Podcast
Questions and Answers
Which of the following is a risk factor for developing open-angle glaucoma?
Which of the following is a risk factor for developing open-angle glaucoma?
What is the most common symptom of open-angle glaucoma in its early stages?
What is the most common symptom of open-angle glaucoma in its early stages?
What is the most common form of glaucoma?
What is the most common form of glaucoma?
Which of the following describes the mechanism of open-angle glaucoma?
Which of the following describes the mechanism of open-angle glaucoma?
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Which of these is NOT a common complaint associated with visual field loss in open-angle glaucoma?
Which of these is NOT a common complaint associated with visual field loss in open-angle glaucoma?
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What is the normal range for intraocular pressure (IOP)?
What is the normal range for intraocular pressure (IOP)?
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What specific ophthalmological test is used to evaluate the anterior chamber angle in open-angle glaucoma?
What specific ophthalmological test is used to evaluate the anterior chamber angle in open-angle glaucoma?
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Which of the following is a definitive diagnostic finding for open-angle glaucoma?
Which of the following is a definitive diagnostic finding for open-angle glaucoma?
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Which of the following conditions is NOT a potential complication of chronic glaucoma?
Which of the following conditions is NOT a potential complication of chronic glaucoma?
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A patient presents with sudden, painless loss of vision in one eye, described as a 'curtain coming down'. Which condition is most likely?
A patient presents with sudden, painless loss of vision in one eye, described as a 'curtain coming down'. Which condition is most likely?
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A patient presents with sudden, severe eye pain, redness, and blurred vision. They report seeing halos around lights. Which condition is most likely?
A patient presents with sudden, severe eye pain, redness, and blurred vision. They report seeing halos around lights. Which condition is most likely?
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Which of the following is a common feature of both hypertensive retinopathy and diabetic retinopathy?
Which of the following is a common feature of both hypertensive retinopathy and diabetic retinopathy?
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Which of the following conditions is considered a vision-threatening emergency that requires immediate referral?
Which of the following conditions is considered a vision-threatening emergency that requires immediate referral?
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Which of the following medications is primarily used to decrease the production of aqueous humor in open angle glaucoma?
Which of the following medications is primarily used to decrease the production of aqueous humor in open angle glaucoma?
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What symptom is commonly associated with closed angle glaucoma that differentiates it from open angle glaucoma?
What symptom is commonly associated with closed angle glaucoma that differentiates it from open angle glaucoma?
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In the physical examination of a patient suspected of having closed angle glaucoma, which finding is indicative of increased intraocular pressure?
In the physical examination of a patient suspected of having closed angle glaucoma, which finding is indicative of increased intraocular pressure?
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Which of the following is NOT a risk factor for developing closed angle glaucoma?
Which of the following is NOT a risk factor for developing closed angle glaucoma?
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What should be avoided in the management of a patient with acute closed angle glaucoma?
What should be avoided in the management of a patient with acute closed angle glaucoma?
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Which treatment is considered the gold standard for diagnosing closed angle glaucoma?
Which treatment is considered the gold standard for diagnosing closed angle glaucoma?
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Which pharmacological treatment aims to increase aqueous outflow in open angle glaucoma?
Which pharmacological treatment aims to increase aqueous outflow in open angle glaucoma?
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What physical examination finding might indicate scarring during chronic closed angle glaucoma?
What physical examination finding might indicate scarring during chronic closed angle glaucoma?
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What is the primary risk when managing a ruptured globe?
What is the primary risk when managing a ruptured globe?
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Which of the following is NOT a characteristic of strabismus?
Which of the following is NOT a characteristic of strabismus?
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What is an essential part of diagnosing amblyopia in children?
What is an essential part of diagnosing amblyopia in children?
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What type of treatment is primarily used to address amblyopia?
What type of treatment is primarily used to address amblyopia?
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What is the focus of initial management for strabismus?
What is the focus of initial management for strabismus?
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Which test is commonly utilized to evaluate strabismus?
Which test is commonly utilized to evaluate strabismus?
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Which ocular condition is characterized by rhythmic oscillations of the eyes?
Which ocular condition is characterized by rhythmic oscillations of the eyes?
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What should be avoided in treating a ruptured globe?
What should be avoided in treating a ruptured globe?
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In nystagmus, the 'jerk' type is characterized by what motion?
In nystagmus, the 'jerk' type is characterized by what motion?
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What is a common ocular issue associated with amblyopia?
What is a common ocular issue associated with amblyopia?
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What is the most common cause of retinal detachment?
What is the most common cause of retinal detachment?
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Which treatment is typically NOT indicated for anterior uveitis?
Which treatment is typically NOT indicated for anterior uveitis?
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What is the classic initial symptom associated with cataracts?
What is the classic initial symptom associated with cataracts?
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Which of the following symptoms would most likely indicate posterior uveitis?
Which of the following symptoms would most likely indicate posterior uveitis?
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What is the primary treatment for retinal artery occlusion?
What is the primary treatment for retinal artery occlusion?
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In patients with papilledema, which symptom is typically NOT associated with increased intracranial pressure?
In patients with papilledema, which symptom is typically NOT associated with increased intracranial pressure?
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Which condition typically leads to an acute visual loss accompanied by flashes and floaters?
Which condition typically leads to an acute visual loss accompanied by flashes and floaters?
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What characterizes non-proliferative diabetic retinopathy?
What characterizes non-proliferative diabetic retinopathy?
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Which risk factor has the most significant association with the progression of diabetic retinopathy?
Which risk factor has the most significant association with the progression of diabetic retinopathy?
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Which treatment is most appropriate for optic neuritis?
Which treatment is most appropriate for optic neuritis?
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What is a common sign of hypertensive retinopathy seen during a physical examination?
What is a common sign of hypertensive retinopathy seen during a physical examination?
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Which form of retinal detachment is associated with systemic diseases causing fluid accumulation in the subretinal space?
Which form of retinal detachment is associated with systemic diseases causing fluid accumulation in the subretinal space?
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What symptom is most likely associated with anterior uveitis?
What symptom is most likely associated with anterior uveitis?
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What type of vision loss occurs first in open-angle glaucoma?
What type of vision loss occurs first in open-angle glaucoma?
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Which of the following is the main pharmacological treatment for open-angle glaucoma?
Which of the following is the main pharmacological treatment for open-angle glaucoma?
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Main symptoms of closed angle glaucoma
Main symptoms of closed angle glaucoma
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Which of the following are physical exam findings associated with Closed Angle Glaucoma? (Select all that apply)
Which of the following are physical exam findings associated with Closed Angle Glaucoma? (Select all that apply)
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What is the characteristic pupil response in closed-angle glaucoma?
What is the characteristic pupil response in closed-angle glaucoma?
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What is uveitis?
What is uveitis?
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Uveitis often occurs in patients with which of the following conditions? (Select all that apply)
Uveitis often occurs in patients with which of the following conditions? (Select all that apply)
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Which of the following treatments is commonly prescribed for uveitis? (Select all that apply)
Which of the following treatments is commonly prescribed for uveitis? (Select all that apply)
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Which of the following are key physical exam findings for cataract? (Select all that apply)
Which of the following are key physical exam findings for cataract? (Select all that apply)
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What is a retinal detachment?
What is a retinal detachment?
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Key symptoms of retinal deatchment
Key symptoms of retinal deatchment
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Which of the following are symptoms of vitreous hemorrhage? (Select all that apply)
Which of the following are symptoms of vitreous hemorrhage? (Select all that apply)
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If a patient reports decreased, hazy vision, or cobwebs, what is the most likely diagnosis?
If a patient reports decreased, hazy vision, or cobwebs, what is the most likely diagnosis?
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Macular degeneration results in irreversible loss of what?
Macular degeneration results in irreversible loss of what?
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What are drusen spots?
What are drusen spots?
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What drug may modestly improve visual function in patients with macular degeneration?
What drug may modestly improve visual function in patients with macular degeneration?
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What are the biggest risk factors of retinal vein occlusion? (Select all that apply)
What are the biggest risk factors of retinal vein occlusion? (Select all that apply)
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Which of the following are symptoms of retinal vein occlusion? (Select all that apply)
Which of the following are symptoms of retinal vein occlusion? (Select all that apply)
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Blood and Thunder describes what?
Blood and Thunder describes what?
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What is a Marcus Gunn pupil?
What is a Marcus Gunn pupil?
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What is the main cause of a retinal artery occlusion?
What is the main cause of a retinal artery occlusion?
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What is the most likely origination site of retinal artery occlusion?
What is the most likely origination site of retinal artery occlusion?
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Sudden painless monocular vision loss is a key symptom of which condition?
Sudden painless monocular vision loss is a key symptom of which condition?
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Cherry red spot in the macula is a classic finding of which condition?
Cherry red spot in the macula is a classic finding of which condition?
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What is giant cell arteritis?
What is giant cell arteritis?
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What is amaurosis fugax?
What is amaurosis fugax?
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A patient that presents with transient vision loss in one or both eyes most likely has which diagnosis?
A patient that presents with transient vision loss in one or both eyes most likely has which diagnosis?
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Which of the following is a microvascular complication of diabetes?
Which of the following is a microvascular complication of diabetes?
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Capillaries of the retina that leak proteins, lipids, or red blood cells (RBCs) into the retina is known as what?
Capillaries of the retina that leak proteins, lipids, or red blood cells (RBCs) into the retina is known as what?
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Growth of new vessels and fibrous tissue due to severe capillary occlusion and retinal ischemia is?
Growth of new vessels and fibrous tissue due to severe capillary occlusion and retinal ischemia is?
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Cotton wool spots are indicative of which condition?
Cotton wool spots are indicative of which condition?
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Which of the following are key clinical features of hypertensive retinopathy? (Select all that apply)
Which of the following are key clinical features of hypertensive retinopathy? (Select all that apply)
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Optic neuritis is a key finding of what disease?
Optic neuritis is a key finding of what disease?
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A patient comes in with subacute unilateral loss of vision, reduced color vision, and periocular pain. What condition is most indicative of these symptoms?
A patient comes in with subacute unilateral loss of vision, reduced color vision, and periocular pain. What condition is most indicative of these symptoms?
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What is the first line treatment for optic neuritis?
What is the first line treatment for optic neuritis?
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Optic disc swelling is indicative of which condition?
Optic disc swelling is indicative of which condition?
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A patient presents with a headache that is positional, usually worsening with recumbency and early in the morning. This is most indicative of?
A patient presents with a headache that is positional, usually worsening with recumbency and early in the morning. This is most indicative of?
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A patient presents with a teardrop pupil and a positive Seidel's test. What condition is this most indicative of?
A patient presents with a teardrop pupil and a positive Seidel's test. What condition is this most indicative of?
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What is Seidel's sign?
What is Seidel's sign?
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Misalignment of the eyes is known as what?
Misalignment of the eyes is known as what?
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What is commonly referred to as lazy eye?
What is commonly referred to as lazy eye?
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Study Notes
CLINICAL MEDICINE II: ACUTE & CHRONIC VISION LOSS; EYE TRAUMA
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This course covers the etiology, pathophysiology, clinical features, diagnosis, complications, and treatment of various eye conditions, including acute and chronic vision loss and eye trauma.
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Key conditions discussed include glaucoma (acute & chronic), uveitis, iritis, cataract, retinal detachment, vitreous hemorrhage, macular degeneration, retinal vein occlusion, retinal artery occlusion, amaurosis fugax, diabetic retinopathy, hypertensive retinopathy, optic neuritis, papilledema, and ruptured globe.
OBJECTIVES
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Summarize the etiology, pathophysiology, clinical features, diagnosis, potential complications, and treatment of the listed conditions.
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Review common causes of eye trauma and physical examination techniques in the setting of eye trauma.
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Differentiate between acute angle-closure and chronic glaucoma.
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Differentiate between amblyopia and strabismus (in lecture).
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Define nystagmus, describe its features, and common causes (central and peripheral).
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Establish parameters for which ocular conditions are vision-threatening and whether the condition requires emergent or non-emergent referral.
GLAUCOMA...ANATOMY REVIEW
- Diagrams and descriptions of the eye's anatomy, focusing on the structures relevant to glaucoma.
GLAUCOMA: OVERVIEW
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Glaucoma is defined as increased intraocular pressure sufficient to damage the optic nerve, leading to vision loss.
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Different types of glaucoma (open-angle, angle-closure, normal-tension) are distinguished.
GLAUCOMA: ESSENTIALS
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Open-angle glaucoma is the most common type, accounting for at least 90% of cases.
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It's characterized by a more chronic, insidious onset
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Acute angle-closure glaucoma is a "do not miss" diagnosis, leading to permanent blindness if not treated within 24 hours.
OPEN-ANGLE GLAUCOMA
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Reduced aqueous fluid flow through the trabecular meshwork is a key aspect of open-angle glaucoma.
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Age, family history, ethnicity, systemic hypertension, diabetes mellitus, and myopia are among the risk factors.
OPEN ANGLE GLAUCOMA SYMPTOMS
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Initial symptoms are often minimal, detected on routine eye testing.
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Progression involves peripheral vision loss and scotomas, with central vision typically spared until late stages of the disease.
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Symptoms include impaired night driving, near vision, reading speed, and outdoor mobility.
OPEN ANGLE GLAUCOMA PHYSICAL EXAM
- Includes visual acuity evaluation, visual field testing, optic disc analysis and evaluation of intraocular pressure (IOP) levels. IOP levels normally are between 10-21 mmHg, but can vary with different stages and severity.
OPEN ANGLE GLAUCOMA DIAGNOSIS
- Suspect if any of the listed conditions are present. Consistently elevated IOP, suspicious-appearing optic nerve, abnormal visual field, are all factors considered. Diagnosis is confirmed by the presence of progressive optic neuropathy along with other signs of structural damage to optic nerve and open anterior chamber angles.
OPEN ANGLE GLAUCOMA: TREATMENT
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Pharmacological treatments aim to increase aqueous outflow, decrease production or increase outflow (e.g., prostaglandin analogs, cholinergic agonists, beta blockers, carbonic anhydrase inhibitors).
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Surgical and laser treatments may also be indicated.
CLOSED ANGLE GLAUCOMA
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Obstruction of the angle by the iris, often caused by adhesion, inflammation, and scarring is a hallmark characteristic.
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Risk factors include advancing age and hypermetropia.
CLOSED ANGLE GLAUCOMA SYMPTOMS
- Severe ocular pain, facial pain, sudden vision loss, blurred vision (typically unilateral), halos around lights, headache, eye redness, nausea, and vomiting.
CLOSED ANGLE GLAUCOMA: PHYSICAL EXAM
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Conjunctival hyperemia/injection, hazy cornea, and IOP measurements.
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Changes in the optic nerve and associated visual field loss are observed as well.
CLOSED ANGLE GLAUCOMA: DIAGNOSIS
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Initial diagnosis is based on history and physical examination.
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Emergent ophthalmologic consultation is critical.
CLOSED ANGLE GLAUCOMA: TREATMENT
- Urgent ophthalmologic consultation is essential for managing the condition, including medication to reduce IOP and possible laser peripheral iridotomy.
UVEITIS: ESSENTIALS
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Intraocular inflammation of the uvea (middle portion of the eye) is prevalent.
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Systemic medical conditions, infections, and autoimmune diseases often accompany uveitis, and a precise etiology should be investigated.
UVEITIS: SIGNS AND SYMPTOMS
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Symptoms depend on the anatomical location of inflammation. Anterior uveitis, also known as iritis, presents with pain, redness, ciliary flush, and constricted pupils.
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Posterior uveitis is characterized by painlessness, with the possibility of non-specific visual changes.
UVEITIS: DIAGNOSIS
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A referral to ophthalmology along with a dilated ophthalmology exam is required.
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Diagnosis involves slit-lamp examination observing for inflammation in the anterior chamber. Direct visualization of any inflammation or a presence of leukocytes in the vitreous is diagnostic of posterior uveitis.
UVEITIS: TREATMENT
- The treatment strategy for uveitis relies on its precise etiology, severity of inflammation, and location, and usually involves an ophthalmology consultation. Corticosteroids, both systemic and topical, or intravitreal preparations may be used. Specific antimicrobial therapy is needed for infectious conditions
CATARACT: ESSENTIALS
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Clouding or opacity of the lens leads to vision loss.
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Senile cataracts result for age-related structural changes.
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Acquired cataracts can result from trauma, irradiation, and metabolic conditions like diabetes or steroid use.
CATARACT: DIAGNOSIS
- Patients may not initially show symptoms, but gradual painless loss of vision, reduced contrast, diminished color intensity (especially in distance vision), reduced capacity to recognize familiar faces, and outdoor mobility problems are symptoms often observed.
CATARACT: PHYSICAL EXAM
- Routine eye exams during which lens opacity is visible and the red reflex is dark or absent are indicative for diagnosis. Visual acuity testing is often reduced.
CATARACT: TREATMENT
- Ophthalmological consultation leads to surgical intervention through intraocular lens placement and removal, and phacoemulsification.
RETINAL DETACHMENT: ESSENTIALS
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Separation of the retina from its underlying pigment epithelium comprises the condition of retinal detachment.
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Cases may arise from rhegmatogenous retinal detachment (tears, holes, or breaks in the retina or vitreous) or non-rhegmatogenous retinal detachment due to exudative and serous retinal detachment secondary to systematic diseases and tractional retinal detachment (mechanical forces on retina from diseases in the past but NO break).
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Risk factors include age, cataract surgery, retinal atrophy, myopia, and trauma.
RETINAL DETACHMENT: SYMPTOMS
- Symptoms include pain-free, sudden vision loss that often occurs at first in the periphery extending inward, and an acute onset of floaters and flashes that occur before a dark curtain over the visual field.
RETINAL DETACHMENT: DIAGNOSIS
- Diagnosis is made with ophthalmoscopy, often requiring referral for professional assessment.
RETINAL DETACHMENT: MANAGEMENT
- Emergency ophthalmologic referral is necessary. If immediate referral is not possible: patients should lie in bed with their face turned to the side opposite the visual field deficit. Surgery for reattachment, ideally performed within 7 days of detachment.
VITREOUS HEMORRHAGE: ESSENTIALS
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Bleeding into the vitreous humor may stem from blunt trauma, spontaneous retinal tears, spontaneous vitreou detachment, or poor diabetic control.
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Key risk factors include child abuse head trauma, and associated subarachnoid/subdural head trauma.
VITREOUS HEMORRHAGE: DIAGNOSIS
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Vision loss is often proportional to the amount of blood in the vitreous gel
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Visual decline, blurred vision with black spots/cobwebs are common symptoms.
VITREOUS HEMORRHAGE: PHYSICAL EXAM
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If hemorrhage is considerable, there could be a reduced red reflex with ophthalmoscopy, preventing visualization of the retina
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CT Head scans are indicated in cases of suspected vitreous hemorrhage, particularly in young children or infants with no history of head injuries to rule out non-accidental injuries.
VITREOUS HEMORRHAGE: TREATMENT
- Confirmation that no retinal detachment is present is necessary. Ophthalmologic intervention is needed. Spontaneous resolution may occur within 2–3 months, though, interventions like vitrectomy may be necessary.
MACULAR DEGENERATION: ESSENTIALS
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Macular degeneration is a degenerative disorder of the central portion of the retina (macula), causing irreversible central vision loss.
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Factors like age, prior cataract surgery, smoking, sunlight exposure, low intake of vitamins, ETOH, obesity, cardiovascular conditions, and family history are risk factors. This condition is often divided into 'dry' and 'wet' forms.
MACULAR DEGENERATION: DRUSEN SPOTS
- Drusen deposits on the Bruch membrane that leads to nutritional deficits and atrophy
MACULAR DEGENERATION: SYMPTOMS
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Gradual central visual distortion is common.
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Metamorphopsia (distorted vision), decreased vision, difficulties with light adaptation, and presence of perceived flashes of light are common symptoms.
MACULAR DEGENERATION: DIAGNOSIS
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Includes patient history and examination on dilated eyes for 'dry' and 'wet' form findings
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Staging is often based on visual symptoms.
MACULAR DEGENERATION: TREATMENT
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Patients should stop smoking to slow progression
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Referrals to ophthalmologists for observations and monitoring are common, especially for intermediate and advanced stages.
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Antioxidant vitamins including zinc may help slow progression. Lutein supplementation sometimes improves vision.
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Intravitreal injections can be used to reduce disease progression in neovascular cases (wet form).
RETINAL VEIN OCCLUSION: ESSENTIALS
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Blockages of the retinal veins, usually as a result of thrombotic events, cause the condition.
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Glaucoma, age, hypertension, diabetes, smoking, obesity, and hypercoagulable states are risk factors.
RETINAL VEIN OCCLUSION: SYMPTOMS
- Acute vision loss in only one eye that is painless, blurred or loss of vision in one eye is the major symptom. Scotoma (partial vision loss) or visual field defects may correspond to the area of retinal vein occlusion.
RETINAL VEIN OCCLUSION: PHYSICAL EXAM/DIAGNOSIS
- The pupil is assessed and the fundus examined. Other potential causes and risk factors are assessed and evaluated by the practitioner.
RETINAL VEIN OCCLUSION: TREATMENT
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Treatments are not usually effective at opening occluded retinal veins, and a vision recovery is variable among patients.
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Immediate ophthalmologic referral is critical.
RETINAL ARTERY OCCLUSION: ESSENTIALS
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Blockage of retinal arteries causing ischemia or infarct that causes vision loss.
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Common etiologies include embolisms, thrombi, vasculitis, coagulopathies, or sickle cell disease. Carotid artery disease, atrial fibrillation, hypertension, diabetes mellitus, hyperlipidemia, history of TIA or CVA, and giant cell arteritis are risk factors.
RETINAL ARTERY OCCLUSION: SYMPTOMS
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Sudden, painless, monocular vision loss or degradation.
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Vision loss may be reduced to counting fingers or worse.
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Occasionally, visual impairment may be restricted to a part of the visual field, and some patients have cilioretinal arteries that supply the macula.
RETINAL ARTERY OCCLUSION: PHYSICAL EXAM/DIAGNOSIS
- Includes pupillary exam, fundus exam, and evaluation of retinal swelling, which subsides over time and causes the area of the optic disk to appear pale, with the presence of a "cherry-red spot" in the macula.
RETINAL ARTERY OCCLUSION: DIAGNOSIS
- Diagnosis is often made using fundoscopy with the associated findings of a cherry-red spot, retinal opacity, visible embolus, and narrow vessels, and other signs of retinal ischemia. MRI of brain may be necessary if other causes are not clear.
RETINAL ARTERY OCCLUSION: TREATMENT
- An emergent ophthalmologist is necessary
- Treatment is usually focused on reducing further risk and potentially resolving blockage, such as ocular massage, high oxygen concentrations, or vasodilators.
AMAUROSIS FUGAX: ESSENTIALS
- Intermittent and sudden monocular or binocular vision loss that can be a transient ischemic attack (TIA).
- It's often associated with various vascular causes and may indicate a higher risk for stroke
- Potential etiologies include ischemic conditions like carotid disease (GCA), hypercoagulable states, hyperviscosity, papilledema, optic nerve compression, or idiopathic causes.
AMAUROSIS FUGAX: SYMPTOMS AND PHYSICAL EXAM
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Transient vision loss (one or both eyes) is the primary symptom.
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Duration, specific descriptions, and monocular or binocular occurrence are valuable in determining underlying cause
AMAUROSIS FUGAX: MANAGEMENT
- Many cases mimic other conditions, therefore, a neuroimaging and referral to a stroke center or hospital admission if two or more episodes occur within a week should be performed. Blood tests (ESR/CRP), EKG and possible hypercoagulable testing may also be used to assess for other problems.
DIABETIC RETINOPATHY: ESSENTIALS
- Microvascular complications of diabetes that are frequent causes of preventable blindness.
- The condition presents gradually in patients with diabetes, either type I or II.
- It involves damage to the retinal blood vessels due to long-term hyperglycemia
DIABETIC RETINOPATHY: RISK FACTORS
- Duration of diabetes mellitus, age of onset of diabetes as well as hyperglycemia, dyslipidemia, history of cataract surgery, and hypertension.
DIABETIC RETINOPATHY: SYMPTOMS
- Often asymptomatic, with symptoms appearing only once the condition progresses to more advanced stages.
- Symptoms may include blurred vision or double vision, vision loss in the peripheral or narrowing of visual field, dark spots, and possible pain or pressure in the eye.
DIABETIC RETINOPATHY: PHYSICAL EXAM
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Non-proliferative retinopathy is shown through the presence of microaneurysms, retinal hemorrhages, retinal edema, or hard exudates, optic nerve fiber layer infarcts = cotton wool spots.
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Proliferative retinopathy presents as neovascularization, hemorrhages, fibrosis, and potential retinal detachment.
DIABETIC RETINOPATHY: DIAGNOSIS
- Clinical diagnosis made through eye examinations that examine for non-proliferative and proliferative signs and presence of new vessels.
DIABETIC RETINOPATHY: TREATMENT
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Optimal management involves optimizing glycemic and lipid control, stringent blood pressure management, and frequent (initially every 3-4 months then yearly) ophthalmology visits.
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VEGF therapy and possibly laser photocoagulation therapy may reduce progression risks in patients with high-risk diabetic retinopathy.
HYPERTENSIVE RETINOPATHY: ESSENTIALS
- Vascular changes (visualized directly) are signs of the condition
- Severity of hypertension can be graded using clinical features for diagnosis
- Hypertension & other vascular diseases such as kidney disease or atherosclerosis are risk factors
HYPERTENSIVE RETINOPATHY: CLINICAL FEATURES
- Often asymptomatic
- Vascular changes, including arteriolar narrowing, "copper/silver wiring," A-V nicking, exudates, cotton wool spots, hemorrhages, and potential papilledema.
HYPERTENSIVE RETINOPATHY: TREATMENT
- Regular eye examinations during which potential changes can be detected
- Managing hypertension is the cornerstone of treatment.
OPTIC NEURITIS: ESSENTIALS
- Inflammation of the optic nerve is the core feature of the condition, often manifesting as visual loss.
- Viral and/or MS-related etiologies and damage to the retinal nerve fiber layer are common causes.
OPTIC NEURITIS: SYMPTOMS
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Subacute unilateral vision loss of varying intensity ranging from mild blurring to complete loss of light perception.
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Reduced color vision and pain in the eye exacerbated by movement are common symptoms. Symptoms typically last several days to a few weeks.
OPTIC NEURITIS: PHYSICAL EXAM/DIAGNOSIS
- The primary diagnosis strategy relies on a clinical assessment based on history and physical findings (visual acuity, color vision, visual field test, and RAPD tests).
- Reduced vision, color vision, contrast, and central scotoma are frequently observed. Papillitis (swelling and pallor, particularly with small flame-shaped hemorrhages) is observed in some cases.
- MRI of the brain and orbits to rule out other conditions and evaluate the risk of MS.
OPTIC NEURITIS: TREATMENT
- High-dose intravenous corticosteroids may speed visual recovery. However, long-term visual acuity and field improvement may not always be achieved.
- Further testing and evaluation with neurologists may be necessary.
PAPILLEDEMA: ESSENTIALS
- Optic disc swelling caused from increased intracranial pressure.
- Several causes like brain tumors/lesions, brain bleeds, increased cerebrospinal fluid (CSF) production, decreased CSF absorption, venous outflow obstructions, and idiopathic intracranial hypertension can trigger the condition
PAPILLEDEMA: SYMPTOMS
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The primary symptom is headache, often positional, worsening when recumbent or during the early morning hours; nausea and vomiting are also common.
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Double vision and a pulsating sound, often described as machinery-like can also occur.
PAPILLEDEMA: PHYSICAL EXAM
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Fundoscopic exam findings include loss of spontaneous venous pulsations, presence of splinter hemorrhages, and often the elevated, swollen appearance of the optic disc with obscuring or obliteration of the disc cup.
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This could be an early or chronic stage.
PAPILLEDEMA: DIAGNOSIS
- Neuroimaging (MRI) aids in determining the source of increased intracranial pressure.
- Lumbar puncture (with opening pressure analysis) can further help establish diagnosis if the initial imaging is either inconclusive or normal..
- Formal visual field testing measures vision loss associated with papilledema.
PAPILLEDEMA: TREATMENT
- Treatment focuses specifically on the reason for increased intracranial pressure which may vary depending on the etiology.
RUPTURED GLOBE/OPEN GLOBE: ESSENTIALS
- Disruption of the eye's outer membranes that result from blunt trauma or penetrating injuries
- Patients with a prior history of eye surgeries or other ocular problems may be at higher risk
RUPTURED GLOBE/OPEN GLOBE: CLINICAL FEATURES
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The patient experiences pain with vision loss, blurry vision, double vision.
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Key physical exams include assessing visual acuity, presence of a teardrop pupil and conducting the Seidel test
RUPTURED GLOBE/OPEN GLOBE: DIAGNOSIS
- The diagnosis includes clinical assessment of any visual impairment
- CT scans are useful for confirming ocular rupture and associated optic injuries and foreign bodies.
RUPTURED GLOBE/OPEN GLOBE: TREATMENT
- Urgent consult and transfer to ophthalmology is essential, followed by protective measures to prevent further injury
- Protecting the eye from direct pressure.
- Leaving any impaled foreign body in place to prevent further issues. Avoiding activities like valsalva, sedation and analgesics are strategies used. Prophylactic antibiotics are often used.
STRABISMUS: ESSENTIALS
- Eye misalignment, whether horizontal, vertical, or torsional, is the defining feature of strabismus.
- Causes of strabismus include congenital or acquired factors
STRABISMUS: DIAGNOSIS
- Physical examinations are critical, particularly looking into the corneal light reflex for any misalignment, corneal light reflex
- Cover and uncover tests help detect different forms of eye misalignment
- Thorough assessment of visual acuity and fundus.
STRABISMUS: TREATMENT
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Initial management focuses on correcting refractive errors.
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Glasses, or contact lenses, along with occlusion therapy, or medication may be used.
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Surgery of the extraocular muscles may also be required in many cases.
AMBLYOPIA: ESSENTIALS
- Often referred to as "lazy eye", amblyopia manifests as reduced, sometimes near-zero vision in one eye
- Reduction is a result of abnormal neurologic stimulation from a period of visual impairment within developmental periods
AMBLYOPIA: PRESENTATION
- Chief complaint is visual loss usually in only one eye
- Possible medical history, such as the presence of strabismus, congenital cataract, or Horner syndrome, that lead to possible lesions obstructing vision.
AMBLYOPIA: DIAGNOSIS
- Clinical assessment and thorough eye examinations are crucial in establishing the diagnosis of amblyopia include assessing for intermittent/fixed strabismus, patterns of eye fixations, fundus evaluation (including pupil and red reflex evaluation), testing visual acuity
AMBLYOPIA: TREATMENT
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An important first step involves addressing any refractive errors (glasses/contact lenses).
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Occlusion therapy (covering the better-seeing eye) forces use of the amblyopic eye.
NYSTAGMUS: OVERVIEW
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Rhythmic, regular oscillations in eye movements, which may be congenital or acquired can indicate jerky oscillations or pendular ones.
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Types: horizontal, vertical, rotatory (torsional), or mixed may be observed, and this may or may not be associated with other conditions.
NYSTAGMUS: DIAGNOSIS
- Various diagnostic techniques including physical exam to ascertain if there are other conditions such as associated nystagmus is critical in identifying the underlying cause.
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Test your knowledge about open-angle glaucoma, including risk factors, symptoms, diagnostic methods, and complications. This quiz will challenge your understanding of this common eye condition and its various aspects.
