Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Eye Disease > Vascular Diseases of the Eye > Flashcards

Vascular Diseases of the Eye Flashcards

1
Q

What is high bp (for hypertensive retinopathy)

A
  • bp of >140/90mmHg on at least 2 occasions
  • global prevalence of 40% in adults > 25
  • major risk factor for heart disease, stroke, renal problems, visual impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is malignant htn

A
  • rare
  • systolig >200mmHg
  • diastolic >140mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

risk factors for raised bp (for hypertensive retinopathy)

A
  • age
  • family history
  • obesity
  • smoking
  • african - caribbean race
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ocular complications of raised bp (for hypertensive retinopathy)

A
  • cranial nerve palsies
  • sub conjunctival haemorrhage
  • hypertensive retinopathy - visible on fundoscopy, early signs easily overlooked
  • systemic diseases tend to present in bilateral retinopathy - may not be symmetrical, but are similar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Grade 1 hypertensive retinopathy

A
  • px may be asymptomatic
  • mild to moderate narrowing or sclerosis of the retinal arterioles
  • vasospasm of arteial walls
  • refer to gp if not being treated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

grade 2 hypertensive retinopathy

A
  • px may be asymptomatic
  • moderate to marked narrowing of arterioles - local and or generalsied
  • arteriovenous crossing changes
  • increases in the light reflex
  • refer to gp if not being treated
  • reduced av ratio
  • may see nipping or gunns sign
  • may see copper wire effect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is nipping or gunn’s sign in grade 2 hr

A
  • in nipping, the artery pushes down on the vein
  • thinning of venuole at an arteriole crossing
  • classic sign of systemic htn
  • may persist even if htn under control
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is copper wire effect in grade 2 hr

A
  • indicates a narrow lumen
  • increase in elastic and muscular componenets of artery wall
  • hypertensive arteriosclerosis - increased light reflex
  • can also get beading - risk of occlusion
  • silver wiring - when the no column of blood can not longer be visualised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

grade 3 hr

A
  • arteriole narrowing and focal constriction
  • cotton wool spots
  • retinal haemorrhages
  • hard exudates
  • retinal oedema
  • typically diastolic > 110-115mmHg
  • rapid referral to gp
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are cotton wool spots

A
  • occlusion of pre capillary arterioles
  • micrinfarction of retinal nerve fibre layer
  • axon swells and creates an opaque appearance in the retinal nerve fibre layer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is a vascular leakage in hr

A
  • flame shaped haemorrhage
  • superficial and follow the parth of the nfl
  • retinal oedema
  • exudates (leakage from blood vessels) - lipo proteins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

grade 4 hr

A

grade 3 plus optic disc swelling

  • malignant htn diastolic > 130-140mmHg
  • visual symptoms
  • headaches
  • refer to a&e - risk of ocular, cardiac, renal and cerebral damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are occlusive vascular diseases

A
  • unilateral sudden painless loss of vision - very rarely bilateral but asymmetrical with respect to time
  • typically affects the elderly, but not exclusively
  • may go unnnoticed by elderly px as only affects one eye so less noticeable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

central retinal artery occlusion epidemiology

A

= obstruction of central retinal artery by embolus or thrombus
- usually before surface of ONH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

crao epidemiology

A
  • onset mid 60s
  • male to female ratio 2:1
  • rare (incidence 1.9 in 100,000 in us)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

crao presentation

A
  • sudden painless profound loss of vision

- may be preceded by transient loss of vision - AMAUROSOS FUGAX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is amaurosis fugax

A
  • transient obscuration of retinal artey by embolus (TIA) < 24 hrs
  • sudden monocular loss of vision
  • painless
  • ‘like a blind coming down’
  • repetitive - with each one, theres a risk of an artery occlusion
  • optometric management - refer to gp urgentl after excluding GCA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

crao early signs

A
  • visually acuity usually CF to LP - exceptions cilio retinal artery (25%) , some vision may be retained
  • pale oedematous retina esp in the posterior pole
  • cherry red spot at macula, due to macula blood supply from choroid via posterior ciliary arteries
  • arterial attenuation
  • segmentation
  • emboli may be seen
  • RAPD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

crao late signs

A
  • optic disc atrophy - pale
  • arterial atteniation and segmentation
  • va usually remains markedly reduced despite treatment
  • another signs is during fluorescein angiography, there is a black area ( mean there is a blockage and retina isnt being supplied in that area)
20
Q

crao causes

A
  • embolus > thrombus
    embolus:
  • carotid artery and heart disease
  • cholestrol crystals from carotid arteries
  • platelet fibrin emboli arising from large vessel stenosis
  • calcific emboli arising from carotid valve stenosis
  • thrombosis - blood clot, stenosis of carotid artery
21
Q

crao risk factors

A
  • systemic htn
  • diabetes mellitus
  • hyperlipidemia
  • carotid artery disease
  • tia/cva
  • giant cell arteritis
  • tobacco smoking
22
Q

crao optemetric management

A
  • measure va
  • check pupils
  • urgent referral to eye cas - if < 12 hours old
  • first aid - aim to dislodge embol
  • ocular digital massage
  • breathe into paper bag - increase of co2 levels - to dilate blood vessels and encourage embol to move through
23
Q

crao opthal management

A

reduce iop

  • anterior chamber paracentesis
  • intra venous acetazolamide and ocular massage

dilation of arteries

  • ocular massage
  • retrobulbar vasodilator drugs
  • inhalation of carbogen - lysing of embolus/ thrombus, sytemic anticoagulants

investigation of cause
- increased mortality with presence of emboli

24
Q

crao with cilio retinal artery

A

20% of pop have cilio retinal artery
- va preserved - some, and wont be great
- functionally useful
visual field defect

25
Q

what is a branch retinal artery occlusion

A
  • occur in 7th decade
  • results from ebolus
  • 90% temporal arteries
  • sudden painless loss of vision - hemifield or sector loss of vision
  • prognosis good - 74% VA 6/12 + VF defect
26
Q

central retinal vein occlusion epidemiology

A

= obstruction of central retinal vein below lamina cribosa

  • more commonly affect older people in their mid 60s but can also occur in younger pxs
  • male to female ratio equal - 5.2 in 1000
27
Q

crvo presentation

A
  • sudden painless loss of vision
  • variable deficit
  • may go unnoticed
28
Q

crvo general signs

A
  • ‘blood and thunder’ ie lots of activity
  • flame shaped haemorrhages in all 4 quadrants
  • disc oedema
  • venous dilation
  • cotton wool spots
  • rapd
29
Q

crvo non ischaemic signs

A
  • va is better than 6/60
  • rapd is not marked
  • less haemorrhages
  • no cotton wool spots
  • 20% become ischaemic
30
Q

crvo ischaemic signs

A
  • visual acuity < 6/60 less
  • marked rapd
  • extensive haemorrhages in 4 quadrants
  • disc swelling
  • venous tortuosity
  • cotton wool spots
  • risk of developing retinal and iris neovascularisation
31
Q

crvo: neovascular glaucoma

A 
'100 day' glaucoma 
= new bv in iris, which can develop in angle and stop aqueous outflow and iop increase = secondary glauc 
- retinal hypoxia
- angiogenesis substance released 
- new vessels develop in angle 
- fibrovascular membrane develops across trabecular meshwork 
- early intervention required 
- intractable and devastating
32
Q

crvo causes systemic and ocular

A

systemic

  • systemic htn
  • diabetes
  • arteriosclerosis
  • hyperviscosity syndromes
  • oral contraceptive pill

ocular
- raised iop > 30mmHg

33
Q

crvo optometric management

A
  • if normal iop, refer to opthalmologist within 2 weeks, refer to gp for full cardiovascular investigation
  • if iop > 30mmHg, refer to opthalmologist within 24 hrs, refer to gp for full cv investigation - more risk of neovascular glaucoma
34
Q

crvo opthalmological management

A
  • fluoroscein angiogram - ischaemic or non ischaemic
  • pan retinal photocoagulation
  • investigation and treatment of underlying cause
35
Q

what is a branch retinal vein occlusion

A
  • hemi field visual loss
  • obstructed vein dilated and tortuous
  • retinal oedema
  • scattered superficial and deep retinal haemorrhages - respect the horizontal midline, confined to one quadrant
  • causes - systemic cardiovascular
36
Q

brvo optometric management

A
  • measure va
  • fundus examination - dilated bio
  • pupil reactions
  • visual field
  • refer to gp cardiovascular investigation
37
Q

brvo opthalmogical management

A
  • fluorescein angiogram
  • grid laser coagulation if macula oedema persistent
  • retinal neovascularisation rarer in brvo
  • prognosis good if untreated va is equal or more than 6/12 - but 25% will have va <6/60
38
Q

anterior ischaemic optic neuropathy description

A
  • ischaemia of anterior optic nerve head
  • occlusion of the posterior ciliary arteries

arteritic

  • associated with temporal arteritis
  • 5-10% cases
  • older age group (70%)

non arteriric

  • 90-95 % cases
  • younger age group (60%)
39
Q

aion epidemiology

A
  • almost exclusively after the age of 50 years
  • incidence 18 per 100,000 after 50 years
  • woman > men (2:1) ratio
40
Q

arteritic aion

A
  • older px than NA-AION - typically 7 to 8th decades
  • profound loss of vision - nlp, lp or hm
  • pale oedematous optic nerve head
  • splinter haemorrhages
  • rapd
41
Q

what is temporal arteritis

A
  • giant cell arteritis

- inflammation of medium and large arteries

42
Q

temporal arteritis symptoms

A

1) headache
- normally constant
- gradual onset to a diffuse severe aching
- superficial scalp tenderness
- worse at night and in the cold

2) general malaise, weight loss, jaw claudication, amaurosis fugax
3) polymyalgia rheumatica

43
Q

na-aion presentation

A

1) sudden loss of vision
- mild to severe
- usually on walking
- vision loss either static or progressive

2) 20% lose vision in other eye within 5 years
3) ‘at risk’ disc
4) associated with htn, dm

44
Q

na-aion signs

A

1) oedematous optic nerve head
- diffuse or segmental
- hyperaemic or pale

2) visual field loss
- usually altitudinal

3) contralateral eye
- small disc
- small or absent cup
- subsequent optic atrophy

4) 33% left with near normal v/a

45
Q

aion optometric management and investigation

A

investigation:
- va, pupils, colour vision, vfs, iop
- dilated examination

management:
- emergency referral to casualty - contact opthalmologist

46
Q

aion opthalmological investigation and management

A

investigation:
- blood tests
- tenporal artery biopsy
- scans (doppler, mri)

management:
- aspirin
- if arteritic high doses of systemic steroids for years

Eye Disease (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions