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70 Cards in this Set
- Front
- Back
- 3rd side (hint)
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5 thing to ask about acute visual loss
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transient vs. persistent
monocular or binocular abrupt vs. hours, days wks pts age and pmh documented normal vision in the past |
None
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Exam in acute visual loss
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visual acuity
confrontation field testing (uncovers homonymous hemianopia) pupillary reaction (damage to retina or nerve will send less light to brainstem -> Marcus Gunn pupil) Ophthalmoscopy Penlight exam (for corneal disease) Tonometry for glaucoma |
None
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What is the Marcus Gunn pupil
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when light moved from normal to abnormal eye the pupil of abnormal eye will continue to dilate (relative afferent pupillary defect) = positive swining flashlight test
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What is the relative afferent pupillary defect represent
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Damage to afferents is a sign of monocular visual loss
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What are the 4 clear refractive media of the eye?
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cornea
anterior chamber lens vitreous humor |
None
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Damage to clear refractive media causes what symptoms
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blurred vision but no relative afferent pupillary defects
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What 2 things can cause altered pupillary reflexes
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miosis in acute iritis
middilated and fixed pupils in acute angle-closure glaucoma |
None
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What is observed in corneal edema?
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sudden opacificiation of the cornea -> dulling of light reflecting off the cornea resulting in ground glass appearance
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What is the most common cause of corneal edema?
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increased IOP. Conreal edema is what causes vision loss in angle closure glaucoma
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What condition can mimic corneal edema?
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acute infection or inflammation (HSV keratitis)
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What two conditions cause gradual onset of vision loss due to coreal edema?
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damage to corneal endothelium by dystrophies or following cataract surgery
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Blood in the anterior chamber is known as ____
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hyphema
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What 4 conditions predispose to hyphema?
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abnormal vessels due to:
tumors DM intraocular SGY chronic inflammation |
None
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What 2 conditions can alter hydration of the lens
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Suddent changes in blood sugar or serum electrolytes can cause large fluctuations in refractive error interpreted as visual loss by pt
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In what case does cataract produce acute visual loss
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When it progresses rapidly
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What 3 conditions will cause vitreous hemorrhage
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trauma, retinal neovascularization (DM & retinal vein occlusion), and subarachnoid hemorrhage (aneurysm rupture)
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Under what conditions should vitreous hemorrhage be suspected
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Clear anterior chamber and lens but retina cannot be seen
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3 inflammatory processes affecting the retina that will result in acute visual loss
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infectious chorioretinitis
vasculitides idiopathic inflammation |
None
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What are the symptoms of retinal detachement
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Large number of floaters then shade over the vision in one eye, relative afferent pupillary defect in involved eye
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What is found on retina in retinal detachmeht
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elevated retina +/- folds and indistinct choroid background
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What causes suddent visual loss ini macular disease?
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bleeding from neovascular net formed in macular degeneration
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____ is a defect of central vision in which shapes of objects appear distorted, seen due to neovascularization in macular degeneration
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metamorphopsia
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What is the treatment for metamorphopsia
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laser surgery before progression to significant and permanent visual loss
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Loss of vision in one eye lasting for several minutes is suspicious for ____
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amaurosis fugax, suspect ipsilateral carotid artery disease
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What are the 3 signs of central retinal artery occlusion
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suddent painless and often complete visual loss
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Vascular stasis is seen in __(time range)__ of central retinal artery occlusion
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minutes to hours
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What are the two thing seen in vascular stasis
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narrowing of arterial blood columns
interruption of venous blood columns -> appearance of bloxcarring - rows of corpuscles are separated by clear intervals |
None
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How long after centra retinal artery occlusion will the cornea become opalescent?
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Several hours
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What causes the cherry-red spot in central retinal artery occlusion?
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pallor of the perifoveal retina standing out in contrast to the normal color of the fovea, also seen in Tay-Sachs and Neimann-Pick due to metabolite deposition
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What causes swelling of the optic disc?
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Occlusion of the ophthalmic or carotid artery (proximal to the origin of the central retinal artery) - some vision may be spared in complete centra retinal A occlusion
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In what case can part of the retina be spared in central retinal artery occlusion?
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If part of the retina is supplied by choroidal circulation via a celioretinal artery
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What causes pallor of the disc in the blinded eye months after central retinal artery occlusion?
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As the edema resolves and ganglion cells die their axons atrophy
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How long is the window for treating central retinal artery occlusion
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Several hours
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What techniques could potentially dislodge the embolus blocking the central retinal artery?
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rise in fall in IOP by pressing and releaseing the eye in 10sec intervals for 5 min
injeciton of anesthetic and paracentesis of anterior chamber |
None
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What can be used to treat branch retinal artery occlusion
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ocular massage
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What causes branch retinal artery occulusion
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usually embolus
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5 signs of central retinal vein occlusion
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disc swelling
venous engorgement cotton wool spots diffuse retinal hemorrhages subacute onset |
None
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What is the treatment for central retinal veing occulsion?
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No standard treatment, not a true ophthalmic emergency
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What are 4 risk factors for central retinal vein occlusion
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age
HTN atherosclerotic vascular disease disease affected blood viscosity (polysythemia vera, SCD, leukemia/lymphoma) |
None
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What 3 things take place as central retinal vein occulsion resolves?
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swelling resolves
shunt vessels develop from retinal to choroidal circulation and ocular neovascularization (risk of neovascular glaucoma - need laser) |
None
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What is the initial appearance of the optic nerve in acute visual loss in optic nerve disease?
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nerve may or may not look normal but pupillary response is abnormal
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What causes optic neuritis
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usually idiopatic
may be associated with MS |
None
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What is the appearance of the optic nerve in optic neuritis
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hyperemic and swollen
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What is the prognosis for return of vision after optic neuritis?
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good
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What is the treatment for acute optic neuritis
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corticosteroids
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Classic presentation for retrobulbar optic neuritis (5 items)
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young adult
vision loss over hours - days pain with eye movement normal ophthalmic exam but poor vision afferent pupillary defect |
None
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What is the differential diagnosis for retrobulbar optic neuritis?
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comprehenssive optic neuropathy
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How is retrobulbar optic neuritis diagnosed?
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MRI or CT, will show lesion compressing nerve
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What are 2 subtypes of optic neuritis and findings
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retrobulbar optic neuritis
papillitis significantly decreased vision relative afferent pupillary defect |
None
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What is papillitis?
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Inflammation of the optic disc or papilla
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What is papilledema?
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swelling of the optic disc from increased ICP, bilateral
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In papiledema what is the effect on visual acuity and pupillary reflexes
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These are normal but some pts have momentrary bulurring or transient oscurations of vision
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What is the long term effect of acute papilledema
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minor alternations in vision if any
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What should be suspected in an older pt with swelling of the disc and visual loss
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vascular event (ex. giant cell atreritis), noninflammatory
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What is the presentation of ischemic optic neuropathy? (5)
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pale, swollen disk
+/- splinter heme and loss of vusial acutity and visual field |
None
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What is the pattern of visual loss seen in schemic neuropathy?
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altitudinal
superior or inferior field |
None
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What are the symptoms of systemic giant cell arteritis? (4)
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malaise
limb girdle pain scalp tenderness/pain combing hair pain on chewing (jaw claudication) |
None
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What test should be ordered for an elderly pt with ischemic optic neuropathy or unexplained ophthalmoplegia
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ESR, look for >60 for giant cell arteritis
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What is the treatment for giant cell arteritis?
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high dose corticosteroids
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What will be find on temporal vessel biopsy in giant cell arteritis? (3)
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giant cells
fragmentation of the elastica with surrounding chronic inflammation occlusion of the vessel |
None
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What is the chance for contralateral eye involvement in nonarteritis ischemic optic neuropathy?
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40% chance
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loss of vision on one side of both visual fields is called ____
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homonymous hemianopia
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What can cause homonymous heminanopia?
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occlusion of one of the posterior cerebral arteries with infaction of occipital lobe, or MCA occlusion (will have other symptoms)
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What tests should be ordered in a patient with homonymous hemianopia?
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cerebral CT or MRI
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What causes cortical blindness
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extensive bilateral damate othe cerebral visual pathways -> complete vision loss
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What are the 2 findings on ophthalmic exam in a patient with cortical blindness
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normal pupillary reactions
normal fundus |
None
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What is the prognosis of a pt with cortical blindess
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either improvement or death due to severe neurologic damage
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What causes functional acute visual loss
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hysteria or malignering
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What are the findings in functional visual loss?
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normal pupillary reactions
normal stereopsis if one eye is "affected" |
None
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Why can chronic visual loss be an acute discovery?
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Vision is normal in one eye and the patient does not notice
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