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HEENT > Refractive Errors, Glaucoma and Cataracts > Flashcards

Refractive Errors, Glaucoma and Cataracts Flashcards

1
Q

Refractive errors include

A

Myopia
Hyperopia
Astigmatism
Presbyopia

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2
Q

Myopia is

A

near sightedness

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3
Q

Hyperopia is

A

Farsightedness

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4
Q

Astigmatism is

A

distorted vision at all distances

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5
Q

Presbyopia is

A

loss of ability to focus up close (reading), usually 40-50 yo

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6
Q

Point of focus is in front of retina: cornea too steeply curved, axial length of the eye too long or both
distant objects are blurred but near objects are seen clearly =

A

Myopia

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7
Q

to correct myopia you need

A

a concave (minus) lens

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8
Q

Point of focus is behind retina, cornea too flatly curved, axial length too short or both
in adults both near and distant objects are blurred

A

Hyperopia

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9
Q

To correct hyperopia you will need

A

a convex (plus) lens

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10
Q

non-spherical (variable) curvature of cornea or lens causes light rays of different orientations to focus at different points

A

astigmatism

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11
Q

To correct astigmatism you need

A

a cylindrical lens

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12
Q

Loss of the lens’ ability to change shape to focus on near objects due to aging
typically becomes noticeable upon reaching early-mid 40s

A

Presbyopia

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13
Q

To correct Presbyopia you need

A

a convex (plus) lens used for correction when viewing near objects, lenses may be supplied as separate glasses or built into a lens as bifocals or variable focus lenses

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14
Q

Treatment of refractive errors

A

eyeglasses
contact lenses
refractive surgery

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15
Q

primary sx of refractive errors is

A

blurred vision for distant/ near or both objects
HA
excessive staring - eye irritation, itching, visual fatigue, FB sensation, redness
Perceived imbalance, dizziness, stumbling

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16
Q

Amblyopia means

A

lazy eye

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17
Q

functional reduction in visual acuity of an eye caused by disuse during visual development - development takes place in first 3yrs of life but not complete until 8 yo
severe loss of vision can occur in affected eye if not detected and treated before 8 yo

A

amblyopia

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18
Q

Treatment of amblyopia

A

eyeglasses or contact lenses
cataract removal
patching
atropine drops
treatment of strabismus if present

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19
Q

Strabismus is

A

misalignment of eyes resulting in different retinal images being sent to visual cortex

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20
Q

most common cause of irreversible central vision loss in older pts

A

AMD - age-related macular degeneration

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21
Q

Two different forms of AMD

A

dry (all AMD starts as dry form) - nonexudative or atrophic
wet - exudative or neovascular

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22
Q

Treatment of AMD

A

dietary supplements, intravitreal injection of antivascular endothelial growth factor drugs, laser photocoagulation, photodynamic, low-vision devices

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23
Q

causes changes of retinal pigment epithelium, typically visible as dark pinpoint areas
accumulation of waste products from rods and cones results in drusen, which appear as yellow spots
no elevated macular scar, edema, hemorrhage or exudation

A

Dry AMD

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24
Q

new abnormal blood vessels develop under the reina, choroidal neovascularization
localized macular edema or hemorrhage may elevate an area of the macula or cause a localized retinal pigment epithelial detachment

A

Wet AMD

25
Q

Wet AMD - Untreated neovascularization will cause

A

a disciform scar under the macula

26
Q

________ usually occurs late and can become severe in Dry AMD

A

central blind spots (scotomas)

27
Q

Dry AMD sxs are usually

A

bilateral

28
Q

Wet AMD sxs are usually

A

unilateral - affects one eye at a time usually

29
Q

Exams for wet AMD

A

color fundus photography = wet AMD
fluorescein angiography = wet AMD

30
Q

Fundoscopic exam will dx both

A

wet and dry AMD

31
Q

Treatment of dry AMD

A

no way to reverse damage
reduce risk of wet AMD taking supplements, reduce CV risk factors (eat foods high in Omega 3 fatty acids and dark green leafy vegetables)

32
Q

Treatment of wet AMD

A

daily nutritional supplements as recommended for dry AMD
intravitreal injection of anti-vascular endothelial growth factor
thermal laser photocoagulation
photodynamic therapy
corticosteroids

33
Q

clouding of the lens (looking through a steamed window) - leading cause of blindness worldwide, leading cause of vision loss in US

A

Cataracts

34
Q

Main sx of Cataracts

A

gradual, painless vision blurring

35
Q

Treatment of Cataracts

A

surgical removal and placement of an intraocular lens

36
Q

_____ use by women after menopause may be protective but should not be used solely for this purpose

A

estrogen

37
Q

early sx of cataracts

A

loss of contrast, glare (halos and starburst around lights), needing more light to see well, problems distinguishing dark blue from black

38
Q

Treatment of Cataracts

A

frequent refractions and corrective lens prescription changes may help maintain useful vision during cataract development
surgical removal of the cataract
placement of intraocular lens - if lens is not implanted, contact lenses or thick glasses are needed to correct

39
Q

Cataracts - indications for surgery include

A

best vision with glasses is worse than 20-40
pt reports that vision is limiting (preventing ADLs)

there is no advantage to removing a cataract early

40
Q

Cataracts - Post-op treatment

A

tapering schedule of topical abx and topical steroids for up to 4 wks
abx may instead be injected into eye at end of surgery
pts wear eye shield while sleeping and should avoid valsalva maneuver, heavy lifting, excessive forward bending, eye rubbing for several wks

41
Q

2nd most common cause of blindness worldwide and 2nd most common cause of blindness in US

A

Glaucoma

42
Q

Most common type of glaucoma in the US is

A

primary, open-angle glaucoma

43
Q

an acquired loss of retinal ganglion cells and axons within the optic nerve (optic neuropathy), that results in a characteristic optic nerve head appearance and corresponding progressive loss of vision
increase in IOP

A

Glaucoma

44
Q

associated with physically obstructed anterior chamber angle, chronic or acute
sx - severe ocular pain and redness, decreased vision, colored halos around lights, HA, nausea, vomiting
IOP is elevated

A

angle - closure glaucoma

45
Q

Angle - closure glaucoma pathophysiology

A

pressure from continued secretion of aqueous into posterior chamber by ciliary body pushes peripheral iris anteriorly
closure blocks aqueous outflow, resulting in rapid and severe elevation of intraocular pressure

46
Q

What are the 5 supplements recommended for AMD treatment

A

Zinc
Copper
Vit C
Vit E
Lutein/zeaxanthin (or beta carotene or vit a)

47
Q

acute angle - closure glaucoma treatment

A

homatropine or systemic meds with potential to dilate pupils

48
Q

if episode of pupillary block resolves spontaneously after several hours, usually after sleeping supine

A

intermittent angle - closure glaucoma

49
Q

if angle narrows slowly, allowing scarring between peripheral iris and trabecular meshwork, IOP elevation is slow

A

chronic angle-closure glaucoma

50
Q

mechanical obstruction due to coexisting condition, contraction of neovascular membrane or inflammatory scarring can pull iris into angle

A

secondary angle - closure

51
Q

Severe ocular pain and redness, decreased vision, colored halos around lights, HA, nausea, vomiting
systemic complaints may be so severe that misdiagnosed as neurologic or gastrointestinal problem

A

acute angle - closure glaucoma

52
Q

acute angle - closure treatment

A

laser peripheral iridotomy (LPI)
opens another path to pass fluid from posterior to anterior chamber

53
Q

chronic angle - closure treatment

A

LPI

54
Q

syndrome of optic nerve damage associated with open anterior chamber angle and elevated or sometimes average IOP

A

primary open-angle glaucoma

55
Q

Treatment for primary open-angle glaucoma

A

topical drugs (prostaglandin analogs, beta blockers) open requires laser or incisional surgery to increase aqueous drainage

56
Q

Sx of open-angle glaucoma

A

result of visual field loss, both eyes usually affected but not usually equally

57
Q

Open-angle glaucoma pathophysiology

A

aqueous humor drainage in inadequate but production by ciliary body is normal

58
Q

Open-angle treatment

A

drug therapy, then laser therapy, then incisional surgery if target IOP is not/ cannot be met

HEENT (7 decks)

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