Posterior Chamber DIsorders

Question 1

Retinal detachment

Answer 1

• Primary event is retinal tear
• Vitreous fluid passes through tear and lodges behind the sensory retina.
• Retina progressively detaches.

Question 2

Predisposing retinal detachment factors

Answer 2

Age:  50-75
Myosis
Cataract extraction
Trauma
Family history
Advanced diabetes

Question 3

Retinal detachment S/S

Answer 3

• Blurred vision in one eye
• Floaters, move about vision
• Flashing lights
• No pain or redness

Question 4

Central Retinal Artery Occlusion (CRAO)

Answer 4

An embolism that enters and occludes the retinal artery

Question 5

CRAO predisposing factors

Answer 5

Old age
Carotid artery disease
A-fib
HTN
Diabetes
Temporal Arteritis

Question 6

CRAO S/S

Answer 6

Sudden profound monocular vision loss
Painless
Can detect hand movements, but cant count fingers

Question 7

Main fundascopic exam finding in CRAO

Answer 7

Pallor of the optic disc
Inchemic retinal whitening
Cherry red macula
Marked afferent pupillary defect

Question 8

CRAO prognosis

Answer 8

Very poor vision prognosis if not resolved within 90 minutes.
REFER!

Question 9

Central Retinal Vein Occlusion

Answer 9

An occlusion of the central vein that results in vision loss. Painless.
Refer to an optho

Question 10

A Pt with a central retinal artery occlusion should be screened for?

Answer 10

Diabetes, HTN, Hyperlipidemia and Glaucoma

Question 11

Amaurosis Fugax

Answer 11

Monocular loss of vision lasting a few minutes with a complete recovery
Characterized by a curtain closing vertically over the visual field, and a similar curtain opening.

Question 12

What must be evaluated in patients with amaurosis fugax?

Answer 12

• Doppler ultrasound of carotids
• EKG to R/O A.fib
• Labs

Question 13

Amaurosis Faux Tx

Answer 13

Refer
Ocular massage
Lower IOP
Low dose ASA

Question 14

Optic Neuritis

Answer 14

Generally occurs in young females and is an early sign of MS.
Unilateral decrease in vision over 1-3 days
Loss of color vision

Question 15

How to pupils appear in optic neuritis?

Answer 15

Relative afferent pupillary defect (RAPD)

Question 16

Should oral steroids be given to patients with optic neuritis?

Answer 16

NO, push IV steroids. Oral steroids are malpractice for some reason…

Question 17

Papilledema

Answer 17

Optic disc swelling due to increased intracranial pressure.

• Tumors
• Subdural hematoma
• Brain abscess, meningitis

Question 18

Papilledema S/S

Answer 18

Slow vision loss from ICP/optic nerve swelling
Acute attacks of blindness while lying flat
Usually bilateral
disc margins blurred

Question 19

Giant cell Arteritis - Temporal Arteritis

Answer 19

Sudden, painless nonprogressive vision loss.
HA, scalp tenderness
Jaw claudication
Patients >55

Question 20

GCA findings

Answer 20

+ RAPD
Pale, swollen disc
Get Labs

Question 21

GCA Tx

Answer 21

Treat with steroids (do not wait for biopsy)

Refer to surgery

Question 22

Age Related Macular Degeneration (ARMD)

Answer 22

10% of elderly have it
Wearing out of the retina and photoreceptors
More common in caucasians

Question 23

Dry ARMD

Answer 23

Gradual vision loss

Drusen

Question 24

Wet ARMD

Answer 24

Sudden vision loss
subretinal neovascularzation
Accumulation of fluid and blood
Acute distortion in vision

Question 25

ARMD Tx

Answer 25

Control CVD
DIet high in fruits and veggies
Antioxidants
Stop smoking
MOnitor vision with amsler grid