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Clin Med Exam 2 (Lauren) > Vision Loss > Flashcards

Vision Loss Flashcards

1
Q

How should you test visual fields?

A

One eye at a time

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2
Q

Which kind of glaucoma is more rare?

A

Acute angle closure glaucoma

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3
Q

What is the mechanism of acute angle closure glaucoma?

A

Acute rise of IOP due to outflow obstruction

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4
Q

What type of glaucoma:
Chronic narrowing of angle

Optic neuropathy

IOP not elevated significantly

Optic nerve damage

A

Open angle glaucoma

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5
Q

Can both types of glaucoma cause optic nerve damage?

A

Yes

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6
Q

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

A

Acute angle glaucoma

STEAMY
HALOS

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7
Q

What do you need to do right away if you see acute angle closure glaucoma? (Before they even go to ophthalmology)

A

Start on topical ocular hypertension meds:
Beta-blockers

Alpha-2 agonists

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8
Q

What should you NOT do to someone with acute angle closure glaucoma?

A

Give Mydriatics (DO NOT DILATE THEIR PUPILS)

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9
Q

Name the glaucoma:

Asymptomatic early

CHronic painless vision loss that starts peripherally

Increased cup/disc ratio

No AV nicking

No exudates

A

Open angle glaucoma

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10
Q

What kind of glaucoma is an emergency

A

Acute angle closure

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11
Q

How do you manage open angle glaucoma?

A

Refer to ophtho, but it is not an emergency

Topical ocular hypertension meds

Laser trabeculoplasty/surgical trabeculectomy

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12
Q

What can cause cataracts?

A

Age related

Congenital

Traumatic

Long term steroid therapy

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13
Q

Name it:
Lens opacity

Gradual, chronic, painless loss of vision

“Foggy vision”

Decreased visual acuity

Clouding/opalescent changes to lens

A

Cataract

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14
Q

How do you manage cataracts

A

Refer to ophthalmology if their lifestyle is affected.

Surgery has an excellent prognosis

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15
Q

What is the #1 cause of central legal blindness in Western world?

A

Macular degeneration

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16
Q

Name it:
Gradual or acute blurred vision

Metamorphosis (wavy vision)

Central scotoma (blind spot)

Amsler grid distortion

+/- decreased vision

A

Macular degeneration

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17
Q

Which is worse: wet or dry age related macular degeneration?

A

Wet

18
Q

Wet or Dry ARMD:

Drusen bodies**

Pigment mottling**

Geographic atrophy

Slow/gradual vision loss

One or both eyes

A

Dry

19
Q

Wet or Dry ARMD:
Subretinal neovascular degeneration

Subretinal fluid or blood**

Fibrosis/scarring

RAPID vision distortion

Loss of central vision

Usually just one eye

A

Wet

20
Q

What is the management of macular degeneration?

A

Vitamins (antioxidants/zinc)

Omega 3 FA’s

STOP SMOKING

Daily Amsler grid checks

Photocoagulation, photodynamic therapy, intravitreal steroid/monoclonal antibodies

21
Q

What are the two types of retinal detachment?

A

Rhegmatogenous

Nonrhegmatogenous

22
Q

Which type of retinal detachment:

Posterior vitreous detachment

Traumatic retinal detachment

A

Rhegmatogenous

23
Q

Which type of retinal detachment:

Traction retinal detachment

Associated with diabetes

Exudative (rare)

A

nonrhegmatogenous

24
Q

What is the presentation of retinal detachment?

A

Curtain-like vision loss **

Painless

Floaters

Photopsias (light flashes)

Loss of vision

May be peripheral only

Raised whitish retina

25
Q

What should you do if you have a patient with only one retinal detachment?

A

Check the other eye! It is bilateral 20% of the time

26
Q

How do you manage retinal detachment/

A

Refer to ophthalmology

Medical: laser/cryo surgery

Surgery: scleral buckle/vitrectomy

27
Q

Name it:

Arteriolar narrowing “copper wiring”

Arteriolar sclerosis “silver wiring”

AV nicking

Retinal hemorrhage’s

Retinal edema/exudates

Disc edema

A

Hypertensive retinopathy

28
Q

How do you manage hypertensive retinopathy?

A

Control BP

Refer to ophthalmology if severe and they have vision loss

29
Q

What are the two types of diabetic retinopathy?

A

Non-proliferative

Proliferative

30
Q

Name it:
Blurred vision

Hard Exudates (microaneurysms)

Retinal hemorrhage

Retinal edema

Macular edema

Cotton-wool spots

Venous dilation

A

Non-proliferative Diabetoic retinopathy

31
Q

Name it:
Neovascularization

Preretinal and vitreous hemorrhage

Subsequent fibrosis

Traction retinal detachment

Macular edema: retinal thickening and edema invloving the macula

A

Proliferative diabetic retinopathy

32
Q

Which type of diabetic retinopathy is worse?

A

Proliferative

33
Q

How do you manage diabetic retinopathy?

A

Control blood sugar

Refer to ophthalmology

Laser photocoagulation (stops bleeding)

Vitrectomy

34
Q

What are the two types of retinal vascular occlusion?

A

Central retinal artery occlusion

Central retinal vein occlusion

35
Q

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”

A

Central retinal artery occlusion

36
Q

Name the type of retinal vascular occlusion:
Thrombotic

Variable, painless loss of vision

+/- afferent pupillary defect

“Blood and thunder” retinal appearance

A

Central retinal vein occlusion

37
Q

How do you manage central retinal artery occlusion?

A

No effective treatment

Evaluate etiology to prevent future strokes - carotid plaques, cardiac thrombi

Poor prognosis

38
Q

How do you manage central retinal vein occlusion?

A

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

39
Q

What causes optic neuritis?

A

Demyelination of the optic nerve

40
Q

How does optic neuritis present?

A

Monocular vision loss over hours to days

Central scotoma

+/- abnormal color vision

+/- flashes of light

+/- visible papillitis (inflammation of optic disc) with disc swelling

41
Q

How do you manage optic neuritis?

A

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

42
Q

What is the prognosis of optic neuritis?

A

30% will have Multiple Sclerosis at 5 years ~demyelination~

Clin Med Exam 2 (Lauren) (6 decks)

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