Vision Loss Flashcards
components of eye exam that pertain to vision loss
visual acuity, visual fields, pupils (PERRLA), tonometry, slit lamp/ pen light, dilated fundus
amsler grid
tests changes in vision
acute angle closure is rare/ common
rare
acute rise of IOP due to outflow obstruction (aqueous outflow)
acute angle closure
IOP
intraocular pressure
acute angle closure has a ____ mechanism than open angle glaucoma
different
which is more common, acute angle closure or open angle glaucoma
open angle glaucoma
glaucoma with acute narrowing of angle, inc IOP, optic nerve damage
acute angle closure glaucoma
glaucoma with chronic narrowing of angle, optic neuropathy, IOP not always significantly elevated, optic nerve damage
open angle glaucoma
crescent shadow occurs
because chamber is shallow, light cant pass through
crescent shadow might indicate
acute angle closure glaucoma (because of inc IOP)
ACUTE decresed vision, halos around lights, headache, N/V, severe eye pain, feeling of “pressure” (inc IOP)
acute angle closure
decreased vision, circumlimbal injection/ ciliary flush, steamy cornea, mid-dilated pupil, narrow anterior chamber, firm globe
acute angle closure
acute angle closure is a
ophthalmologic emergency
acute angle closure tx
topical ocular HTN meds (beta blockers, alpha 2 agonists), oral/IV osmotic agents (mannitol), laser peripheral iridotomy, surgical trabeculectomy, NO MYDRIATICS
early presentation of open angle glaucoma is
asymptomatic
late presentation of open angle glaucoma is
chronic painless visual field loss (1st peripheral, then central)
increased IOP, inc cup:disc (optic nerve), no AV nicking, no exudates
seen in open angle glaucoma exam
tx for open angle glaucoma
topical ocular HTN meds (beta blocker, alpha 2 agonists), laster trabeculoplasty, sx trabeculectomy
1 cause of central legal blindness in western world
macular degeneration
lens opacity (age related, congenital, traumatic), gradual, CHRONIC & PAINLESS loss of vision, “foggy vision”, glare at night, dec visual acuity, clouding/ opalescent changes to lens
cataracts
cataracts tx
glasses, sx (extracapsular cataract extraction, intraocular lens implant)
the prognosis for cataracts is
excellent
macular degeneration is caused by
aging (ARMD- Age Related Mac Degeneration) or toxic drug effects
gradual/acute blurred vision, metaorphopsia, central scotoma, +/- decreased vision, amsler grid distortion
macular degeneration
metamorphopsia
wavy/ distorted vision
central scotoma
blind spot
drusen bodies
lipid deposits
drusen bodies, pigment mottling, geographic atrophy, vision loss slow/ gradual, uni or bilateral
Dry ARMD
subretinal neovascular degeneration, subretinal fluid or blood, fibrosis/ scarring, rapid vision distortion, loss of central vision, usually unilateral
Wet ARMD
macular degeneration tx
vitamins (antiox, zinc, omega 3’s), smoking cessation, daily amsler grid changes, photocoagulation, photodynamic therapy, intravitreal steroids/monoclonal antibodies, low vision aids, stop the offending drugs
separation of retina from underlying epithelial layer
RD
RD
retinal detachment
posterior vitreous detachment, traumatic RD
rhegmatogenous RD
traction RD (associated with DM), exudative (extremely rare)
nonrhegmatogenous RD
painless, rapidly progresses, floaters, photopsias, complete/partial vision loss, curtain like vision loss, may be peripheral only, raised whitish retina, bilateral 20% of the time
retinal detachment
photopsias
light flashes
curtain like vision loss is from ___ to __
top to bottom
emboli in artery, edema in the retina, the only place the retina does not line is fovea
cherry red spot
worry about thrombotic events more in pts with
HTN
tx of RD
Surgery: laser/cryo/ scleral buckle/ vitrectomy
retinal vascular changes due to systemic HTN
hypertensive retinopathy
asymptomatic, arteriolar narrowing, arteriolar sclerosis, AV crossing changes, nerve fiber layer infarcts, retinal hemorrhages, retinal edema/ exudates, disc edema
hypertensive retinopathy
arterial narrowing looks like
copper wiring
arteriolar sclerosis looks like
silver wiring
AV crossing changes looks like
AV nicking
nerve fiber layer infarcts look like
cotton wool spots
hypertensive retinopathy tx
systemic BP control
severe hypertensive retinopathy can cause
associated visual loss
2 classifications of diabetic retinopathy
nonproliferative and proliferative
blurred vision, retinal hemorrhage, retinal edema, macular edema, cotton wool spots, venous dilation, microaneurysms
nonproliferative diabetic retinopathy
microaneurysms seen as
hard exudates
neovascularization, preretinal and vitreous hemorrhage, subsequent fibrosis, traction retinal detachment, macular edema
proliferative diabetic retinopathy
macular edema
retinal thickening and edema involving the macula
preretinal and vitreous hemorrhage can cause ___ and subsequent ___
preretinal and vitreous hemorrhage can cause sudden blindness and subsequent fibrosis
diabetic retinopathy tx
blood sugar control, laser photocoagulation, vitrectomy
when you think about IOP also think about
hyphema and hypophyon
central retinal artery occlusion is
embolic
central retinal vein occlusion is
thrombotic
CRAO
central retinal artery occlusion
CRVO
central retinal vein occlusion
acute TOTAL painless loss of vision, “black as night”, “no light perception”, afferent pupillary defect, whitening of retina, cherry red spot
CRAO
acute VARIABLE painless loss of vision, variable vision, +/- afferent pupillary defect, “blood and thunder” retinal appearance
CRVO
CRAO tx
no effective tx, eval etiology to prevent future strokes (carotid plaques, cardiac thrombi)
CRVO tx
aspirin, observation, tx retinal edema/ischemia, eval etiology if young (severe HTN, hypercoagulable)
acute inflammatory demyelination of the optic nerve
optic neuritis
monocular vision loss over hours to days, central scotoma, painful, +/- abnromal color vision, +/- flashes of light, 1/3 visible papillitis with disc swelling
optic neuritis
optic neuritis tx
MRI brain and orbits, IV methylprednisolone for severe loss or 2+ white matter lesions on MRI, no tx (improves in 2-3 weeks, typically 20/40 vision by one year)
IV methylprednisone has a ____ recovery and ____ long term vision fxn in the tx of optic neuritis
IV methylprednisone has a MORE RAPID recovery and DOES NOT IMPACT long term vision fxn in the tx of optic neuritis
when doing a history, think ___ and ___
when doing a history, think ACUTE and CHRONIC
perform a careful eye exam and do not forget
vision
when performing an eye exam, go from ___ to ___
outside to in