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Ophthalmology > Vision loss - Gradual > Flashcards

Vision loss - Gradual Flashcards

1
Q

In general how does gradual types of vision loss generally occur ?

A
  • Usually bilaterally
  • Early with reduced visual acuity
  • Late with reduced fields
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2
Q

What is the acronym for remembering the causes of gradual vision loss ?

A
  • Cataract
  • Age related macular degeneration (dry type)
  • Refractive error
  • Diabetic retinopathy (covered in other lecture)
  • Inherited diseases e.g. retinitis pigmentosa
  • Glaucoma
  • Access (to eye clinic) Non-urgent

CARDIGAN

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3
Q

Describe the typical presentation of cataracts

A
  • Blurred or cloudy vision
  • Cloudiness of the lens
  • Absent red reflexes
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4
Q

What are some of the causes of cataracts ?

A
  • Age related
  • Congenital – intrauterine infection e.g. Rubella, CMV, Toxoplasmosis (importance of checking red reflex in neonates)
  • Traumatic
  • Metabolic – diabetes
  • Drug-induced (steroids)
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5
Q

What is the treatment of cataracts ?

A
  • If symptomatic - then surgery (Phaco-emulsification with intra-ocular lens)
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6
Q

What is dry ARMD & what is it characterised by?

A
  • Essentially ‘wear and tear’ of the retinal pigment epithelium (RPE)
  • Characterised by deposition of drusen (hard or soft) and RPE hypo/hyperpigmentation
  • Results in slow, progressive drop in central VA
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7
Q

What are the common signs/symptoms of Dry ARMD?

A

Symptoms:

  • Gradual decline in vision
  • Central vision missing

Signs:

  • Drusen (the yellow patches)
  • Atropic patches of retina
  • Sometimes haemorrhage at macula
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8
Q

What is the treatment of Dry ARMD?

A

No cure so supportive with vision aids e.g. magnifiers

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9
Q

Define what is meant by refractive error ?

A

This is disorders to do with the size and shape of the eye preventing the eye from being able to focus clearly

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10
Q

What are the 4 main types of refractive error ?

A
  • Myopia
  • Hypermetropia
  • Astigmatism
  • Presbyopia
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11
Q

Define myopia

A
  • This is short-sightedness
  • The light focuses in front of the retina
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12
Q

Define hypermetropia

A
  • This is long sightedness
  • The light is focuses behind the retina
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13
Q

Define astigmatism

A
  • This is where images are distorted longitudinally or vertically.
  • This is caused if the cornea and lens does not have the same degree of curvature in the horizontal and vertical planes
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14
Q

Define presbyopia

A
  • This is where with age the lens stiffness preventing it from quickly changing in shape going from far away objects to up-close ones
  • Hence the need for reading glasses as you get older
  • (this is normal age-related refractive error)
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15
Q

What is done to correct refractive errors ?

A

Corrective glasses given

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16
Q

Specifically what type of lens is used to correct myopias ?

A

Concave lens’s

17
Q

Specifically what type of lens is used to correct hypermetropias?

A

Convex lens’s

18
Q

Describe the overall idea of how gluacomas result in vision loss ?

A
  • May be due to raised IOP but pathogenesis not fully understood
  • But essentially there is damage to the optic nerve therefore vision loss
19
Q

What are the 2 main classes of glucaoma’s?

A

Open and closed gluacomas

20
Q

How do patients typically present with close-angle gluacomas ?

A
  • Acutely
  • Very painful red eye
  • Visual loss
  • Headache
  • Nausea
  • Vomiting
21
Q

What are the signs/symptoms of open-angle gluacomas ?

A

Often symptomless

Signs:

  • Increased cup to disc ratio (>0.7)
  • Notching of optic cup
  • Optic disc pallor - indicating optic atrophy
  • Bayonetting of vessels - vessels have breaks as they disappear into the deep cup and re-appear at the base
  • Peripheral vision loss & decreased VA
  • +/- raised IOP
22
Q

What is the first-line treatment of open angle gluacomas ?

A

1st line: (eye drops)

1st line = Topical ophthalmic prostaglandin analogues - e.g. lantanoprost, tovoprost (think oprost)

2nd line either:

  • Topical ophthalmic beta-blockers - just think olol
  • Topical ophthalmic carbonic anhydrase inhibitors - e.g. dorzolamide (think zolamide)
  • Topical ophthalmic alpha-2 adrenergic agonists - e.g. apraclonidine (think onidine)
23
Q

What is the treatment of acute close-angle glaucoma’s ?

A
  • 1st line: carbonic anhydrase inhibitors and/or topical beta-blocker and/or topical alpha-2 agonist
  • adjunct: topical ophthalmic cholinergic agonists - e.g. pilocarpine
  • adjunct: hyperosmotic agents - e.g. glycerol
  • plus: laser peripheral iridotomy after acute attack resolved

Ophthalmology (23 decks)

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