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CLIN MED > Vision > Flashcards

Vision Flashcards

1
Q

Anatomy of the eye layers

A 
Fibrous coat ( outermost) 
Sclera, cornea
Vascular coat (uvea)
Choroid, ciliary body, iris
Nervous coat ( innermost) 
Pigmented layer, retina
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2
Q

Job of ciliary body

A

muscle that surrounds the lens

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3
Q

what does the choroid do?

A

is at the posterior part of the else. richly vascularlized and provides nourishment to the retina

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4
Q

what does the iris do?

A

controls the size of the pupil

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5
Q

What condition is possible in the nervous coat layer of the eye?

what is that?

why?

A

Melanoma possible

because of the pigmented layer in the eye

nevous coat is the innermost layer of the eye

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6
Q

Optometrist vs Opthalmologist

A

Optometrist
Diagnose and treats eye disease and disorders
Prescribes topical and sometimes oral medication to treat eye disease
Prescribes eyeglasses, contact lenses and vision therapy

don’t require a referal and can send directly to an opthalmologist

Ophthalmologist
Diagnose and treats eye disease and disorders
Surgical and medical management of eye disease and disorders.
require a referal from an MD or an optometrist

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7
Q

Most common cause of vision loss in north america?

A

uncorrected refractive error

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8
Q

Big 4 causes of vision loss in north america

A
  1. cataracts
  2. macular degeneration
  3. Glaucoma
  4. Diabetic retinopathy
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9
Q

Assessment of visual acuity ?

what is it?

why is it important?

A

measure with eye glasses on - we want to see corrected vision

Acuity = ability to discriminate detail

Useful to establish severity of vision loss in the monitoring of disease
Sudden onset = immediate referral ( blindness. double vision, blurred vision)

Gradual loss = refractive error change or progressive chronic disease

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10
Q

When to use the snellen chart? hand held card?

A

SC - 20 feet

HHC - 14 inches ( note it only assesses central vision, not distance)

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11
Q

20/20 what does that mean?

20/200?

20/50?

A

20/20 means that someone is reading at 20 feet with others with good vision read at 20 feet

20/200 means that at 20 feet the patient can read print that
a person with normal vision could
read at 200 feet.
also constitutes legal blindness

20/50 minimum driving requirements

you see at 20 what others see at 50 feet

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12
Q

what is refraction? why is that important?

A

Refraction: bending of light waves as they pass from one medium to another with different refractive indices

different diopters change the refraction so that eyes that have trouble seeing can see clearly

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13
Q

Refractive index

A

Refractive index: ratio of velocity of light in air to the velocity in the substance

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14
Q

Diopter

A

Diopter: degree to which a lens bends a light ray; “refractive power”

On opthalmoscope : + diopters are green and are used for patients or self with hyperopia

  • diopters are red and used for patients/self with myopia
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15
Q

Convex lens does what?

A

converges the light rays

useful for hyperopia

positive diopter corrects

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16
Q

Concave lens does what?

A

Diverges the light rays

useful for myopia

negative diopters correct

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17
Q

Focal point

A

point at which all rays converge after passing through a refractive medium

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18
Q

Focal length

A

distance beyond a lens at which convergence occurs

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19
Q

Hyperopia short

A

shorter globe compared to iris

positive diopter corrects - brings focal point closer and on the retina

converge rays
use convex lens

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20
Q

Myopia short

A

longer globe compared to iris

negative diopter corrects

diverge rays to get picture further back on retina

use convex lens

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21
Q

4 interfaces that make up the lens of the eye

A 
(Air)
Cornea 
Aqueous humor
Crystalline lens ( anatomical lens)
Vitreous humor
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22
Q

what is the goal of the lens of the eye?

A

to create a focal point

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23
Q

vitrous humour’s job?

A

gel like substance that supports the eye

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24
Q

Which nerve moves the lens of the eye?

A

CN 3 - occulo motor

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25
Q

what position is the lens in the most relaxed?
contracted?

outside of the eyeball?

A

relaxed - it’s flat

contracted - the cilliary muscles contract and make it more spherical

out of the eyeball the natural shape is round

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26
Q

Normal plane of focus in regards to the retina

A

focal point of the light rays is perfectly on the retina

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27
Q

suspensory ligaments of the eye relationship to ciliary bodies

A

To focus light from a distant object, the ciliary muscles relax. … To accommodate for a near object, the ciliary muscles contract, thereby decreasing tension in the suspensory ligaments and allowing the lens to spring back into a more rounded shape.

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28
Q

Accomodation concept

A

is an adjustment of refraction

a relaxed eye (distance) rays are paralell
the lens is flat held by suspensary ligaments

focusing on near objects the rays are diverging

ciliary muscles contract, and the lens becomes rounder

controlled by PNS CN 3

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29
Q

Hyperopia details (5)

FP? accomodation? globe size? corrected with?

rays/lens?

A

Difficult accomodation
With lens in relaxed (flat) position, focal point is past the retina and must accommodate even for distance

Becomes too difficult for near vision

shorter globe compared to iris

positive diopter corrects - brings focal point closer and on the retina

converge rays
use convex lens

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30
Q

Presbiopia

A

lens is less elastic, less able to have a spherical shape, less able to accomodate

blurring of near vision with age

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31
Q

Myopia - details

FP? accomodation? globe size? corrected with?

rays/lens?

A

Relaxed lens = focal point in front of the retina

Can’t make lens more flat = no accommodation for distance

As object moves nearer to the eye …
After this point, can accommodate further

myopia occurs when there is alonger globe relative to lens

negative diopter corrects

diverge rays to get picture further back on retina

use convex lens

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32
Q

Astigmatism

why?
what?
FP?

A

Different points of focus from different planes in the lens because of irregular curvature of the cornea

Accommodation will be too much in one plane or not enough in another, and good in another

focal point in multiple areas of the retina (front or behind)

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33
Q

irregular curvature of the cornea causes what?

A

astigmatism

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34
Q

What is the crystaline lens?

tissue?
shape?
controlled?

A

Anatomical lens of the eye. Adjusts for accomodation ( near vision)

made of avascular epithelium ( enclosed in a capsule - no vacular supply)

normally spherical / convex

controlled by CN and the suspensory ligaments ( controlled by ciliary muscles)

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35
Q

Cataract?

what?
presentation?
risks?

A

Congenital or acquired lenticular opacities
Deposition of protein in the lens

lens looks opaque

(accumulation of epithelial cells that were sloughed off with no where to go)

this is a pathology but rooted in normal process

risks : age, poorly managed diabetes, age are the main ones

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36
Q

dirty window analogy ( for the eye)

A

the lens is like a window, when clear light can shine through and hit the optic nerve producing visual stimuli ; however, when the window is dirty such as in cataracts, it is cloudy and the visual acuity may not be present.

may still be light sensitive

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37
Q

Cataract presentation (5)

A

Blurring of vision gradually

tinting of lens ( change in colour vision)

Glare or halos

Poor night vision

No pain

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38
Q

what does melanin do in the eye?

special population to consider?

A

stops light from bouncing around by absorbing it and prevents reflection

albino populations generally have reduced visiual acuity b/c rays bounce around inside of the eye due to decreased melanin

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39
Q

What creates the red reflex in the eye?

what might interfere?

A

reflection of vascular tissue in the retina and choroid ( is the vascular layer of the eye, containing connective tissues, and lying between the retina and the sclera.)

abscence of the red reflex may be due to cataracts, less commonly detached retina or retinoblastoma (cancer)

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40
Q

what is the choroid?

A

is the vascular layer of the eye, containing connective tissues, and lying between the retina and the sclera.

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41
Q

Light sensitive receptors

A

Most concentrated on the fovea at the focal point

Rods : dark vision and peripheral vision

Cones: colour vision, acute vision

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42
Q

Nervous layer of the eye

A

Light sensitive receptors : rods and cones

excited by light rays, AP transmitted via neurons to CN 2 and occipital cortex

Maximum visual acuity; <2° of visual field
Gradual decrease in acuity towards periphery

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43
Q

Fovea and Macula

A

highest concentration of cones

acute central vision

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44
Q

Maximum visual acuity is where? why?

A

Maximum visual acuity; <2° of visual field
Gradual decrease in acuity towards periphery

b/c of the shape of the eye - doesn’t get light so no need for photoreceptors

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45
Q

Features of the retina ( structures ) 4

A

Macula and fovea

optic disc

no lymph drainage

blood supply

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46
Q

Optic disc

A

Site of optic nerve head, central artery and vein

“Blind spot”

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47
Q

Is there lymph drainage in the retina?

A

no lymph

the vitrous humour picks up the waste

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48
Q

Why when doing an ophthalmic exam, we enter the eye at 15 degrees temporal instead of straight on?

A

To get a clear view of the optic disk to orient ourselves

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49
Q

ARMD

what?
risks?

A

Age-Related Macular Degeneration

Deterioration of the macula ; therefore, colour and central vision ( acuity)

Risk factors:
Age
Smoking … oxidative damage?
Genetic

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50
Q

Where does ARMD target?

A

RPE + Bruch membrane + choriocapillaris (The capillary lamina of choroid)
=
Functional layer

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51
Q

What is VEGF? what does it do?

A

Vascular endothelial growth factor (VEGF), is a signal protein produced by cells that stimulates the formation of blood vessels.

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52
Q

2 types of ARMD

A

Non-neovascular (atrophic, dry)
- drusen

Neovascular (exudative, wet); 10-20%
- leaking, hemorrhage etc.

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53
Q

Non-neovascular

ARMD (specifics)

A

Non-neovascular (atrophic, dry) ARMD

Deposits (drusen) in Bruch membrane (Bruch’s membrane is the innermost layer of the choroid. It is also called the vitreous lamina, because of its glassy microscopic appearance.)

and geographic atrophy of the RPE (retinal pigment epithelium)
Secretion of inflammatory cytokines and recruitment of VEGF = angiogenesis

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54
Q

What is Bruch’s membrane? what part of the eye is it in?

A

Bruch’s membrane is the innermost layer of the choroid. It is also called the vitreous lamina, because of its glassy microscopic appearance.

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55
Q

Neo vascular ARMD

A

Neovascular (exudative, wet); 10-20%
Choroidal neovascular membranes penetrate Bruch membrane, possibly RPE
Leaking, hemorrhage –> macular scarification
Can cause retinal detachment

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56
Q

ARMD presentation (3)

A

Loss of central vision; gradual change

Difficulties with night vision

Painless

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57
Q

Amsler Grid and relevance

A

cover one eye and stare at the black dot

someone with ARMD , the lines pattern may appear wavy or some of the lines may be missing or broken

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58
Q

What is the aqueous humor? 4

secreted by what/ flow?

A

part of the lens system

Clear, free flowing fluid

Continually formed and resorbed

Supports wall of eyeball; nourishes cornea and lens; drains metabolites

Secreted by ciliary processes into posterior chamber –> bathes lens –> moves through pupil to anterior chamber –> resorbed via trabecular meshwork –> canal of Schlemm

(front of lens and back of iris –> through pupil and ant iris back of cornea)

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59
Q

Glaucoma prevalence

prevention?

A

2nd leading cause of blindness

most prevalent is primary open angle

not preventatble but treatment delays progression

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60
Q

Open Angle Glaucoma generals

A

there us resistance to the aqueous flow which increases the intra-ocular pressure

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61
Q

Primary open angle glaucoma 4

A

most common

aqueous humor has physical access to the trabecular meshwork but there us resistance to the aqueous flow which increases the intra-ocular pressure

normal depth of anterior chamber

obstruction distal to anterior chamber angle

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62
Q

Secondary open angle glaucoma

A

due to clogging of trabecular meshwork with debris which strains the mechanism and the flow of aqueous humor

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63
Q

Angle closure glaucoma primary

A

shallow anterior chambers

Apposition of periphery of iris to lens (pupillary block) with pupil dilation

genetic/anatomical, less common

Elevated pressure in posterior chamber
Apposes iris to trabecular meshwork
Chronic elevation in IOP can lead to acute elevation

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64
Q

Angle closure glaucoma secondary

A

due to neovascular changes associated with diabetes

Formation of contractile membrane over iris which occludes trabecular meshwork

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65
Q

Secondary ACG special considerations

A

poorly managed diabetes : VEGF is pumped out in the iris and new blood vessels are formed

slow chronic elevation of pressure with accute dilation - immediate increase in pressure can be painful

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66
Q

Glaucoma Generals (9)

A

Retinal changes

  1. Compression of optic nerve and retinal artery
  2. Obstruction of axonal cytoplasmic flow,
  3. ischemia of ganglion cells ( decrease nutrient transport to the optic nerve)
  4. Cupped and atrophic optic nerve head
  5. Increased “cup-to-disc ratio”
  6. Necrosis of retinal nerve cells
  7. Thinning of retina
  8. Focal scleral thinning
  9. Lens opacities due to lack of nutrition
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67
Q

What is a normal cup to disc ratio?

relevance?

A

Glaucoma

should be less than 1/3-1/2

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68
Q

Open angle glaucoma presentation

A

Open angle = slow progression
Loss of peripheral vision (“tunnel vision”)
No pain

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69
Q

Closed angle glaucoma presentation

symptoms

A

Closed angle = slow progression until acute, rapid rise in IOP (rare) due to pupil dilation

Emergent; blindness within 24 hours

Symptoms:
Typically unilateral
Blurred vision, halos, tunnel vision
Red, painful eye; headache
Headache, photophobia, nausea, vomiting (what does this sound like?)
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70
Q

Why would a patient with mild symptoms of glaucoma improve in a bright room?

A

because the pressure is increased, so when the pupil is dialated in a dark room, it puts pressure on the eye while a bright room makes it better

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71
Q

How are field of vision defects different from glaucoma?

A

field of vision defects usually pertain to full or 1/2 of vision changes in the nasal or temporal regions and are idfferent in each eye.

glaucoma the peripheral vision is lost

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72
Q

Testing for POAG - 6

A 
No method (in primary care) has very good sensitivity; no good screening methods
Regular annual eye exams advised over 40; more frequent or earlier if high risk

Tonometry = measuring IOP

Fundoscopy aka Ophthalmoscopy

Fundus photography

Thickness of optic nerve fibres

Visual field testing

73
Q

Tonometry

A

Tonometry = measuring IOP

Cornea anesthetized

Apply pressure to cornea

Amount of corneal displacement measured
Reflects intraoccular pressure

74
Q

Assessing for shallow angles?

relevance?

A

we should be able to illuminate the iris on the other side

if the shadow is cast, it shows a very narrow anterior chamber in a patient with ACG

75
Q

Areas affected in the diabetic eye? 5

A 
lens
iris
ciliary body
retina
optic nerve
76
Q

Causes of diabetic neuropathy

A

elevated blood sugar

sugar molecules attaching to other RBCs, immune cells etc that they aren’t supposed to ( Production of advanced glycosylated end products)

77
Q

prevalence of diabetic neuropathy?

A

very common - the higher the blood sugar in both type 1 and type 2 the increased risk for diabetic retinopathy

78
Q

Background Retinopathy 3

A

aka : non-proliferative retinopathy

  1. Thickening of endothelial basement membrane
    Formation of microaneurysms and microhemorrhages
  2. Increased permeability of retinal endothelia
    Macular edema
    Exudates
  3. Micro-occlusion : (small thrombi restrict acess of blood to tissue) no new neovascularization
79
Q

Proliferative neuropathy

A

Characterized by neovascularization
A web of vessels form a contractile neovascular membrane

leaky vessels

secretion of VEGF increases angiogenesis

predisposes for a retinal detachment

late complication of diabetes

80
Q

In which conditions is there formation of a neovascular membrane?

what is it?

A

Proliferative retinopathy

Secondary Closed Angle Glaucoma

new dmaaging blood vessels that grow beneath the retina

81
Q

Vision of a person with diabetic neuropathy

A

depends on the person and specific to their manifestation

no characteristics

82
Q

Arteriosclerosis of the retina

A

Arteriosclerosis = thickening

Vessels are narrower
Colour of blood column changes –> copper, silver
Compression of paired venule –> “nicking”

Exudate into retina
Possible hemorrhage
Focal ischemia and infarcts –> “cotton wool spots”

normal arteries = nice and thin

83
Q

What condition happens with arteriosclerosis of the retina?

and keynotes 4

A

Hypertensive retinopathy

  • blood column changes to copper or silver
  • venule compression “ nicking”

possible hemmorhage

exudates ( cotton wool spots)

84
Q

Why are arterioles in the eye thickened? what is this called?

A

tortuous blood vessels

due to arteriosclerosis of the retina/ hypertensive retinopathy

85
Q

What are cotton wool spots?

relevance

which condition(s)?

A

microinfarct

hard to tell the difference if it’s CWS or exudate

relevance :
hey are caused by damage to nerve fibers and are a result of accumulations of axoplasmic material within the nerve fiber layer.

diabetes mellitus, systemic hypertension, and acquired immunodeficiency syndrome

86
Q

Red flags for vision patient 6

A

Sudden vision loss or change

other indicators of urgency ( with or w/o vision loss) :

Pain
Double vision
Sudden blur
Flashing lights
Floater onset
87
Q

Vitreous humor

what?

job?

pathologies?

A

transparent gel

nutrient and waste management system

holds globe of the eye open

supports posterior surface of the retina and and pigmented layer ( keeps close contact)

vulnerable to opacification

88
Q

How common is retinal detachment?

A

2/10 000 people a year

emergent - don’t miss

89
Q

What is retinal detachment?

A

Separation of neurosensory layer from pigmented epithelium; ischemia and necrosis of photoreceptors
Medical emergency!

90
Q

Causes of retinal detachment?

3

increased risk? 3

A

trauma, inflammation, contracture (shortning) of vitreous humor

increased risk with age, myopia, and F&PH

91
Q

Rhegmatogenous detachment

A

more common

Separation of neurosensory retina from pigmented epithelium with a full-thickness retinal tear

Often subsequent to posterior vitreous detachment causing traction on the retina (occurs with aging)

Vitreous humor enters potential space between the pigmented epithelium and neurosensory retina and separates them

92
Q

Consequences of a Rhegmatogenous detachment

A

a detachment with tear, a tear in the retina allows seepage through the tear of liquefied vitreous humor, which accumulates beneath the retina and pushes it away

longer for nutrients to travel and results in necrosis

93
Q

Non-rhegmatogenous detachment

A

No retinal defect

Associated with vascular disorders causing exudation into subretinal space
Inflammation and damage of the RPE
Leaking of exudate from choroidal circulation

94
Q

Non-rhegmatogenous detachment consequences 2

A

In a detachment without tear, the retina is pulled away by conditions in the vitreous humor.

vascular disorder
blood vessels coming up into that space

95
Q

Retinal detachment presentation

most likely due to?

and what to do if you see symptoms?

A

Painless!

Acute-onset unilateral floaters, flashers

Sudden and progressive monocular vision loss

Sensation of a veil over one field of view (FOV)

Location depends on location of tear
Apparent curving of straight lines
(Vitreous hemorrhage or pigmentation on slit light exam)

Most likely due to posterior vitreous detachment, but can lead to retinal tears

Refer immediately for dilated exam!

96
Q

What chronic conditions can predispose to or cause retinal detachment?

What are the mechanisms for this?

A

look up *

97
Q

rippling of retinal surface is due to what condition?

A

Rhegmatogenous retinal detachment.

In the picture:

The inferior temporal portion of the retina is detached and the subretinal fluid makes visualization of the pigment epithelium and choroid relatively difficult.

98
Q

Floaters and flashers are major warning signs of what?

A

Rentinal Detachment - but can happen with other conditions too such as trauma

99
Q

What is the cornea?

what does it do?
what kind of tissue?
vulnerable to what?

A

Transparent anterior component of fibrous coat
Junctions with sclera

Major refractive surface of the eye

Shape will impact ability to focus directly on retina

Epithelial surface, avascular

Vulnerable to keratinization, scarification
Dramatic changes to refraction and vision

100
Q

Is the cornea vascular? why or why not?

A

Not vascular - if it was it couln’t be transparent and it is part of the lens system

101
Q

Corneal abraison

presentation

A 
eye pain
redness
tearing
decreased vision
increased inflammation response
sensation of foriegn body in the eye
102
Q

Corneal abraision consequences and diagnosis

A

permanent change in vision possible if the healing results in scarring or keratinization

utilizing blue setting on the opthalmoscope

103
Q

CN 2

describe?

what would you see in a pathological situation?

A

Optic Nerve

Snesory tract of CNS - leads to vision

surrounded by meninges and CSF

subject to CNS lesions

ie) lesion of the optic nerve, we need to consider tumor, etc.

you would see a protruding optic disc with increased ICP

104
Q

What is optic neuritis?

what condition is this common in?

A

Inflammation of the optic nerve
Swelling of optic nerve head = “papilledema”
Blurred disc margins

common in MS
demylination is due to inflammatory changes

105
Q

Optic neuritis in MS

Describe MOA and symptoms

A

demylination due to inflammatory changes

may involve extra-occular muscles

swelling of the optic nerve head (papilledema)

may be severe to permanently damage the nerve

106
Q

What happens when there is inflammation behind the eye that you don’t seee it in an eye exam?

what might we see?

A

there may be swelling of the optic disc - we don’t see well defined borders

it may be red and inflammed

107
Q

what is papilitits?

A

swelling associated with the optic disc

108
Q

What is Retinal artery occlusion?

A

Embolus/thrombus of central retinal artery or branch
sudden onset of painless vision loss

Distal ischemia = diffuse or segmental infarct

see : cherry spot ( b/c everywhere except the fovea is swollen)

109
Q

What is the characteristic presentation of acute retinal artery occlusion? (6)

A

sudden onset of painless vision loss

Classic Cherry red spot :

Acute swelling of neurosensory layer blocks view of vascular choroid

opacity of retina is enhanced (more cloudy

Fovea is excepted “cherry-red spot”

can’t see the red reflex

the eye is not supplied with sufficient oxygen

110
Q

What other condition can we compare a retinal artery occlusion to? why?

A

A heart attack

there is an ischemic (restriction of blood supply) change which causes tissue necrosis

typically acute

111
Q

What does red eye signal?

most common cause(s)?

A

sign of inflammation via cytokines, dilation or rupture of blood vessels

most often benign due to conjunctivitis

112
Q

Urgent red eye scenarios? 9

A
  1. Acute closed-angle glaucoma
  2. Optic neuritis
  3. Trauma,
  4. corneal penetration,
  5. blood in anterior chamber
  6. Orbital cellulitis
  7. Scleritis
  8. Anterior uveitis
  9. Infectious keratitis (HSV, VZV)
113
Q

Short

Orbital cellulitis?

A

cellulitis - bacterial skin infection

may cause red eye

114
Q

short - Scleritis?

A

threatens vision

Severe, boring pain radiating to periorbital area; pain increases with eye movements; ocular redness; watery discharge; photophobia; intense nighttime pain; pain upon awakening

115
Q

episcleritis vs scleritis?

A

epi - red eye, superficial vessels of the eye doesn’t affect vision

scleritis - threatens vision - very painful

116
Q

Systemmic conditions associated with red eye ( some)

A 
Graves
Sjogren
Rheumatoid arthritis
Reiter syndrome
Lupus
Polyarteritis nodosa
HIV
Diabetes mellitus
117
Q

Red flags with red eye

A

pain and red eye major red flag

118
Q

Diabetes and red eye

MOA and clinical presentation?

A

poorly managed blood sugar and high cholesterol can result in micro occlusions, rigidity, leakiness etc.

widespread damage to vasculature which includes the eye

clinically we might see cotton wool spots

119
Q

Which factors do we assess for urgen eye exam?

why **

A

Cornea (use fluorescein staining)
- to see if there is abrasion

Pupils (size, shape, reaction to light, symmetry)

issues with CNs, etc.

Anterior chamber (clarity) and iris

Hyperemia (location and pattern)
- changes in blood flow and how that affectst the body

ie) occlusion

120
Q

The aperture of the eye is what?

A

the pupil

121
Q

The aperture of the eye is controlled by what?

what does it do?

abnormalities?

A

CN 3 - PNS

contracts and dilates in response to light - accomodation (PERLA)

Abnormals in drug use, head trauma, systemic conditions : blocked transmission of visual signals from the retina to the optic centers of the brain

122
Q

PERLA

A

Pupils and Equal and Reactive to Light and Accomodation

123
Q

Ways to evaluate the pupil ( 3 exams)

A

Size, shape and symmetry
miosis ( excessive contriction?)
mydriasis ( dilation of the pupil?)

Reaction to light?
- Direct or consensual

Near reaction

124
Q

Near reaction - who cannot do this?

A

people with hyperthyroidism - specifically graves disease

125
Q

Consensual and Direct Pupillary light reflex findings

A

Consensual - responds to light on the opposite side as it shines

Consensual may be present if light is shone into good eye, may show up ion blind eye but not vice versa

occulomotor nerve

126
Q

Acute conjunctivitis : what would you see on the eye?

A

Global injection pattern - very red sclera of the eye.

blood vessels excentuated

127
Q

Subconjunctival hemorrhage : what would you see on the eye?

A

The extravasated blood has completely obscured the sclera underneath. Note the slightly raised appearance of the affected area.

very red

128
Q

Scleritis : what would you see on the eye?

A

Diffuse scleritis with a violaceous hue caused by deep inflammation.

Vessels do not blanch

129
Q

epicleritis : what would you see on the eye?

A

redness on only the most superficial vessels of the eye

130
Q

Acute angle closure gluacoma : what would you see on the eye?

A

Eye that does better in a bright room

may be red, cloudy pupil or cornea, dilated pupil in normal light

131
Q

Anterior uveitis : what would you see on the eye?

A

Note the perilimbal injection ( all over red vessels)
and the irregularly shaped pupil.

direct and consensual photophobia

132
Q

Extraoccular Muscles and Innervations

A

LR 6 SO4

Superior Oblique (4) (down towards nose) and Infectior Oblique (3)

Medial rectus (3) and lateral rectus (6) (out)

Superior and inferior rectus (3)

133
Q

Biggest risk factors for primary open angle glucoma AMA

A

high myopia, increased CDR, family history, black race, increasing age, presence of dic hemorrhage

low IOP makes glucoma unlikely

134
Q

T or false

Glaucoma is an optic neuropathy characterized
by irreversible loss of retinal
ganglion cells, resulting in progressive
thickening of the retinal nerve fiber
layer. It is often associated with higher
IOP

A

False :

to do with the thinning of retinal nerve fibers

135
Q

How to differentiate closed and open angle glaucoma AMA?

A

open-angle and closed-angle forms
based on the morphological appearance
of the iridocorneal angle at which
aqueous drainage takes place.

136
Q

T or false normal IOP is less or equal to 21 mmHg?

A

True

137
Q

What gives glaucoma it;s characteristic appearance of optic nerve cupping and increased CDR?

A

The loss of retinal nerve (ganglion) fiber layer tissue

138
Q

T or False

Progrssive loss of retinal ganglial cells causes peripheral vision loss?

A

Yes, in glaucoma

139
Q

T of False

Glaucoma was defined by the presence
of an optic disc with changes characteristic
of glaucoma that could not be explained
by another cause with a corresponding
visual field abnormality.
A

True

140
Q

T or False

Increased cup to dic ratio is present in diabetic neuropathy?

A

false

141
Q

True or False

CDR is measured by size, asymmetry, dic hemorrhages, IOP, and patient reported vision loss

A

False

not reported vision loss

142
Q

T or F

POAG is the second most dominant form of gluacoma in North America

A

False - it is the second leading cause of blindness worldwide

primary form of glaucoma in NA

143
Q

T or F

Increased CDR should always warant a referral to an opthamologist?

A

true - for glaucoma assessment. If they already know then no

144
Q

Most common cause of red eye?

A

conjunctivitis

145
Q

Common causes of red eye

A

Conjunctivitis is the most common cause of red eye. Other common causes include blepharitis,
corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis.

146
Q

Signs and symptoms of red eye

A

include eye discharge, redness, pain, photophobia, itching, and visual changes

147
Q

When is a referral for red eye needed (10)

OUCM

A

Referral is necessary when 1. severe pain
is not relieved with topical anesthetics;
2. topical steroids are needed;
3. the patient has vision loss, 4. copious purulent discharge,
5. corneal
involvement,
6. traumatic eye injury,
7. recent ocular surgery, 8. distorted pupil,
9. herpes infection,
10. or recurrent infections.

148
Q

Causes of conjunctivits (4)

A

viral , bacterial, chlamydial, noninfectious ( allergies)

149
Q

Which virus is the most virulent in viral conjunctivits?

A

Adenovirus

150
Q

Categories of bacterial conjunctivits

A

hyperacute - neisseria gonorrhoeae ( sexually active adults)

acute - most common. stap aureus,(adults) strep pneumoniae (children)

chronic - sx last for 4 weeks

151
Q

Herpes zoster conjunctivitis

signs (3)
symptoms

A

Vesicular rash, keratitis, uveitis

Pain and tingling sensation precedes
rash and conjunctivitis, typically
unilateral with dermatomal
involvement (periocular vesicles)

152
Q

Viral conjunctivits

signs (3)
symptoms 2

A

normal vision
redness
preauricular lymphadenopathy

Symp : mild/no pain
often unilateral

153
Q

Bacterial Conjunctivits

signs 1
symptoms (4)

A

eyelid edema

symp: mild to moderate pain - stinging
red eye with foriegn body sensation
purulent discharge
glued eyes upon waking

154
Q

Aleergic conjunctivits

signs 1

symptoms (5)

A

Visual acuity preserved

bilateral
painless tearing
very itchy
red
watery discharge
155
Q

Keratoconjuctivits sicca

signs 2

symptoms (7)

A

Dry eye

vision usually preserved

bilateral 
 red
itchy
foreign body sensation
mild pain
intermittent excessive watering
156
Q

Blepharitis

signs 3 , symp, 4

A

Dandruff like scaling on eyelashes
swollen eyelids
leads to conjunctivitis

red
irritated eye
worse when waking
crusty eyelids

157
Q

Corneal abrasion

signs 3, symptoms,

A

corneal edema or haze
foriegn body sensation
may have decreased visual acuity

severe eye pain
red
watery eyes

158
Q

Subconjunctival hemorrhage

signs 2 symptoms 3

A

signs - normal vision
bright red patch
white sclera

mild to no pain
no visual disturbance
no discharge

159
Q

Episcleritis

signs 1 symptoms 1

A

vision preserved
confined red patch on outer vessels of the sclera

vision preserved

160
Q

Keratitis

signs 1 symptoms 4

A

diminished vision

painful red eye
diminished vision
mucopurulent discharge

bacterial origin

161
Q

irits

signs 3 symptoms 3

A

diminished vision
poorly reacting pupils
constricted pupils

constant eye pain
watering red eye
photophobia

162
Q

ACAG

signs 4 symptoms 1

A

reduction in visiual acuity
dilated pupils
diffuse redness
halos appear when patient is around lights

acute onset of severe throbbing pain

163
Q

Scleritis

signs 1 symptoms 1

A

diminished vision

severe pain radiating to preorbital area

164
Q

dry eye

aka

associated with what?

A

keratoconjunctivitis sicca

increased age, female, and anticholinergics

165
Q

what constitutes serious eye disease? 4

A

red eye, photophobia, visual blurring, and eye pain

166
Q

What is ansiocoria?

A

a test - smaller pupil in the red eye and difference in pupil diameters

167
Q

Serious eye diseases ( 4)

A

uveitis
keratitis
corneal abrasion
scleritis

168
Q

Bengin disorder of the conjunctiva

A

conjunctivitis
episcleritis
subconjunctival hemorrhage

169
Q

Diagnostic score for bacterial conjunctivitis
(Rietveld)

what are we testing for?
what score do we need?

A 
2 glued eyes in the morning 
 plus 5 points
1 glued eye in the morning plus 2 points
Itching minus 1 points
History of conjunctivitis minus 2 points

score of 4 increases the probablity of bacterial conjunctivists

170
Q

Strabismus

what?

history?

PE?

next step?

A

most common cause of vision loss in children
2 eyes do not point in the same direction

history:
family reports childs eyes cross

PE: extraoccular movement abnormal
cover/uncover test positive

refer to opthamologist

171
Q

Amblyopia

what?

history?

PE?

next step?

A

most common cause of vision loss in children
lazy eye - reduced visual acuity in 1 eye
not correctable with lenses

history of premature birth
down syndrome, CP

vision decreased in 1 eye

refer

172
Q

How to test for refractive errors?

A

we don’t but can use snellen, or refer

173
Q

Optic nerve hypoplasia

what?

history?

PE?

next step?

A

non-progressive disorder

history of vision loss
central vision but no peripheral vision

Optic never is 1/2-1/3 normal size
pale grey
surrounded by halo

refer

174
Q

Retinoblastoma

what?

history?

PE?

next step?

A

intraocular tumor of childhood

Family history
child up to 2 years old

absence of red reflex/partial
strabismus
white flat masses on the retina

refer - can spread to brain or BM

175
Q

What is retinopathy?

A

a disease of the retina which causes vision loss

176
Q

Nystagmus

history?

PE?

next step?

A

histroy of eyes searching

rapid movement of eyes

refer

177
Q

Uveitis

what?

history?

PE?

next step?

A

inflam activity of iris, ciliary body, and choroid

History of chronic inflammation
mild to moderate pain
photophobia and tearing

PE - varied

refer - severe condition

178
Q

Optic Nerve Glioma

A

dimness of vision, loss of fields
unilateral vision loss with pain

visual fields compromised
optic atrophy (decline)

very associated with neurofibromatosis

179
Q

Craniopharygioma

what?
history?
PE?
next step?

A

tumors from the squamous epithelium of the brain

history :
HA, visual disturbance,

PE: increased IC pressire
normal optic discs

refer

CLIN MED (5 decks)

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