.

Revasularization techniques-Thrombolysis

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11
Q

What are systemic etiologies that are predisposing factors to a central retinal vein occlusion?

A

Increasing age. HTN. Coagulation disorders. Diabetes

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12
Q

What are ocular etiologies that are predisposing factors to a central retinal vein occlusion?

A 
Raised intraocular pressure (> 25 mmHg)
vein inflammation (vasculitis)
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13
Q

What are signs and symptoms of central retinal vein occlusion?

A

Visual impairment is commonly first noticed upon waking. Usually a sudden monocular loss of vision
PAINLESS

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14
Q

What does a fundoscopic exam reveal for a central retinal vein occlusion?

A 
Minimal AfferentPupillaryDefect (APD). venous tortuosity / dilatation. Retinal hemorrhages. variable cotton-wool spots. mild to moderate disc edema.
macular edema
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15
Q

What do patients who have a central retinal vein occlusion need to also be screened for?

A

diabetes, systemic HTN, hyperlipidemia and glaucoma.

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16
Q

What are patients who have a central retinal vein occlusion at high risk of developing?

A

neovascular glaucoma / proliferative retinopathy ~ 3 months later

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17
Q

What is amaurosis fugax?

A

Monocular loss of vision described as “a curtain passing VERTICALLY across the field of vision leading to complete loss of vision and then a similar curtain effect as the vision returns” lasting a few minutes with complete recovery

18
Q

What is the usual cause of amaurosis fugax?

A

retinal emboli from ipsilateral carotid disease

19
Q

What further testing should be done for amaurosis fugax?

A

evaluation of carotids by doppler ultrasound or CT/MRI angiography, have EKG to ensure A. Fib is not cause of emboli

20
Q

What is treatment for amaurosis fugax?

A

low dose ASA,Ocular massage is <24 hours, Lower IOP

21
Q

What are differential diagnoses of amaurosis fugax?

A

Impending central retinal artery/vein occlusion. Impending OPHTHALMIC artery occlusion. Carotid stenosis. Temporal arteritis. Ocular migraine

22
Q

What labs should be done for amaurosis fugax?

A

CBC. Fasting blood sugar. ESR and CRP. Lipid profile

23
Q

When should you suspect optic neuritis?

A

young patient with vision loss and no immediately obvious exam findings

24
Q

What are signs and symptoms of optic neuritis?

A

Unilateral decreased vision over 1-3 days. Occasional pain with eye movement. Age 18-45 female

25
Q

What are possible etiologies of optic neuritis?

A

MS, idiopathic, viral infections, TB, sarcoidosis

26
Q

What does a fundoscopic exam of optic neuritis reveal?

A

Optic nerve usually has a normal appearance acutely. Can have swollen disc. Relative afferent pupillary defect (RAPD). Decreased color vision. May get worse with exercise or temperature increase (Uhtoff’s sign).

27
Q

What are the differential diagnoses of optic neuritis?

A

Ischemic optic neuropathy, papilledema, severe HTN, intraorbital or intracranial mass, toxic (ETOH, heavy metals, malnutrition)

28
Q

What is work up and treatment of optic neuritis?

A

Complete ophthalmic exam, Complete neurologic exam / MRI & possible IV steroids, ESR / CRP/ TA bx. check BP. No oral steroids

29
Q

What are the possible etiologies of papilledema?

A

Intracranial tumors. Hydrocephalus. Pseudotumor (young, obese females). Subdural hematoma (trauma). Brain abscess / Meningitis

30
Q

What are signs and symptoms of papilledema?

A

Slow vision loss from increased ICP / optic nerve swelling. Can have acute attacks of vision loss when lying flat. Bilateral. Blurred disc margins. Peripapillary disc hemorrhages. Double vision

31
Q

What is treatment for papilledema?

A

treat underlying cause

32
Q

What are signs and symptoms of temporal arteritis?

A

Patients >55 years old. Sudden, painless, non-progressive visual loss. Headache. Scalp tenderness. Jaw claudication*. Fever. Weight loss.
Polymyalgia rheumatica association

33
Q

What does a fundoscopic exam reveal for temporal arteritis?

A

+ RAPD. Pale, swollen optic disc

34
Q

What labs should be done for temporal arteritis GCA)?

A

ESR (sed rate) and CRP (C-reactive protein).

ESR>47 and CRP>2.45 is 97% specific

35
Q

What makes the definitive diagnosis for temporal arteritis (GCA)?

A

Temporal artery biopsy

36
Q

What does histology show with temporal arteritis (GCA)?

A

granulomatous infiltrate of internal elastic lamina of artery. occlusion of vessel lumen. giant cells present

37
Q

What is treatment for temporal arteritis (GCA)?

A

Treat with steroids even before biopsy is done. if no / mild visual symptoms:60-90mg Prednisone po qd.
if severe symptoms or visual loss:1gm Solumedrol IV q 6 hrs x 3-5 days, then SLOW taper off oral steroids over 2 weeks

38
Q

What happens with age related macular degeneration?

A

“wearing out” of retina / photoreceptors. Degradation products form “drusen” in retina. two types: dry and wet

39
Q

What are risk factors for age related macular degeneration?

A

Age. Smoking (2x higher). Family history. Caucasian. sun exposure.?diet. ?HTN. ?atherosclerosis. ?cataract surgery

40
Q

Describe dry ARMD

A

Gradual vision loss and Drusen. Pt complaints:

gradual loss of vision in one or both eyes

41
Q

Describe wet ARMD

A

Sudden vision loss. Subretinal neovascularization
Accumulation of fluid and blood. Patient complaints:
Acute distortion in vision, especially distortion of straight lines, or loss of central vision. Symptoms usually appear in one eye, although the disease is generally in both eyes.

42
Q

What is treatment of ARMD?

A

antioxidants may prevent cellular damage in the retina by limiting the damaging effects of free radicals: vitamin C 500mg, vitamin E 400IU, beta carotene 15mg, Zn 80mg, Copper 2mg

Opthalmology (9 decks)

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