Posterior Chamber DIsorders Flashcards
Retinal detachment
- Primary event is retinal tear
- Vitreous fluid passes through tear and lodges behind the sensory retina.
- Retina progressively detaches.
Predisposing retinal detachment factors
Age: 50-75 Myosis Cataract extraction Trauma Family history Advanced diabetes
Retinal detachment S/S
- Blurred vision in one eye
- Floaters, move about vision
- Flashing lights
- No pain or redness
Central Retinal Artery Occlusion (CRAO)
An embolism that enters and occludes the retinal artery
CRAO predisposing factors
Old age Carotid artery disease A-fib HTN Diabetes Temporal Arteritis
CRAO S/S
Sudden profound monocular vision loss
Painless
Can detect hand movements, but cant count fingers
Main fundascopic exam finding in CRAO
Pallor of the optic disc
Inchemic retinal whitening
Cherry red macula
Marked afferent pupillary defect
CRAO prognosis
Very poor vision prognosis if not resolved within 90 minutes.
REFER!
Central Retinal Vein Occlusion
An occlusion of the central vein that results in vision loss. Painless.
Refer to an optho
A Pt with a central retinal artery occlusion should be screened for?
Diabetes, HTN, Hyperlipidemia and Glaucoma
Amaurosis Fugax
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.
What must be evaluated in patients with amaurosis fugax?
- Doppler ultrasound of carotids
- EKG to R/O A.fib
- Labs
Amaurosis Faux Tx
Refer
Ocular massage
Lower IOP
Low dose ASA
Optic Neuritis
Generally occurs in young females and is an early sign of MS.
Unilateral decrease in vision over 1-3 days
Loss of color vision
How to pupils appear in optic neuritis?
Relative afferent pupillary defect (RAPD)
Should oral steroids be given to patients with optic neuritis?
NO, push IV steroids. Oral steroids are malpractice for some reason…
Papilledema
Optic disc swelling due to increased intracranial pressure.
- Tumors
- Subdural hematoma
- Brain abscess, meningitis
Papilledema S/S
Slow vision loss from ICP/optic nerve swelling
Acute attacks of blindness while lying flat
Usually bilateral
disc margins blurred
Giant cell Arteritis - Temporal Arteritis
Sudden, painless nonprogressive vision loss.
HA, scalp tenderness
Jaw claudication
Patients >55
GCA findings
+ RAPD
Pale, swollen disc
Get Labs
GCA Tx
Treat with steroids (do not wait for biopsy)
Refer to surgery
Age Related Macular Degeneration (ARMD)
10% of elderly have it
Wearing out of the retina and photoreceptors
More common in caucasians
Dry ARMD
Gradual vision loss
Drusen
Wet ARMD
Sudden vision loss
subretinal neovascularzation
Accumulation of fluid and blood
Acute distortion in vision
ARMD Tx
Control CVD DIet high in fruits and veggies Antioxidants Stop smoking MOnitor vision with amsler grid