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eye > vision abnormalities > Flashcards

vision abnormalities Flashcards

1
Q

what is presbyopia

A

aging eyes
normal aging in middle age– usually by 45 or so

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2
Q

what does presbyopia cause

A

refractive error for close vision (can’t see up close)
eye strain
headaches

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3
Q

what happens to the lens in presbyopia

A

lens gets harder and less flexible with age and stops focusing light correctly onto the retina

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4
Q

how to treat presbyopia

A

corrective lenses

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5
Q

how to assess presbyopia

A

eye exam

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6
Q

three types of glaucoma

A

acute angle closure
chronic angle closure
chronic open angle

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6
Q

what is glaucoma

A

damage to the optic nerve from pressure inside the eye

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7
Q

Glaucoma risk factors

A

individuals with first degree relative
DM
affected ethnic groups (shape of eye)
pts using long term steroid therapy

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8
Q

form of glaucoma caused by rapid narrowing or closure of the anterior chamber angle
(sudden, matter of seconds)

A

acute angle closure glaucoma

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9
Q

inadequate drainage of the aqueous humor leads to increased IOP and damage to the optic nerve

A

acute angle closure glaucoma

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10
Q

acute angle closure glaucoma risk factors

A

shallow anterior chamber which is associated with far sightedness or small eyes
genetics/ancestry
elderly

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11
Q

extreme pain and blurred vision (sudden although can be subacute headaches)
unilateral
halos around lights
headaches
nausea/ abdominal pain
red eye/cloudy cornea/dilated pupil
eye feels hard on palpation

A

acute angle closure glaucoma patient presentation

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11
Q

acute angle closure glaucoma precipitated by

A

pupil dilation
(they went into dark room, pupils dilated, then vision loss)

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12
Q

acute angle closure glaucoma pressure

A

well over 50
(normal IOP 10-21)

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13
Q

acute angle closure glaucoma treatment

A

emergent referral to ophthalmology

reduce IOP:
- IV acetazolamide
- followed by oral acetazolamide
- plus topical medication (timolol maleate)
- topical pilocarpine (after IOP starts to fall)

cataract removal or laser peripheral iridotomy to follow

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13
Q

chronic glaucoma symptoms

A

may be no symptoms (or not noticed) until disease has progressed for a long time

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14
Q

progressive optic nerve damage
leads to visual field loss and ultimately, irreversible blindness if left untreated
gradual loss of peripheral vision “tunnel vision”

A

chronic glaucoma

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15
Q

chronic glaucoma often suspected on

A

routine eye test

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16
Q

optic nerve cupping: looks like a pale cup
nerves don’t connect

A

chronic glaucoma vision loss

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17
Q

chronic glaucoma prevention
screen patients with IOP measurements and optic disk exam if

A

inuit or asian ancestry
affected 1st degree relative
DM
older people with African or hispanic ancestry
long term oral, intranasal, and inhaled corticosteroid use

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18
Q

increased aqueous production and/or decreased outflow are possible mechanisms for elevated IOP
most common and usually bilateral

A

open angle chronic glaucoma

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19
Q

chronic low vascular perfusion, Raynaud’s phenomenon, migraine, nocturnal systemic hypotension and over treated systemic hypertension

A

normal tension chronic glaucoma

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20
Q

flow of aqueous humor is obstructed
similar to acute form, can have eye redness, discomfort, and headache
progression much slower
may have only mildly elevated IOP

A

angle closure chronic glaucoma

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21
Q

the outer rim tends to be orange or pink in color and contains the nerve fibers

A

disc

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21
Q

(in the center) is a pit where there are no nerve fibers – this is where blood vessels enter the eye

A

cup

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22
Q

the disc takes on a hollowed out appearance on fundoscopic exam from the death of smaller nerves around the optic nerve

A

cupping

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23
Q

the cup should not make up more than _______ of the total area of the optic nerve

A

30%

24
Q

what happens to central vision in glaucoma

A

remains good until late in disease

25
Q

glaucoma diagnosis
consistent and reproducible abnormalities in at least 2 of 3 parameters:

A

optic disk
visual fields
intraocular pressure

26
Q

chronic glaucoma treatment

A
  • prostaglandin analog drops: reduce IOP (latanoprost, travoprost, latanoprostene bound)
  • topical beta blockers: reduce production of fluid
  • laser treatment or surgery if medication fails: open up space to improve flow of aqueous humor
    (trabeculoplasty, trabeculectomy, iridectomy)
27
Q

what causes strabismus

A

problems with the eye muscles
nerves that transmit information to the muscles
control center in brain that directs eye movements

28
Q

misalignment of the eyes

A

strabismus

29
Q

strabismus usually presents in

A

children

30
Q

eye deviated inward

A

esotropia (strabismus)

31
Q

eye deviated outward

A

exotropia (strabismus)

32
Q

epicanthal skin folds cover the medial canthus
lack of development of the bridge of the nose

A

pseudostrabismus

33
Q

what tests do you do for strabismus

A

Hirschberg test to see if white light is in same spot on pupil
cover test to see if bad eye will move into place

34
Q

risk factors for amblyopia

A

prematurity
small size for gestational age
first degree relative with amblyopia
neurodevelopmental delay

35
Q

functional reduction in visual acuity caused by abnormal visual development early in life

most common cause of pediatric visual impairment

unilateral

often associated with impaired or absent fine depth perception

A

amblyopia

36
Q

abnormal binocular interaction and long term suppression of one eye

A

strabismic amblyopia

37
Q

appropriately focused visual stimuli are crucial to the development of

A

normal vision
critical period of visual cortex neuroplasticity

38
Q

affected children are often diagnosed at the first vision screening when they are old enough to identify letters or figures (typically 4-5 years)

A

refractive amblyopia

38
Q

visual acuity typically reaches the adult level by

A

3-5 years of age

39
Q

growth on eyelid

A

deprivational amblyopia

40
Q

amblyopia diagnosis

A

complete eye exam by skilled eye care specialist

defined as >2 line difference in visual acuity between eyes

41
Q

what does amblyopia screening include

A

vision risk assessment at all health maintenance visits and vision screening at 3,4, and 5

42
Q

objection to occlusion test
(amblyopia: preverbal screening and referral)

A

monitoring Childs response to alternate occlusion of the eyes

42
Q

who should be screened for amblyopia

A

all children younger than five

43
Q

during objection to occlusion test what can you expect from children with moderate to severe visual impairment in one eye when the eye with better vision is occluded

A

become irritable

44
Q

children with suspected amblyopia should be referred to a

A

pediatric ophthalmologist or optometrist

45
Q

indications for amblyopia referral

A
  • visual acuity worse than 20/40 in a child 3-5 or worse than 20/30 in a child 6 or older
  • visual acuity difference > 2 lines between eyes
  • strabismus
    -abnormal red reflex
  • asymmetry of vision
  • unilateral ptosis or other lesions that threaten the visual axis
46
Q

amblyopia treatment

A

occlusion therapy (patching better eye)
atropine
fix structural problems

47
Q

retinal tumor of childhood
67% diagnosed before the age of 2, rare after 6

A

retinoblastoma

48
Q

most common presenting symptoms of retinoblastoma

A

leukocoria (white reflex) or strabismus

49
Q

retinoblastoma diagnosis

A

fundoscopic exam under anesthesia with maximally dilated pupil
imaging studies to confirm and evaluation for extension

50
Q

retinoblastoma management

A

ophthalmology and oncology

51
Q

transient emboli to a retinol artery
carotid artery stenosis

A

amaurosis fugax

51
Q

this is a symptom
sudden unilateral vision loss
painless
typically lasts a few minutes
like a curtain going down and then up

A

amaurosis fugax

52
Q

how do patients present with amaurosis fugax

A

almost always present after transient visual loss episode has resolved

  • neurologic and ophthalmologic exam is usually normal
53
Q

Amaurosis fugax: differential diagnosis

A

carotid artery disease

giant cell arteritis
(swelling of the arteries of the head reduces blood supply)
(usually with pain and headache)

54
Q

amaurosis fugax: evaluation
> 45

A

ischemic cause likely

55
Q

amaurosis fugax: evaluation
< 40

A

benign migrainous cause likely

56
Q

Amaurosis fugax: exam

A

visual acuity
visual fields
examination of optic fundus
carotid artery

57
Q

Amaurosis fugax: evaluation

A
  • ophthalmologic evaluation
  • erythrocyte sedimentation rate and C-reactive protein
  • carotid imaging
58
Q

what to do if initial testing for amaurosis fugax is normal

A

Cardiac evaluation
brain MRI
EEG
hypercoagulable testing

59
Q

Amaurosis fugax treatment

A

depends on the cause
treat like stroke until proven otherwise

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