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Ophthalmology Test 2 > Posterior Chamber Disorders > Flashcards

Posterior Chamber Disorders Flashcards

1
Q

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

Retinal Detachment Predisposing factors

A 
Age – 50-75
Myosis
Cataract extraction
Trauma
Family history
Advanced diabetes
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3
Q

Retinal Detachment Signs and Symptoms

A

Blurred vision in one eye, progressively worse
Floaters (photopsias)
Move about vision
Sometimes described as “ a large horsefly”
Flashing lights
Last less the a second
Cause by the tugging on the retinal surface by the separating vitreous

NO PAIN, NO REDNESS

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4
Q

Retinal Detachment Treatment

A

Cryotherapy (freezing)
Scleral buckle
Intravitral gas
Vitrectomy

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5
Q

Central Retinal Artery Occulsion (CRAO)

A

Emboli enter and occlude the retinal artery

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6
Q

Central Retinal Artery Occulsion (CRAO) Predisposing factors

A 
Age – mean is 60-80, can happen earlier
Carotid artery disease
Atrial fibrillation
Hypertension
Diabetes
Temporal Arteritis
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7
Q

Central Retinal Artery Occulsion (CRAO) Signs and Symptoms

A

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

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8
Q

Central Retinal Artery Occulsion Fundascope exams reveals

A

Pallor of the optic disc
Ischemic retinal whitening
Cherry red spot on macula or fovea
Arteriole narrowing
“boxcar” segmentation of the retinal veins
Marked afferent pupillary defect = 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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9
Q

Central Retinal Artery Occulsion (CRAO) Treatment

A

Very poor prognosis for vision (particularly if not resolved within 90 minutes)
REFER immediately

Ocular massage
Anterior chamber paracentesis
Revasularization techniques
Thrombolysis

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10
Q

Central Retinal Vein Occlusion Etiology

A 
Systemic etiologies:
Increasing age
HTN
Coagulation disorders
Diabetes
Ocular etiologies:
Raised intraocular pressure (> 25 mmHg)
vein inflammation (vasculitis)
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11
Q

Central Retinal Vein Occlusion Signs and Symptoms

A

Visual impairment is commonly first noticed upon waking
Usually a sudden monocular loss of vision
PAINLESS
Diagnosis can be made with ophthalmoscopic exam
Refer ALL to ophthalmologist

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12
Q

Central Retinal Vein Occlusion Fundoscopic exam

A 
(WHAT differs CRAO and CRVO)
Minimal APD
venous tortuosity / dilatation
Retinal hemorrhages
variable cotton-wool spots 
mild to moderate disc edema
macular edema
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13
Q

Amaurosis Fugax

A

Monocular loss of vision lasting a few minutes with complete recovery
Usually caused by retinal emboli from ipsilateral carotid disease
Visual loss is usually 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”
MUST have evaluation of carotids by doppler ultrasound or CT/MRI angiography
ALL MUST also have EKG to ensure A. Fib is not cause of emboli
In ALL CASES, place them on low dose ASA

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14
Q

Amaurosis Fugax Labs

A

CBC
Fasting blood sugar
ESR and CRP (C reactive protein)
Lipid profile

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15
Q

Optic neuritis Etiology

A 
Multiple sclerosis (MS)
optic neuritis is often the initial manifestation of MS
30% risk at 5 years
Check MRI - consider IV steroids
Idiopathic
Viral infections, TB, sarcoidosis
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16
Q

Optic neuritis Signs and Symptoms

A

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

17
Q

Optic neuritis Fundoscope exam

A

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

18
Q

Optic neuritis treatment

A 
Complete ophthalmic exam 
pupils!!
color vision
decreased light brightness sensitivity with penlight
visual field test

Complete neurologic exam / MRI & possible IV steroids
Do NOT use oral steroids - MALPRACTICE!!!
Check BP
ESR / CRP/ TA bx if suspect Giant Cell Arteritis (if >55 y/o)

19
Q

Papilledema Etiology

A 
Intracranial tumors
Hydrocephalus
Pseudotumor (fat fertile females)
Subdural hematoma (trauma)
Brain abscess / Meningitis
20
Q

Papilledema signs and symptoms

A

Slow vision loss from increased ICP / optic nerve swelling

Can have acute attacks of vision loss when lying flat

21
Q

Giant cell arteritis (GCA)-Temporal Arteritis signs and symptoms

A 
Patients >55 years old
Sudden, non-progressive visual loss
Headache, eye pain
Scalp tenderness
Jaw claudication
Fever
Weight loss
Polymyalgia rheumatica association (Muscle and joint aches)
22
Q

Giant cell arteritis (GCA)Temporal Arteritis Labs

A

ESR (sed rate)
CRP (C-reactive protein)
ESR>47 and CRP>2.45 is 97% specific
Go by SYMPTOMS; ESR & CRP can be NORMAL in 20% of patients

23
Q

Giant cell arteritis (GCA)Temporal Arteritis Exe fundoscopic exam

A

+ RAPD

Pale, swollen optic disc

24
Q

Giant cell arteritis (GCA)Temporal Arteritis Treatment

A

Treat with steroids even before biopsy is done
DON’T WAIT FOR BIOPSY IF SUSPICIOUS
Treatment is to preserve visual loss in other eye
risk to the fellow eye of significant visual loss without TX
a. 30% in 24 hours
b. 30% in 1 week
c. 30% in 1 month
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

25
Q

Age Related Macular Degeneration

A

“wearing out” of retina / photoreceptors
Degradation products form “drusen” in retina
Rare before age 50
More common in Caucasians

26
Q

Age Related Macular Degeneration Risk Factors

A 
Age
Smoking (2x higher)
Family history
Caucasian
sun exposure
?diet
?HTN
?atherosclerosis
?cataract surgery
27
Q

Age Related Macular Degeneration-Dry

A 
90%
Gradual vision loss
Drusen bodies
Pt complaints:
gradual loss of vision in one or both eyes
28
Q

Age Related Macular Degeneration-Wet

A

10%
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.

29
Q

Age Related Macular Degeneration Treatment

A

antioxidants may prevent cellular damage in the retina by limiting the damaging effects of free radicals produced in the process of light absorption.
Vitamin C 500mg
Vitamin E 400 IU
Beta carotene 15 mg (non-smokers only)
Risk of lung CA associated with beta carotene
Zinc 80mg
Copper 2 mg

Ophthalmology Test 2 (6 decks)

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