Vision Flashcards
Gradual, chronic, painless loss of peripheral vision. Night glares, cloudiness.
Cataracts
Components of eye exam for vision loss? (3)
confrontational visual fields
pupil reactivity
dilated fundus exam
vision loss, increased cup to disc ratio
glaucoma
which glaucoma is painful?
acute angle closure glaucoma
floaters, photopsias, curtain-like loss of vision
retinal detachment
on physical exam: raised, whitish retina, rather than yellow
Retinal detachment
Retinal detachment can be associated with? 2
myopia
diabetes
central vision loss
macular degeneration
degeneration of photoreceptors and their supporting structures
macular degeneration
painless, gradual/acute blurred vision, wavy/distorted vision, central scotoma
macular degeneration
central scotoma with debris upon fundoscopic exam
Dry macular degeneration
central scotoma w/ neovascularization
wet macular degeneration
characteristic sign of dry macular degeneration
Drusen bodies on funduscopic exam
acute, painless, total loss of vision
Central retinal artery occlusion
on exam: no light perception, afferent pupillary defect, white retina, cherry red spot in the macular area
Central Retinal Artery Occlusion
etiology of central retinal artery occlusion
embolus- originated elsewhere
acute, variable painless loss of vision
Central retinal vein occlusion
variable vision, +/- afferent pupillary defect, “blood and thunder” retinal appearance
Central retinal vein occlusion
No symptoms, hx HTN
Hypertensive retinopathy
Hypertensive retinopathy fundoscopic findings (multiple)
copper wiring (arteriolar narrowing), silver wiring (arteriolar sclerosis)
A:V nicking
cotton-wool spots, retinal hemorrhages, other exudates
disc edema
Hypertensive retinopathy tx (2)
BP control
refer if vision loss or exudates
non-proliferative/proliferative retinopathy
+
macular edema
diabetic retinopathy
hemorrhages, exudates/etc and neovascularization
Diabetic retinopathy
traction retinal detachment pathophysiology
neovascularization- vessels pull away —> retinal detachment
diabetic retinopathy tx
control blood sugar
refer w/ vision loss
chronic itching, burning, scratching. Worse in AM. No vision decrease. Erythema, inflammation of the eyelid
Blepharitis
Blepharitis txs
Warm compress
Baby shampoo wash- clean off crusts
Antibiotics/steroids for secondary infection
acute onset of pain, swelling. Warm, erythemic, tender. +/- systemic sxs, +/- vision changes
cellulitis
cellulitis tx
systemic abx
when to refer for cellulitis?
Orbital involvement- EOM involvement, decreased eye movement
chronic itching, burning, scratching. “Tired eye”. Vision fluctuation
Dry eye
dry eye etiology
deficient aqueous tear production
dry eye tx
artificial tears/ointments
In severe cases: topical cyclosporin
acute onset, bilateral, itching/burning/general irritation, moderate to severe injection, watery discharge, possible URI sxs, preauricular lymphadenopathy
viral conjunctivitis
acute onset, unilateral, burning/general irritation, moderate to severe injection, mucopurulent discharge, ~adherent lids
bacterial conjunctivitis
chronic/seasonal onset, bilateral, itching, mild-moderate injection, stringy/mucoid discharge, chemosis (edema)
allergic conjunctivitis
viral conjunctivitis tx
artificial tears, vasoconstrictors, warm compress
bacterial conjunctivitis tx
antibiotic drops
allergic conjunctivitis tx
artificial tears
antihistamine drops
components of problem-focused Red Eye exam
visual acuity tonometry slit lamp (pen light) exam
painless blood in the conjunctiva, no vision effect
Subconjunctival hemorrhage
subacute onset of foreign body sensation, pain, inflammation of episcleral/scleral tissue
Episcleritis
acute onset of pain, foreign body sensation
corneal abrasion
corneal abrasion tx
topical lubricants
topical antibiotics
Never topical anesthetics
chemical injury tx
Irrigate! and refer quickly
acute onset of pain/foreign body sensation w/ associated event. Vision usually unchanged. Foreign body present
Corneal foreign body
Corneal foreign body tx
remove if simple- be careful of causing more damage
lubricant and/or antibiotic drops
refer for follow up
acute onset of pain, mucous discharge. Vision decreased. White infiltrate
keratitis/corneal ulcer
keratitis/corneal ulcer tx
topical antibiotics
refer
keratitis/corneal ulcer pathophysiology
infection of the cornea
dendritic pattern on keratitis- etiology & tx
HSV, antivirals
never steroids
ciliary flush, acute onset photophobia, +/- vision decrease
inflammation of the uveal tissue
Iritis/Uvetis
Iritis/uveitis tx
Refer- never give steroids
acute pain, photophobia due to pressure on the iris, +/- vision loss. Layered heme in iris
Hyphema
Hyphema etiology
blood in anterior chamber
Hyphema tx
eye shield, bed rest.
Control intraocular pressure
Refer
which is better: eye shielding or patching?
Eye shielding- less risk of increased infection/injury due to fibers or scratching
acute decrease in peripheral vision, halos around lights. pain.
glaucoma
“steamy” cornea, mid-dilated pupil (reacts slowly), circumlimbal injection
Glaucoma
glaucoma physical exam findings
shadowing on penlight exam due to loss of anterior chamber
more common form of glaucoma, less painful
& tx
open angle glaucoma is less acute, less painful
controlled by medication
