Acute Visual Loss

Question 1

Define ophthalmoscopy

Answer 1

Looking in the back of the eye

Question 2

Sudden visual loss questions to ask the patient

Answer 2

Age

medical condition

visual loss transient, persistent, or progressive?

visual loss monocular or binocular?

Severe is the loss of vision?

• What was the tempo? Did the visual loss occur abruptly, or did it develop over hours, days, or weeks?
• Did the patient have normal vision (with glasses if needed) in the past?
• Was pain associated with the visual loss?

Question 3

What are the 6 things included in an eye exam?

Answer 3

1. Visual acuity (VA) testing
2. Pupillary reaction
3. Confrontation field testing
4. Ophthalmoscopy (red reflex & fundus)
5. Penlight examination
6. EOM motility

Question 4

What is a media opacity

Answer 4

Something in the eye that prevents the patient from seeing out of their eye and you from seeing into it)

Question 5

Answer 5

abnormal red reflex

(indicates retinoblastoma- urgent referral)

Question 6

Define red reflex

Answer 6

• Reflection of light off of the ocular fundus
• red in color

Question 7

Answer 7

1. Peripheral Iris shuts off the trabecular meshwork and it elevates the intraocular pressure
2. Severely painful → nausea and vomiting

Question 8

Symptoms of acute angle closure glaucoma

Answer 8

1. pain
2. red eye
3. hazy/cloudy cornea
4. decreased vision
5. pupil mid-dilated and fixed (no rxn to light)

(black people 1/3 will not have pain)

Question 9

Acute angle closure glaucoma can develop from which medical procedure?

Answer 9

Dilating a patient’s eye with a narrow angle glaucoma

(if it does, they need to be referred immediately)

Question 10

What is this?

Answer 10

trauma to the eye may disperse blood in anterior chamber

(if they sit for 20 minutes the blood will collect at the bottom)

Question 11

Answer 11

Mature cataract: total opacity to the eye

Question 12

Answer 12

Acute vitreous hemorrhage

Question 13

Answer 13

Retinal detachment

(must be dilated to view)

Question 14

Retinal detachment symptoms

Answer 14

• Sudden shower of floaters & lightning streaks
• Straight ahead vision absent

+/- A shadow curtain Falls over there vision

Question 15

Why is a retinal detachment and urgent referral?

Answer 15

1. It can be repaired if the macula remains intact
2. Vision will remain intact

Question 16

Answer 16

Dry form of macular degeneration

(note pigmentation)

Question 17

MCC have legal blindness in the United States

Answer 17

Question 18

Most patients with the dry form of macular degeneration will also develop ______.

Answer 18

The wet form of macular degeneration

Question 19

Answer 19

What form of macular degeneration

(donut looking structure = retinal pigment epithelium elevation, deep net of new vessels push it upward. also seen with hemorrage)

Question 20

What is a typical sign of this condition?

Answer 20

The patient will say that tables look tilted and telephone poles look bent

(Wet Macular Degeneration - urgent)

Question 21

Answer 21

Leaking sub retinal net in the fovea visualized via fluorescein angiography (injected into arm vein)

(trmt: anti-VEGF)

Question 22

What are these? Where are they typically seem?

Answer 22

• Hollenhorst plaques
• Bifurcation of arteries

(typically do not obstructs the artery; typically comes from the Atria of the heart or carotid a.)

Question 23

How will the patient present?

Answer 23

Sudden blindness

(the cherry red spot is the only part of the normal retina left)

Question 24

What is the cause of this?

Answer 24

Stroke

(if this is not fixed immediately, they will be permanently blind)

Question 25

What is the treatment for acute central retinal artery occlusion (cherry-red spot)?

Answer 25

* SED rate * prednisone (current recommendations are to send them to a stroke center. If you do not they could develop a CVA)

Question 26

Answer 26

Branch retinal artery occlusion with hollenhorst plaque

Question 27

Answer 27

" blood and Thunder fundus" Central retinal vein occlusion, blood pours everywhere (poor prognosis)

Question 28

Answer 28

Branch retinal vein occlusion with macular edema

Question 29

Branch retinal vein occlusion with macular edema: treatment

Answer 29

Intravitreol injections of anti-VEGF Rx

Question 30

Answer 30

Question 31

Optic neuritis is associated with _____ (disease)

Answer 31

multiple sclerosis

Question 32

\_\_\_\_ % of patients with multiple sclerosis will develop optic neuritis. If someone presents with optic neuritis, \_\_\_\_\_\_% of the time they will develop multiple sclerosis.

Answer 32

* 50 * 15

Question 33

Symptoms of optic neuritis

Answer 33

* Decrease vision * Afferent pupillary defect (APD)

Question 34

Retrobulbar neuritis:

Answer 34

decrease vision and APD, BUT fundus looks normal bc nerve inflammation is BEHIND the globe, and before the optic chiasm.

Question 35

Optic neuritis is most common in which patient population?

Answer 35

MC in females 20-30s

Question 36

What is the difference of papillitis and papilledema on examination

Answer 36

* Both have swollen disc in the back of the eye * **Papillitis**: Vision will be decreased, only in one eye, APD * **Papilledema**: will not have decreased vision, it will be both eyes.

Question 37

Ischemic optic neuropathy (ION) types

Answer 37

* nonarteritic (NAION) * Arteritic (AION)

Question 38

Nonarteritic (NAION) symptoms:

Answer 38

1. Swollen disc 2. Decrease vision 3. Altitudinal field defect (they can't see the upper field as well as the lower or vice versa) (seen in patients over 60 y.o.)

Question 39

Arteritic optic neuropathy (AION) is seen in which patient population?

Answer 39

70's-80's

Question 40

Arteritic optic neuropathy (AION) symptoms

Answer 40

1. SED rate ~ 70 2. Giant cell arteritis 3. TIA (they will say, "I went blind for 5 min and it went away. I'm find. )

Question 41

TIA is an urgent referral to \_\_\_\_\_\_

Answer 41

stroke center

Question 42

Answer 42

ischemic optic neuropahty

Question 43

What is the cause of ischemic optic neuropathy?

Answer 43

unknown

Question 44

Define the 2 types of hemianopia

Answer 44

1. Homonymous hemianopia: half the field on same side 2. Bitemporal hemianopia: temporal portions affected

Question 45

What is the cause of hemianopia?

Answer 45

lesion of the pituitary

Question 46

What do the pupils look like in a patient with cortical blindness?

Answer 46

Normal: pupillary fibers do not go to the occipital cortex. They go to optic tracts → decussate in the optic chiasm → right and left geniculate body → dive down to the Edinger Westphal nucleus in the midbrain → decussate → follow the third nerve out to the eye

Question 47

Cortical blindness symptoms

Answer 47

* normal pupils * confabulation: they think that they ***_can_*** see (if you ask them how many fingers you are holding up, but you hold up none, they will give you an answer)

Question 48

List two functional ophthalmologic disorders

Answer 48

1. Hysteria 2. Malingering

Question 49

Define hysteria

Answer 49

psychosomotic blindness (ex: they are a sniper and going to be deployed in war and they all of the sudden can't see. They really experience blindness, but it is not true)

Question 50

Define malingering

Answer 50

saying that you have a disability for gain (ex: worker's comp, to get a medical leave)

Question 51

Acute central retinal artery occlusion will lead to a ______ if not treated immediately.

Answer 51

stroke

Question 52

What are the two ophthalmology emergencies?

Answer 52

1. Acute Central retinal artery occlusion 2. Chemical Alkali Burns

Question 53

What would you expect to see when a young overweight patient states that they stood up from squatting and they lost vision, but it came right back

Answer 53

bilateral papilledema | (pseudotumor cerebri)