Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
41 Cards in this Set
- Front
- Back
|
This is a group of diseases causing an optic neuropathy associated with a characteristic loss of visual field.
|
Glaucoma
|
|
|
This is the only treatable risk factor in Glaucoma?
|
Elevated eye pressure
|
|
|
What causes elevated eye pressure?
|
The aqueous humor builds up in the eye due to drainage being compromised.
|
|
|
What is the normal pressure range for the eye?
|
10-21 mmHg
|
|
|
What are the two types of glaucoma?
|
Open angle Glaucoma
Closed angle Glaucoma |
|
|
This makes up 90% of gluacoma patients, it is not understood why it happens, but a genetic contribution is believed to be involved.
|
Primary open-angle glaucoma
|
|
|
What are the risk factors, four of them, for open angle glaucoma?
|
Elevated intraocular pressure
Advanced age Positive family history Race - African American at greatest risk |
|
|
What are the exam findings for open angle glaucoma?
|
Anterior exam is unremarkable, pressure may be increased, posterior exam may show cupping of the optic nerve.
|
|
|
How do you diagnose open angle glaucoma?
|
Identify the risk factors
Measure the intraocular pressure Examine the optic nerve If concerning risks factors or exam findings: Perform formal visual field testing. |
|
|
How do you treat open angle glaucoma?
|
Medications:
-topical -oral Laser Surgery Incisional Surgery - Trabectome - Trabeculectomy - Tube-shunt device |
|
|
What specific drugs are used for open angle glaucoma?
|
Beta blockers
- Timolol, Timoptic, Betaxolol A2 Agonists - Alphagan Prostaglandin Analogues - Xalatan, Travatan, lumigan Carbonic Anhydrase Inhibitors - Dorzolamide, Brinzolamide, Acetamazolamide |
|
|
What are the pros/cons of using Beta blockers for open angle glaucoma treatment?
|
Pros = 30 percent reduction in pressure, generally well tolerated
Cons = Careful with asthmatic/bradycardics, decrease HDL, Depression, Impotence |
|
|
What are the pros/cons of using A2 agonists for open angle glaucoma?
|
Pros = 25-30 percent reduction pressure, good for cardiovascular patients.
Cons = Red eyes/eyelids, may present with "conjunctivitis" |
|
|
What are the pros and cons with using prostaglandin analogues for open angle glaucoma?
|
Pros = 27-32 percent reduction in pressure, once daily dosing at night.
Cons = Red eyes/eyelids, long, full lashes, change in iris color. |
|
|
What are the pros and cons with using carbonic anhydrase inhibitors for open angle glaucoma?
|
Pros = 20 percent reduction in pressure, topical and oral treatment.
Cons = Kidney stones, weight loss, fatigue, Aplastic anemia, avoid in sickle cell anemia patients***. |
|
|
What are the problems with steroids in open angle glaucoma?
|
They can increases intraocular pressure, 33 percent of people have a response. Prescribing these long-term you should consider an ophthalmology consult.
|
|
|
What are the three surgical TXs for open angle glaucoma?
|
Trabectome
Trabeculectomy Tube shunt device |
|
|
This is rare, dramatic and causes a sudden pressure rise in hours.
|
Angle closure glaucoma.
|
|
|
What are the risk factors for angle closure glaucoma?
|
Hyperopia (far-sightedness), Eastern Asian lineage.
|
|
|
What are the five main symptoms of angle closure glaucoma?
|
Pain
Redness Vision Loss Nausea Headache |
|
|
What are the acute and definitive txs for angle-closure glaucoma?
|
Acute = Lower pressure with medications (topical and oral)
Definitive = Laser peripheral iridotomy |
|
|
This is opacification of the natural intraocular lens with age, trauma, congenital defect or drug effect.
|
Cataract
|
|
|
What are the patient's five main complaints when presenting with cataracts?
|
Blurred Vision
Difficulty driving and reading Glare Difficulty with night vision Altered color perception (Artists) |
|
|
What are the examination findings with cataracts?
|
Nuclear - central lens opacification
Yellow-brown coloration Most Common Cortical - Outer layers of the lens opacity White in color "spokes" form Posterior subcapsular - on the back surface of the lens Common in chronic steroids users and radiation therapy |
|
|
What is the TX for cataracts?
|
Refer to an ophthalmologist for a full eye exam.
Update glasses Surgery is the definitive TX An unlimited driving license in mass requires 20/40 in one eye. |
|
|
What is the number one reversible cause of blindness in the world?
|
Cataracts
|
|
|
This is a retinal degeneration that affects central vision. It has an unknown etiology and it is the leading cause of vision loss in the US in patients older than 52.
|
Age Related Macular Degeneration
|
|
|
What are the risk factors for ARMD?
|
Age 50 2%, 75 30%
Gender - Women Smoking Family Hx Cholesterol |
|
|
What are the two types of ARMD and which one is more common?
|
Dry and Wet AMRD. Dry is more common at 90%, but wet is much more severe.
|
|
|
This has symptoms of decreased reading and distance vision, gradual onset, slow progression, characteristic findings of drusen.
|
Dry Macular Degeneration.
|
|
|
How do you treat dry AMRD?
|
Monitor it with serial exams
Patient Self monitoring (square pattern image) Consider ocuvite or AREDS vitamins Stop Smoking Consider Sunglasses |
|
|
In this condition blood vessels from the choroid grow underneath the retina and bleed.
|
Wet AMD
|
|
|
What are the symptoms of Wet AMD?
|
No pain
Acute central vision loss Distortion Shadows in the vision |
|
|
What are the TXs for wet AMD?
|
Laser therapy, Medication
|
|
|
This causes a loss of vision, it is sudden, painless and is caused by an acute blockage of the central retinal artery.
|
Central retinal artery occlusion
|
|
|
How does cenral retinal artery occlusion occur?
|
Usually embolic
- visible embolus 20% = hollenhorst plaque - Retinal whitening; "cherry red" spot in macula Usually preceded by "amaurosis fugax" - transient monocular blindness - transient ischemic attack of the retina |
|
|
How do you treat Central retinal artery occlusion?
|
No proven treatment, but you must refer these patients to the ER ASAP!
|
|
|
What should be evaluated in patients with Central retinal artery occlusion?
|
Carotid
Heart Valves Sedimentation rate and C-reactive protein (for older individuals - need to rule out giant cell arteritis) |
|
|
This causes loss of vision, it is monocular, painless, semi-acute (hours)
|
Central retinal vein occlusion
|
|
|
What are the risk factors for central retinal vein occlusion?
|
Diabetes
Hypertension Glaucoma Hypercoagulable states Hyperviscosity |
|
|
How do you treat central retinal vein occlusion?
|
No treatment, laser sometimes helps to improve vision, Treat the risk factors to prevent involvement of the other eye.
|
