Week 1 Notes Flashcards
Child presents with retinal hemorrhage or detachment without history of trauma =
Child Abuse
Vision Loss Scheme - Keratitis
- Acute or Chronic, Def. + Location, Physical Exam
- Acute
- Def: Inflammation of Cornea (Pre-retinal) due to trauma, infection, etc.
- Visualized under cobalt blue light with aid of fluorescein dye
Vision Loss Scheme - Corneal Edema
- Acute or Chronic, Causes, Details
-Acute
- Cause #1 - Blunt Trauma
- Cause #2 - Acute Angle-Closure Glaucoma (EMERGENCY)
Hx: sudden, unilateral eye pain. Seeing HALOS. Nausea and Vomiting.
Px: Red eye, corneal cloudiness, tearing, pupil fixed in mid dilated position.
Vision Loss Scheme: Vitreous Humor
- Acute or Chronic, Hx Risk Factor, Physical
- Acute
- Risk factor to be aware of: Poorly controlled Diabetes = retinal neovascularization = hemorrhage.
- Monocular vision loss, diminished red reflex.
Vision Loss Scheme: Retinal Occlusion = Artery vs Vein
- More detail in 1.12
- Acute
Retinal Artery Occlusion - Def: a form of stroke (via thrombosis, embolism, arteritis, etc.)
- Hx: Sudden, severe, PAINLESS, CENTRAL vision loss
- Px: Vascular narrowing, ischemic retina, cherry red spots
Retinal Vein Occlusion
- DEF: Thrombosis (via venous stasis which I suppose can technically cause a stroke.)
- Hx: Monocular, vision deficit corresponds with area of occlusion.
- Px: “Blood and thunder” fundus = hemorrhages, cotton wool spots, disc swelling.
Vision Loss Scheme: Retinal Detachment
- Hx + Px
- Acute
Hx: Sudden onset of floaters or black dots, PHOTOPSIAS (flashes of light) + NOT PAINFUL
Px: Dulling red reflex, elevated retina with folds
Vision Loss Scheme: Papilledema
- Hx + Px
- Acute or Chornic
Hx: More of Headache, nausea, and vomiting due to elevated intracranial pressure than visual sx.
Px: Bilateral optic disc swelling
Vision Loss Scheme: Optic Neuritis
- Risk Factor + Hx.
- Acute or Chornic
Risk Factor: MULTIPLE SCLEROSIS - Hx: Washed out vision, pain with eye movement, reduced visual acuity.
Vision Loss Scheme: Stroke/Tumor
- Important Px trait
Visual acuity NOT Affected
Vision Loss Scheme: Macular Degeneration
- Dry vs Wet Type
- Chronic
- Def: Degenerative disease of CENTRAL portion of retina + loss of vision in CENTER of visual field (scotomas.
Dry Type
- DRUSEN: Deposition of yellowish extracellular material
- Slowly progressive vision loss
Wet Type
- NEOVASCULAR: Growth of abnormal blood vessels into subretinal space. Blood vessels leak.
- Rapid loss of central vision over weeks/months + metamorphopsia (distortion of straight lines)
Vision Loss Scheme: Diabetic Retinopathy
- Nonproliferative vs Proliferative
Nonproliferative
- Absence of neovascularization
- Vision loss is primarily due tot macular edema
- Intraretinal hemorrhages, nerve fiber infarcts (cotton wool), and hard exudates.
Proliferative
- Neovascularization of both retina and optic disc.
- leads to vitreous hemorrhage, tractional retinal detachment, fibrosis.
Superior Oblique Eye Muscle:
Action vs Testing.
Action of Superior Oblique
- Downward, Abduction + Internal rotation
Testing of Superior Oblique
- Ask the patient to look medially in order to limit lateral rectus
- Then ask the patient to look downwards to test Superior Oblique
- Note: downward motion is not as affected by inferior rectus because the muscle doesn’t align with the orbital axis while the is looking medially.
Eye muscles of adduction.
Main adductor = medial rectus
- Superior/inferior rectus also have some component of adduction.
Fovea
- Distinctive fact
- Area of most visual acuity
- Purely Cones (no rods or ganglion cells)
Retinal Blood Supply
- Inner and Outer
Inner Retina: Ophthalmic artery branch of internal carotid
Outer Retina: Diffusely perfused by arteries from choroid
