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54 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What are 3 common causes of chronic visual loss in the adult patient?
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glaucoma
cataract macular degeneration |
None
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Glaucoma is the leading cause of blindness in what demographic
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African Americans
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What is characteristic of visual field defects in patients with glaucoma (3)
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arcuate-shaped scotomas
contraction of the peripheral field sparing of central vision until late in disease |
None
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What test is used to screen for glaucoma
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tonometry and exam of optic nerve
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What is the pathway taken for drainage of aqueous humor?
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made in ciliary body
through pupil anterior chamber through trabecular meshwork ot Schlemm's canal venous system |
None
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Where in aquous humor drainage is there most resistence?
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trabecular meshwork and Schelmm's canal
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What are the symptoms of abrupt rise in IOP in acute angle-closure glaucoma (3)
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pain
nausea visualization of colored haloses or rainbows around light |
None
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What are the physical findings in acute angle closure attack
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red teary eye
hazy cornea fixed, middilated pupil firm eye |
None
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What is the optic disc
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point of origin of the optic nerve, includes the cup
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What artery supplies the optic nerve
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ophthalmic artery (branch of internal carotid)
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What test is used to assess for glaucomatous visual loss
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visual field testing
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What are 3 risk factors for glaucoma?
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age over 40
DM FHX |
None
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What is gonioscopy
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exam of the anterior chamber angle structures using a special contact lens and anesthetized cornea
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What is the cup:disc ratio
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ratio fo the horizontal diameter of the cup to the disc
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What is the effect of aging on the optic cup
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very little
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What 3 things cause temporal optic nerve pallor
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brain tumors
inflammation glaucoma |
None
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Why do vellsels seem to bend at the edge of the cup
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because the cup is a depression in the optic disc
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The larger the cup, the ____ the possibility of a glaucomatous optic nerve.
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greater
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In what case does the optic cup seem reduced or obliterated
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papilledema due to increased ICP
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What are 6 reasons to suspect glaucoma
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IOP >21.5
IOP difference >5 btw eyes optic cup diameter greater than 1/2 of disc diameter one cup significantly larger than that of the other eye FHX symptoms of acute glaucoma |
None
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At what age should some cataract be expected
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70
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What attaches the lens to the ciliary body?
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filamentous zonules
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___ lies in front of the lens and ___ lies behind the lens
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iris, vitreous humor
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What focuses the lens
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ciliary muscle
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What is found in the lens capsule (3)
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cortex
nucleus single anterior layter of cuboidal epithelium |
None
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What nourishes the lens?
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aqueous fluid and vitreous (it has no blood supply or innervation)
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How does the lens change over time
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It grows, epithelial cells produce new cortical lens fibers, slow increase in size, weight and density, 35% protein by mass, more protein in a cataract
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Define cataract
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opacity of the lens that affects visual acuity
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What are the zones of the lens
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subcapsular, cortical and nuclear
either anterior or posterior |
None
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What defines a cataract as immature
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clear cortex
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Causes of cataract (6)
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Age
trauma inflammation matabolic defect nutritional defect radiation damage |
None
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What are the symptoms of cataract?
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image blurring, yellowing
decreased vision failure of vision |
None
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Opacities in what zones of the lens cause the most disability
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nuclear or central subcapsular opacities
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What causes lenticular myopia and why
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nuclear sclerosis
because the denser nuclear has more refractive power - may cause "second sight" May cause monocular double or multiple images |
None
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What types of conditions are associated with subcapsular cataracts (2)
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DM and corticosteroid use (metabolic causes)
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What effect does an advanced cataract have on the afferent pupillary response
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No effect
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In what case should cataract extraction be done?
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If it interferes with the pts activities
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What is the treatment for opacification of the posterior capsule after cataract extraction
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laser
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What is the potential treatment for macular degeneration?
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argon laser photocoagulation of subretinal neovascular membranes
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Where is the macula?
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2 disc diameteres temporal to the optic disc
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What makes the central macula appear darker than the rest of the retina
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increased vascularity
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What is the fovea
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oval depression in the center of the macula
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The fovea contains a high density of ____, but no _____
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cones, rods
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3 changes due to aging of the macula
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drusen
degenerative changes in retinal pigment epithelium subretinal neovascular membranes |
None
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What are drusen?
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hyaline nodules (colloid bodies) deposited in Bruch's membrane, which separates inner choroidal vesselss form retinal pigment epithelium, come in various shapes, sizes and distribution
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What is seen in degeneration of retinal pigment epithelium?
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clumps of hyperpigmentation or depigmented atrophic areas
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About 20% of eyes with age-related macular degeneration develop ___2____
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subretinal neovascularization
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The extension of vessels form the choriocapsularis into the ____ epithelial space and eventually into the ____ space means that a defect has developed in Bruch's membrane
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subpigment, subretinal
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What 4 things are associated with subretinal neovascular net formation
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subretinal hemorrhage
fibrosis pigment epithelial degeneration photoreceptor atrophy |
None
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What test is used to identify neovascularization and is manditoyr before laser surgery
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flourescein antiography
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What can be seen with flourescein angiography?
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new leaky vessels
defects in retinal pigment epithelium |
None
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What is true of central vs. peripheral vision in pts with macular degeneration?
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poor central vision, good peripheral vision
pts get round okay |
None
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What test is useful for evaluating function of the macula?
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Amsler grid testing
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What findings on Amsler grid testing indicate a scotoma
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lines that are wavy, seem to bow or bend or appear gray or fuzzy
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