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36 Cards in this Set
- Front
- Back
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What is amlyopia?
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Lazy eye; loss of visual acuity not correctable by glasses
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What are 3 types of amblyopia?
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refractive
occlusion strabismic |
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What happens in refractive amblyopia?
How do you treat? |
Uncorrected refractive errors (from birth) --> better seeing eye takes over all sight, poorer eye will not develop visual pathways
Treat with glasses for 4-8 weeks, after which, use a patch on the 'good' eye |
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What is occlusion amblyopia?
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Opacities in ocular media prevents adequate sensory input, disrupts visual development
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What is strabismic amblyopia?
How do you check for alignment? |
Eyes are misaligned at birth, (eso or exotropia), but never achieve alignment
Check for centration of the corneal light reflex |
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How do you treat strabismic amblyopia?
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realign eyes, patch ood eye, spectacles
may need to realign eyes with surgery |
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What is strabismus?
What is the compensation in kids? |
Eyes not properly aligned
Brain suppresses vision in deviated eye to avoid double vision --> kids develop amblyopia |
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How does strabismus in kids differ from that in adults?
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kids --> suppress bad eye, develop amblyopia
adults --> misalignment causes diplopia |
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What are the CN palsies that can cause strabismus?
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CN3, 4, 6
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Patient has oculomotor palsy + dilated pupil
What do you suspect and what test do you do? |
Suspect compression of parasympathetic fibers by a posterior communicating artery aneurysm
Do MRI+contrast, MR angiography with attention to Circle of Willis |
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patient (>50yo) presents with acute, isolated, pupil-sparing CN3 palsy
What conditions do you need to rule out |
Ischemia of CN3 due to diabetes and/or hypertension
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Patient has a fixed, dilated pupil with normal lid and extraocular muscle function
what conditions should you check for |
strabismus, ptosis to make sure there is no
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Patient presents with esotropia
What CN nerve might be the culprit? Possible causes |
CN6 (lateral rectus)
Trauma, stretch from Increased ICP, ischemia (diabetics) |
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Patient presents with vertical double vision + trauma
what should you suspect |
CN4 palsy
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Pathology of nonproliferative stage of diabetic retinopathy?
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Precapillary retinal arterioles are damaged, leak fluid and exudates into the retina, which can become occluded
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What can you see in the eye with diabetic nonproliferative diabteic retinopathy
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retinal microaneurysm
dot and blot hemorrhages hard exudates macular edema --> retinal thickening --> vision loss |
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In diabetic retinopathy, the appearance of cotton wool spots on fundoscopic exam indicate what?
Can lead to what? |
nonproliferative retinopathy
microvascular occlusions --> retinal ischemia Leads to VEGF --> neovascularization --> proliferative diabetic retnopathy |
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what do you see in untreated proliferative retinopathy (diabetic)
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recurrent vitreous hemorrhage --> fibrous tissue + neovascularization --> retinal detachment, blindness
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What is the best way to treat diabetic retinopathy
if macular edema? |
prevention by controling Hb A1c
if macular edema --> focal laser photocoagulation to seal leaking microaneurysms and decrease retinal thickening |
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What is the treatment for proliferative diabetic retinopathy?
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Peripheral retinal laster photocoagulation - converts dying, VEGF-producing peripheral retina to dead retina (avoid macula)
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On fundoscopic exam, you see copper wire arterioles
What's going on? |
Systemic HTN --> arteriolar sclerosis --> broadens to occupy most of the vessel
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On fundoscopic exam, you see silver wire arterioles
Whats going on? |
Fibrosis continues, arteriolar sclerosis obscures entire vessel
Light reflex completely obscured |
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What happens to arterioles and venules in arteriolar sclerosis
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arteriolar vessel wall compresses venule (because they share an adventitial sheath in retina) --> nicking or right angle change, focal narrowing
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Patient has:
exudates in retina cotton-wool spots flame-shaped hemorrhages macular edema What is happening? |
Severe acute rise in BP in someone with hypertensive retinopathy
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What might you see on fundoscopic exam of someone with malignant HTN retinopathy
How should you proceed? |
optic disc swelling bilaterally
lower BP to avoid ischemic stroke or ischemic optic neuropathy |
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most common cause of uni/bilateral proptosis in adults
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graves
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What are 4 complications of graves proptosis?
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1. Eyelid edema and conjunctival vessel edema
2. exposure keratopathy --> dry eye, foreign body sensation 3. Diplopia due to extraocular muscle involvement 4. compression of optic nerve (accum. of glycosaminoglycans) --> do orbital decompression |
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Histologic appearance of sarcoidosis?
Who does it affect most |
focal noncaseating granulomas
black women 20-40 |
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Labs findings:
elevated ACE elevated serum lysozyme abnormal CXR - hilar lymphadenopathy How do you diagnose conclusively |
Sarcoidosis
biopsy of conjunctiva --> see granuloma |
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What are 3 complications of sarcoidosis?
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1. anterior uveitis
2. posterior uveitis 3. posterior uveitis + retinal involvement --> vasculitis, retinal hemorrhages, peripheral retinal neovascularization |
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Where do skin cancers frequently affect?
What types of malignancies are common? |
Eyelids and ocular adnexa
Basal cell carcinoma Less common: sq. cel, sebaceous carcinoma |
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From where do ocular and orbital metastases come from?
where do they infiltrate? |
breast or lung
choroid |
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AIDS retinopathy
What do you see on fundoscopic exam and why |
retinal cotton wool spots
microthrombi from antigen-Ab complex or fibrin --> occlusin of retinal capillaries --> accumulation of axoplasm in retinal nerve fiber layer |
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What is the leading cause of vision loss in AIDS patients
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CMV retinitis
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You see:
Hemorrhagic retinal necrosis with white brush border (cottage cheese and ketchup) How do you treat? |
CMV retinitis in HIV patient
Treat with antiviral treatment |
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Patient has herpes zoster opthalmicus and is younger than 40....what should you test for?
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HIV infection
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