Vision Loss Flashcards
How should you test visual fields?
One eye at a time
Which kind of glaucoma is more rare?
Acute angle closure glaucoma
What is the mechanism of acute angle closure glaucoma?
Acute rise of IOP due to outflow obstruction
What type of glaucoma:
Chronic narrowing of angle
Optic neuropathy
IOP not elevated significantly
Optic nerve damage
Open angle glaucoma
Can both types of glaucoma cause optic nerve damage?
Yes
Name the glaucoma:
Acute decreased vision
Halos around lights**
Headache
Nausea and vomiting
Severe eye pain
Feeling of pressure
STEAMY cornea***
Dilated pupil
Narrow anterior chamber
Firm globe
Acute angle glaucoma
STEAMY
HALOS
What do you need to do right away if you see acute angle closure glaucoma? (Before they even go to ophthalmology)
Start on topical ocular hypertension meds:
Beta-blockers
Alpha-2 agonists
What should you NOT do to someone with acute angle closure glaucoma?
Give Mydriatics (DO NOT DILATE THEIR PUPILS)
Name the glaucoma:
Asymptomatic early
CHronic painless vision loss that starts peripherally
Increased cup/disc ratio
No AV nicking
No exudates
Open angle glaucoma
What kind of glaucoma is an emergency
Acute angle closure
How do you manage open angle glaucoma?
Refer to ophtho, but it is not an emergency
Topical ocular hypertension meds
Laser trabeculoplasty/surgical trabeculectomy
What can cause cataracts?
Age related
Congenital
Traumatic
Long term steroid therapy
Name it:
Lens opacity
Gradual, chronic, painless loss of vision
“Foggy vision”
Decreased visual acuity
Clouding/opalescent changes to lens
Cataract
How do you manage cataracts
Refer to ophthalmology if their lifestyle is affected.
Surgery has an excellent prognosis
What is the #1 cause of central legal blindness in Western world?
Macular degeneration
Name it:
Gradual or acute blurred vision
Metamorphosis (wavy vision)
Central scotoma (blind spot)
Amsler grid distortion
+/- decreased vision
Macular degeneration
Which is worse: wet or dry age related macular degeneration?
Wet
Wet or Dry ARMD:
Drusen bodies**
Pigment mottling**
Geographic atrophy
Slow/gradual vision loss
One or both eyes
Dry
Wet or Dry ARMD:
Subretinal neovascular degeneration
Subretinal fluid or blood**
Fibrosis/scarring
RAPID vision distortion
Loss of central vision
Usually just one eye
Wet
What is the management of macular degeneration?
Vitamins (antioxidants/zinc)
Omega 3 FA’s
STOP SMOKING
Daily Amsler grid checks
Photocoagulation, photodynamic therapy, intravitreal steroid/monoclonal antibodies
What are the two types of retinal detachment?
Rhegmatogenous
Nonrhegmatogenous
Which type of retinal detachment:
Posterior vitreous detachment
Traumatic retinal detachment
Rhegmatogenous
Which type of retinal detachment:
Traction retinal detachment
Associated with diabetes
Exudative (rare)
nonrhegmatogenous
What is the presentation of retinal detachment?
Curtain-like vision loss **
Painless
Floaters
Photopsias (light flashes)
Loss of vision
May be peripheral only
Raised whitish retina
What should you do if you have a patient with only one retinal detachment?
Check the other eye! It is bilateral 20% of the time
How do you manage retinal detachment/
Refer to ophthalmology
Medical: laser/cryo surgery
Surgery: scleral buckle/vitrectomy
Name it:
Arteriolar narrowing “copper wiring”
Arteriolar sclerosis “silver wiring”
AV nicking
Retinal hemorrhage’s
Retinal edema/exudates
Disc edema
Hypertensive retinopathy
How do you manage hypertensive retinopathy?
Control BP
Refer to ophthalmology if severe and they have vision loss
What are the two types of diabetic retinopathy?
Non-proliferative
Proliferative
Name it:
Blurred vision
Hard Exudates (microaneurysms)
Retinal hemorrhage
Retinal edema
Macular edema
Cotton-wool spots
Venous dilation
Non-proliferative Diabetoic retinopathy
Name it:
Neovascularization
Preretinal and vitreous hemorrhage
Subsequent fibrosis
Traction retinal detachment
Macular edema: retinal thickening and edema invloving the macula
Proliferative diabetic retinopathy
Which type of diabetic retinopathy is worse?
Proliferative
How do you manage diabetic retinopathy?
Control blood sugar
Refer to ophthalmology
Laser photocoagulation (stops bleeding)
Vitrectomy
What are the two types of retinal vascular occlusion?
Central retinal artery occlusion
Central retinal vein occlusion
Name the type of retinal vascular occlusion:
Emboli
Total painless loss of vision “black as night”
no light perception
Afferent pupillary defect
Whitening of retina
“Cherry red spot”
Central retinal artery occlusion
Name the type of retinal vascular occlusion:
Thrombotic
Variable, painless loss of vision
+/- afferent pupillary defect
“Blood and thunder” retinal appearance
Central retinal vein occlusion
How do you manage central retinal artery occlusion?
No effective treatment
Evaluate etiology to prevent future strokes - carotid plaques, cardiac thrombi
Poor prognosis
How do you manage central retinal vein occlusion?
Aspirin
Observation
Treatment for retinal edema or ischemia
Evaluate etiology if the pt is young…why did they get a clot? Severe hypertension, hypercoagulable state
What causes optic neuritis?
Demyelination of the optic nerve
How does optic neuritis present?
Monocular vision loss over hours to days
Central scotoma
+/- abnormal color vision
+/- flashes of light
+/- visible papillitis (inflammation of optic disc) with disc swelling
How do you manage optic neuritis?
MRI brain and orbits to look for signs of MS “white matter”
IV Methylprednisolone for sever vision loss or 2+ white matter lesions on MRI (faster recovery, but does not impact long term vision)
No treatment- improve in 2-3 weeks and will have 20/40 vision by one year
What is the prognosis of optic neuritis?
30% will have Multiple Sclerosis at 5 years ~demyelination~
