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22 Cards in this Set
- Front
- Back
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VAMP From Start To Finish
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Visual acuity
Adnexa (external) Motility Pupils Fields Slit lamp examination Tonometry (intraocular pressure) Funduscopy |
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Visual acuity test: use glasses or not?
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yes
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visual acuity test: what if glasses are not available?
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use pinhole
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WBCs in aqueous humor =?
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hypopia
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Causes of Dull corneal light reflex
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Edema
--Endothelial dysfunction --Elevated intraocular pressure |
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Causes of Acute Visual Loss
Anterior chamber |
Hyphema
Iritis |
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Causes of Acute Visual Loss
Lens |
Hyperglycemia-causes hydration of lens and an abrupt myopic change in refractive error
Cataract-almost always associated with slow visual loss Subluxation |
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Describe Exam of Vitreous hemorrhage
Symptoms-blurry vision, floaters |
VA--> reduced proportionately to amount of blood
External, SLE--> normal, Motility normal RAPD--> NO Fields--> normal to reduced, IOP--> normal Fundus--> decreased red reflex, poor visualization |
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Causes of vitreous hemorrhage
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Retinal tears
Retinal neovascularization Diabetes, Sickle cell Subarachnoid hemorrhage Valsalva |
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Describe exam of retinal detachment
Symptoms-flashes, floaters, shade over field of vision, visual loss, painless |
VA-->reduced if macula is involved
RAPD-->usually not unless extensive Fields-->diminished in field OPPOSITE the detachment IOP-->often reduced Fundus-->elevated retina, often with folds |
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Describe exam of Central retinal artery occlusion (CRAO)
Symptoms-sudden, painless and often severe visual loss |
VA--> severely reduced unless fovea spared
RAPD--> YES Fields--> generalized loss Fundus--> vascular stasis, “boxcarring”, cherry-red spot |
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Central retinal artery occlusion (CRAO)
What is Treatment? -ocular emergency |
Ocular massage
Lower intraocular pressure-anterior chamber paracentesis Thrombolytic therapy Patients often admitted for stroke workup Examine carotids, heart valves and chambers for embolic sources Need to rule out giant cell arteritis in elderly patients |
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Describe exam of Branch retinal arterial occlusion (BRAO)
Symptoms-unilateral painless visual disturbance or loss, central or peripheral |
VA--> reduced if macula is involved
RAPD-->usually not unless extensive Fields-->diminished in field OPPOSITE the affected retina Fundus |
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Branch retinal arterial occlusion (BRAO)
-Visual loss may be transient (_________ fugax) -Need stroke work-up |
Branch retinal arterial occlusion (BRAO)
-Visual loss may be transient (amaurosis fugax) -Need stroke work-up |
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Describe exam of Central retinal vein occlusion (CRVO)
Symptoms-subacute, painless visual loss |
VA--> moderately to severely reduced
RAPD--> yes, if severe Fields--> generalized loss Fundus--> diffuse hemorrhages, disc swelling, dilated tortuous veins |
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Describe exam of Branch Retinal Vein Occlusion (BRVO)
Symptoms-blind spot in field of vision |
VA--> normal to mildly to moderately reduced
RAPD--> no Fields--> sectoral field loss Fundus |
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Describe exam of Optic neuritis
Symptoms-visual loss associated with pain on eye movements, occurs over hours to days, usually unilateral, but may be bilateral |
VA--> mild to moderately reduced
RAPD--> YES, even with mild visual loss Fields--> central, cecocentral, or altitudinal field loss Fundus--> hyperemic disc swelling (papillitis), or normal appearance (retrobulbar optic neuritis) Abnormal color vision |
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Tx of optic neuritis
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Use IV steroids followed by prednisone.
PO prednisone can increase chance of recurrence. |
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Points about papilledema
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Bilateral optic disc swelling associated with increased intracranial pressure
Visual acuity typically normal, no RAPD, fields: enlarged blind spot Transient visual obscurations-bilateral visual loss that lasts only for a few of seconds that occurs when rising from a head down position |
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Describe exam of Anterior Ischemic optic neuropathy (AION)
Symptoms-sudden painless, unilateral vision loss |
VA--> moderately to severely reduced
RAPD--> YES Fields--> altitudinal field loss Fundus--> pale disc swelling with splinter hemorrhages Abnormal color vision |
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About Arteritic--> Giant cell or temporal arteritis....
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Typically in patients > 55 y.o., more commonly 70’s to 80’s
Often associated with headaches, scalp tenderness, jaw caludication, PMR, wt. loss, fever Elevated ESR, CRP Needs immediate treatment with prednisone to prevent vision loss in the second eye Confirm diagnosis with temporal artery biopsy |
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About Non-arteritic AION......
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Typically occurs in patients 40 to 60 years of age
Associated with hypertension, diabetes, atheroscerlotic cardiovascular disease No accepted treatment Need to rule out temporal arteritis |
