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OD 2 > Topic A3 > Flashcards

Topic A3 Flashcards

1
Q

What are the classifications of Optic Neuropathy

By cause

A

1) Inflammatory - Optic Neuritis + demylinating, parainfectious,infectious, non-infectious & neuroretinitis
2) Glaucomatous - various types of glaucoma
3) Ischaemic
- Anterior non-arteritic
- Anterior arteritic
- Posterior Ischaemic
- Diabetic Papillopathy
4) Hereditary
- Leber hereditary optic neuropathy
- Other hereditary optic neuropathies
5) Nutritional & Toxic
- Ethamnutol
- Vigabatrin
- Amiodarone
6) Papilloedema - secondary to raised ICP
7) Traumatic - Traumatic optic neuropathy
8) Compressive - including secondary to an orbital lesion
9) Infiltrative
- Inflammatory conditions such as sarcodosis
- Tumours
- Infective agents

ICP - Intra-cranial pressure

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2
Q

State cause & what it is to be differentiated from

What is Papilledema?

A

OD oedema which is secondary to elevated ICP
** Differentiate the OD oedema from other causes
Papilledema vs pseudo-papilledema
- ^presence of OD drusen
- usually bilateral

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3
Q

What are the symptoms of papilledema?

A

1) HA early morning + wakes px up from sleep
- more intense w head movement, bending & coughing
2) Transient Vision Loss - due to postural changes
3) No initial vision complaints
4) Sudden nausea & vomiting

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4
Q

What are the symptoms in the EARLY stage of papilledema?

A

1) Blurred disc margins
2) Swollen hyperaemic disc
3) Paton’s lines/folds
4) Dilation of superficial capillaries

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5
Q

VA+Fundus features

What are the symptoms in the ACUTE stage of papilledema?

A

1) Normal/Reduced VA
2) Severe disc hyperaemia
3) Moderate elevation w indistinct margins & absence of physiological cup (OD not in a defined shape)
4) Venous Engorgement
5) CWS
6) Flame-shaped haemorrhages
7) ONH appears enlarged as swelling increases
8) Paton lines (circumferential retinal folds)
9) Enlarged blind spot

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6
Q

What are the symptoms in the CHRONIC stage of papilledema?

A

1) VA is variable
2) Disc elevation w/o CWS or haemorrhages
3) Nerve fibre loss

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7
Q

What are the symptoms in the ATROPHIC stage of papilledema?

A

1) VA severely impaired
2) Prolonged raised ICP
3) Gross nerve fibre loss
4) Lesser disc swelling
5) Optic disc pallor
6) Optic atrophy (6-8wks)
7) Poor visual function

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8
Q

What is Spontaneous Venous Pulsations (SVP)?

**One of the symptoms for Papilledema

A

It is the pulsations caused by variations in the pressure gradient along the retinal vein as it travels through the lamina cribrosa.

**Differences in pulse pressure is because
1) Intraocular space
2) Cerebrospinal fluid

Normally occurs to 80% of the population as well.

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9
Q

What is the management for papilledema?

A

1) Urgent referral to neurologist / neuro-ophthalmologist
- CT scan
- Brain MRI
2) Differentiate from psuedopapilledema

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10
Q

What is Optic Neuritis/Papillae?

A

Swelling of the OD caused by local inflammation - associated w demyelination of axons = multiple sclerosis

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11
Q

What are the causes of optic neuritis/papillae?

A

Children:
- Mumps
- Meningitis
- Chicken Pox
- Upper respiratory tract infections

Adults:
- Viral Infection
- Toxoplasmosis

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12
Q

What are the signs & symptoms of Optic Neuritis/Papillae?

A

1) Mild/severe pain in or behind eye = vision loss in 1-2 days
2) Loss of vision to 6/18-6/60 = lasts 2-4 weeks
3) Usually unilateral
4) Age typically 18-45 years
5) Swollen & hyperemic disc but w lesser haemorrhage & CWS than papilledema
6) May have macular star
7) RAPD
8) Colour desaturation
9) Central Scotoma
10) May have cells in the vitreous

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13
Q

What is the management for Optic Neuritis/papillitis?

A

1) Urgent referral to a neurologist/neuro-ophthalmologist
2) Intravenous steroids

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14
Q

What is NAION?

A

Non-arteritic anterior ischemic optic neuropathy
This disease occurs due to occlusion of the short posterior ciliary arteries which leads to
partial/total infarction of ONH.

Infarction = obstruction of blood supply to an organ or a region of tissue

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15
Q

What conditions make it prone for people to get NAION?

A

1) small physiological cupping
2) Hypertension
3) DM
4) Usually >50 y/o

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16
Q

What are the signs & symptoms of NAION?

A

1) Sudden painless monocular visual loss, frequently on awakening
2) VA normal OR slightly reduced in about 30% of px
3) Moderate to severe visual impairment in the remaining 70% of px
4) VF defects = usually inferior altitudinal
5) CV defect proportional to the level of visual impairment
6) Diffuse/sectoral hyperemic disc swelling = often comes with splinter haemorrhage

17
Q

What is the management for NAION?

A

1) Immediate referral
2) Treatment
- No definitive treatment
- Some advocate short-term systemic steroid treatment

18
Q

What is AANION?

A

Arteritic Anterior Ischemic Optic Neuropathy

  • It is the ocular manifestion due to Giant Cell Arteritis (GCA).
  • Usually occurs in px >55 y/o
  • HA
  • Jaw claudication = pain with chewing
  • Scalp tenderness esp over superficial temporal arteries (tenderness while combing hair)
  • Proximal muscle & joint aches
  • aneroxia, weight loss
  • fever
19
Q

What are the signs & symptoms of AAION?

A

1) Sudden painless loss of vision usually to CF (severe loss)
2) Unilateral first & then progresses to bilateral within days
3) Optic disc pallor & oedema w surrounding flame-shaped haemorrhage
4) VF defect
5) RAPD
6) Colour desaturation
7) Optic atrophy within 4-8 weeks
8) Prognosis is poor where vision loss is usually permanent

20
Q

** What is GCA?

A

Giant Cell Arteritis
It is the swelling & thickening of the small artery under the skin around temporal artery

  • caused by inflammation in the arteries
  • affects px >50 y/o
  • this causes head pain, jaw pain & vision problems
  • closely linked w polymyalgia rheumatica
    **polymyalgia rheumatica = causes muscle pain & stiffness esp around the shoulders
21
Q

What is the management for AAION?

A

1) Immediate referral
2) Medical emergency in ophthal. in order to prevent further vision loss
- Erythrocyte Sedimentation Rate (ESR) - to test for inflammation & rule out GCA
- Temporal artery biopsy
- Cortiocosteroids
- Treatment done to prevent progression to fellow eye

22
Q

What is RAPD?

A

Relative Afferent Pupillary Defect

1) Marcus Gunn Response
2) Determined by “swinging flashlight test”
3) Causes: (Any optic nerve disease)
- Optic Neuritis/Papillitis
- Unilateral optic neuropathies
- Severe glaucoma
- Optic Nerve damage due to trauma, tumour & infections
4) any large/severe retinal lesions
such as;
- large RD
- CRVO
- CRAO

23
Q

Give a brief explanation on what is done during the swinging flashlight test and what is observed in a px w (+) RAPD

A

1) Light is shone in the RE first & both eyes CONSTRICT
2) Light is then shone in the LE & both eyes DILATE
3) Light is shone back to the RE & both eyes CONSTRICT

24
Q

What are the signs & symptoms of Adie’s (tonic) pupil?

A

1) Unilateral & dilated pupil w low response to light
2) Sluggish near response
3) Dilated pupil becomes miotic over time
4) usually occurs in women b/w the age of 20-40 y/o
5) Photophobia
6) Asthenopia (Eyestrain)

25
Q

What happens during the pharmacological testing for Adie’s pupil?

A

Diluted 0.125% pilocarpine eye drops in administered
A rapid miotic response will be seen in the affected eye

26
Q

What are the causes of Adie’s pupil?

A

1) Denervation of postganglionic supply to the sphincter pupillae & the ciliary muscle due to viral illness
2) Mostly idiopathic although rarely there can be local disorders within order including tumour, inflammation & trauma

**Idiopathic - unknown

27
Q

What is the management for Adie’s pupil?

A

1) Most px don’t need treatment if diagnosis is confirmed
2) Unequal near additions
3) Tinted lenses

28
Q

What is the management for Adie’s pupil?

A

1) Most px don’t need treatment if diagnosis is confirmed
2) Unequal near additions
3) Tinted lenses

29
Q

What are the signs & symptoms of Horner’s Syndrome?

A

1) Usually unilateral
2) Mild ptosis
3) Miosis resulting from unopposed action of sphincter pupillae
- anisocoria is hence greatest in dim illumination as Horner’s pupil does not dilate well
4) Reduced sweating in one side of the head in some cases
5) Hypochromic heterochromia = congenital/long-standing
6) Normal reaction to light to near reflexes

30
Q

What happens during the pharmacological testing for Horner’s Syndrome?

A

1) One drop of 0.5%/1.0% apraclonidine instilled in both eyes
- Horner’s pupil = Dilates
- Normal pupil = Not affected

2) One drop of 4% of cocaine instilled in both eyes
- Horner’s pupil = Not affected
- Normal pupil = Dilates

31
Q

What are the causes for Horner’s Syndrome?

A

Lesion in sympathetic pathway to the eye

1) Central (1st order neuron)
- Stroke
- Tumour
2) Pre-ganglionic (2nd order neuron)
- Tumour
- Neuroblastoma in children
3) Post-ganglionic (3rd order neuron)
- Migraine
- Trauma
- Carotid disease
- Cavernous sinus tumour

32
Q

What is the management for Horner’s Syndrome?

A

Refer IMMEDIATELY to rule out any major causes

OD 2 (8 decks)

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