Trans 008 Aging Eye And Systemic Diseases

Question 1

❛ is caused when the normal drainage system of the eye becomes suddenly blocked, causing pressure to build within the eye at a very rapid rate. Complete blindness (when left untreated) can occur in as little as 3 to 5 days! ❜
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Answer 1

Angle closure glaucoma

Question 2

Symptoms of angle closure glaucoma

Answer 2

❛ • Symptoms 
o Severe pain 
o Pressure over the eye
 o Cloudiness to the cornea  Para syang katulad sa mata ng isda 
o Eye extremely sensitive to light 
o Halos seen around lights  Mas common daw
 o Nausea and/or vomiting ❜
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Question 3

Risk factors for angle closure glaucoma

Answer 3

❛ o Patients with a family history of Glaucoma o African Americans o Patients suffering from Myopia o Patients suffering from Diabetes o People over 35 years of age ❜
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Question 4

❛ occurs when there is damage to the Optic nerve detected in patients who have completely ❜
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❛ normal Inter-Occular pressure. It has the same characteristics as Primary Open-Angle Glaucoma ❜
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Answer 4

❛ Normal tension glaucoma ❜

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Question 5

❛ Primary Open Angle Glaucoma ❜
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Versus ❛ Angle-Closure Glaucoma ❜
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How to differentiate

Answer 5

❛ Primary Open Angle Glaucoma- no symptoms because the pressure is about 30-40. So if the pressure is above 21 up to 35, usually you feel no pain in the eye, depende na lang sa pain tolerance (threshold) ng patient. Pero usually ang pressure is about 25-30 the patient doesn’t feel any pain but it already causing damage to the optic nerve. Matagal mag progress ang primary open angle glaucoma coz pressure is not enough to cause damage to the optic nerve optic nerve damage coz mababa lang yung pressure. Angle-Closure Glaucoma- there’s a sudden rise, usually umaabot yan ng 60 or higher, talagang sasakit mata, nausea and vomiting. ❜
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Question 6

❛ is gently pressed against the eyeball, and the resistance (internal pressure) is measured. This requires that the eye be numbed prior to the test. ❜
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❛ Most commonly used to screen. ❜
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Answer 6

❛ Tonometry ❜

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Question 7

❛ can be used to determine if the angle where the iris meets the cornea is open or closed. ❜
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Answer 7

❛ Gonioscopy ❜

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Question 8

❛ is an essential method used to determine if there is any loss of the visual field. ❜
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Answer 8

❛ Perimetry ❜

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Question 9

❛ performed to determine if there is abnormal cupping in the optic nerve head. ❜
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Answer 9

❛ Stereodisc photography of the optic disk ❜

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Question 10

❛ is the most recent advancement in technology that aids in the diagnosis of Glaucoma. ❜
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Answer 10

❛ Measurement of Retinal Nerve Fiber Layer thickness ❜

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Question 11

❛ More modern way to diagnose glaucoma is ❜
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❛ This is a machine that uses laser light to measure the thickness of any eye tissue inside the eye.

This measures the retinal nerve fiber layer (RNFL) thickness ❜
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Answer 11

❛ Optical Coherence Tomography (OCT). ❜

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Question 12

Management of glaucoma.

Answer 12

❛ o Medications- are available in several forms.

o Laser Surgery- can reduce the need for medications o Filtration Surgery- creates a new drainage channel ❜
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❛ Mostly, in glaucoma, the eye problem is the pressure. So management focuses more on lower down the pressure. ❜
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Question 13

4 main types of eye drops used in glaucoma

Answer 13

1. Reduces inflow/production
   A. Beta blocker: reduces the production of AH by the ciliary bodies.
2. Improve outflow
   B. Alpha agonist: increases the uveal outflow of AH
   C. Carbonic anhydrous inhibitors: increases the absorption going into the venous system
   D. Prostaglandin agonist: increases uveal outflow of AH

Question 14

❛ If topical treatment is not enought to stop progression ❜
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We do what?

Answer 14

Laser iridotomy

Question 15

If medication and laser does not stop the progression, the danger of losing eyesight, last resort is surgery.

Answer 15

surgery.

Question 16

Which needs

Laser iridotomy, primary open angle or angle closure?

Answer 16

Primary open angle- topical medications, laser will not do anything kasi it is open already.
 Angle closure/narrow angle- laser iridotomy + w/wo medications.

Question 17

Difference between macular degeneration, cataract, glaucoma.

Answer 17

Macular degenaration- involves the retina
 Cataract- involves the lens
 Glaucoma- involves the optic nerve

Question 18

Initial symptoms of mace desat Sheraton

Answer 18

Initial symptoms
o Straight lines appear wavy
o Blurryvision
o Distortedvision
o Objects may appear as the wrong shape or size
o Adarkemptyareainthecentreofvision(centralscotoma
in severe)

Question 19

Metamorphpsia

Answer 19

straight lines becomes wavy or distorted,

early signs.

Question 20

What type of age related macular degeneration

Accounts for about 90% of all cases
• Also called atrophic, non-exudative or drusenoid macular
degeneration
• Clinically, dry AMD may manifest:
o Stage of drusen and/or hyperpigmentation
o Stageofincipientatrophy(nongeographicatrophy) o Stage of geographic atrophy

Answer 20

NON-EXUDATIVE AMD (NON-NEOVASCULAR DRY)

Question 21

assesss distorted or reduced vision and

small irregularities in the central field of vision.

Answer 21

Amsler grid test:

Question 22

is the most critical risk factor for the development and progression of diabetes associated retinopathy

Answer 22

Poor glyccemic control

Question 23

Leading cause of blindness in diabetic retinopathy

Answer 23

❛ MACULOPATHY ❜

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Question 24

Classification of diabetic retinopathy

Answer 24

❛ Non proliferative diabetic retinopathy (NPDR/BDR) ❜
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❛ Preproliferative diabetic retinopathy ❜
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❛ Proliferative diabetic retinopathy ❜
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❛ Maculopathy ❜
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Question 25

What classification of diabetic retinopathy

▪ Microaneurysm ▪ Dot and blot hemorrhages ▪ Hard (intra-retinal) exudates

Answer 25

Non proliferative diabetic retinopathy (NPDR/BDR)

Question 26

▪ Venous dilation ▪ Dark blot hemorrhages what diabetic retinopathy

Answer 26

Preproliferative diabetic retinopathy

Question 27

▪ Neovascularization of the retina, optic disk or iris ▪ Late DR- fibrovascular proliferation what diabetic petropatus

Answer 27

Proliferative diabetic retinopathy

Question 28

are focal dilatations of retinal capillaries appear as red dots.

• They are usually seen at the posterior pole, especially temporal to the fovea.

Answer 28

MICROANEURYSMS

Question 29

are yellow deposits oof lipid and protein within the sensory retina.

• Accumulations of lipid leak from surrounding capillaries and microaneurysms, they may form a circinate pattern.

Answer 29

HARD EXUDATES (Intra retinal lipid exudates)

Question 30

result from occulusion of retinal precapillary arterioles supplying the nerve fiber layer with concomitant swelling of local nerve fiber axons.

• Also calles “soft exudates”or “nerve fiber layer infarctions” they are white, fluffy lesions in the nerve fiber layer.

Answer 30

COTTON WOOL SPOTS

Question 31

a sign of severe proliferative disease, it may cause intractable glaucoma.

Answer 31

Rubeosis iridis

Question 32

are often associated with retinal neovascularization, they may dramatically reduce vision within a few minutes.

Answer 32

Pre retinal hemorrhages

Question 33

now the leading cause of legal blindness in

diabetics

Answer 33

Macular oedema

Question 34

The mainstay of treatment of diabetic retinopathy is

Answer 34

retinal photocoagulation.

Question 35

True or false

Answer 35

Rubeosis iridis requires urgent panretinal photocoagulation to prevent ocular pain and blindness from glaucoma.

Question 36

plays a vital role in the management of severe complications of diabetic retinopathy.

▪ The major indications are non-clearing vitreous hemorrhage, traction retinal detachment, and combined traction/rhegmatogenous retinal detachment.

Answer 36

Vitrectomy

Question 37

What protein is one reason why weak abnormal blood vessels may grow under the retina and lead to vision loss.

Answer 37

Anti VEGF (Vascular endothelial growth factor)

Question 38

In what systemic condition are these, seen? Clinical signs:

o Generalized arteriolar narrowing o Focal arteriolar narrowing o A-V nicking o Opacity of arteriolar wall

Answer 38

Hypertension

Question 39

Signs of mild hypertensive retinopathy

Answer 39

Signs of mild hypertensive retinopathy plus:

o Retinal hemorrhages, microaneurysms
• Generalized or focal arteriolar narrowing

• A-V nicking

Question 40

Signs of severe hypertensive retinopathy

Answer 40

• Signs of moderate hypertensive retinopathy PLUS:

o Optic nerve swelling

• Strong association with death

Question 41

In Thyroid eye disease what are the antigen found in the orbit r

Answer 41

Thyroglobulin

Question 42

In Thyroid eye disease what is found on thyroid follicles & orbital fibroblast

Answer 42

TSHR

Question 43

Systemic signs and symptoms o Symptoms: Hyperactivity, hear intolerance, palpitations, weightloss and gain (increased appetite), diarrhea o Signs: Tachycardia, atrial fibrillations, tremor, goiter, warm moist skin, lid retraction and lag, exophthalmos.

o Eye signs usually start within a year of hyperthyroidism (75%) o Occasionally eye signs start years later. What disease?

Answer 43

Thyroid eye disease

Question 44

▪ Due to expansion of orbital fat and muscles. Complete subluxation of the globe (sometimes) ▪ Prolapse of the lacrimal glands ▪ Corneal exposure/epithelial defects ▪ Absence of Bell’s phenomenon (tight IR)

Answer 44

Proposes

Question 45

▪ 30% of patients with TED ▪ Diplopia can be intermittent or constant ▪ During the active phase: enhancement of fat surrounding affected muscles ▪ Inferior recti, medial recti (most common) ▪ Any type of Strabismus (ET and HopT most common) ▪ Oblique muscle involvement more common

Answer 45

Strabismus