Eyeball

• Ophthalmology is the study of the eye and its diseases.

Macular Degeneration

• Macular degeneration results in a central scotoma, leading to a blind spot in the center of vision.
• It primarily affects older patients.
• Fundoscopy detects drusen around the macula.
• Drusen appears as small, yellow spots made of fat and calcium.

Age-Related Macular Degeneration

• Retinal neovascularization due to increased VEGF can result in age related macular degeneration.
• Treatment should target VEGF.

Hypertensive Retinopathy

• Hypertensive retinopathy can cause shadows across the visual field and patchy vision loss.
• This condition can be prevented with proper care.
• Fundoscopic exam shows flame-shaped hemorrhages, bleeding from necrotic vessels, and endothelial disruption

Visual Pathway

• Monocular scotoma is caused by an occlusion to the artery supplying the lower retina of the eye.
• Temporal lobe damage results in "pie in the sky".
• Parietal lobe damage results in "pie on the floor".

Retinopathy of Prematurity (ROP)

• ROP is a condition in premature babies that can cause blindness and retinal detachment.
• Abnormal vascularization in the retina occurs due to premature birth because fetal retinal vascularization is incomplete until term.
• Increased oxygen stops vascularization from properly completing.
• Maintain oxygen between 92-95% to allow proper retinal vascularization.

Central Retinal Artery Occlusion

• Presents as a sudden onset of painless, monocular vision loss.
• Causes include renal artery embolism and Afib.
• Fundoscopy reveals a pale, white retina with retinal artery narrowing and decreased filling of the retinal veins.

Diabetic Retinopathy

• Fundoscopy reveals dot and blot hemorrhages and new blood vessel formation.

Cataracts

• Cataracts present as gradual vision loss, worse at night, and loss of red reflex.
• If age related then it will most likely be bilateral
• Occurrence is most common over 60 years old.
• Glucocorticoids (prednisone) and diabetes mellitus can cause earlier cataract formation.
• Ocular trauma and external radiation exposure can cause cataracts.
• Age-related oxidative injury can cause cataracts.

Pharm (Optho)

• Acetazolamide inhibits carbonic anhydrase in the proximal convoluted tubule (PCT).
• It reduces intraocular pressure in glaucoma.
• It reduces the amount of aqueous solution produced.
• Side effects include increased urine output and more alkaline urine pH (less bicarb resorption).

Pupillary Asymmetry (Anisocoria)

• Sympathetic stimulation causes a big pupil (mydriasis).
• Parasympathetic stimulation causes a small pupil (miosis) via the oculomotor nerve.
• If asymmetry worsens in a dimly lit room, the smaller pupil has a problem.
• If asymmetry worsens in a bright room, the bigger pupil has a problem.

Anatomy

• To get to the retinal artery, it must travel through Internal carotid artery → ophthalmic artery → retinal artery

Glaucoma

• Glaucoma is an eye condition caused by damage to the optic nerve.
• Atropine is used to treat bradycardia, but a side effect of atropine is that it can cause glaucoma as it increases the intraocular pressure.