Ophthalmology Exam

Ophthalmology Exam things to consider in pt with changes in visual acuity - Answer--sudden or gradual? -unilateral or bilateral? (bilateral tends to be gradual, sudden unilateral) -painful or painless-- sudden painful unilateral vision loss warrants urgent referral or ER vs rapid onset painless vision loss related to meds reasons for sudden UNILATERAL changes in visual acuity-- PAINFUL - Answer--issues of cornea, anterior chamber: -*corneal ulcer*- open sore on cornea -*uveitis*- inflammation of middle layer of eye -*traumatic hyphema*- blood in anterior chamber -*acute narrow angle glaucoma* -optic neuritis- inflammation of optic nerve reasons for sudden UNILATERAL changes in visual acuity-- PAINLESS - Answer-- *vitreous hemorrhage*- bleed into vitreous humor, can be from diabetes (incr vasc) or trauma -*macular degeneration*- eye disease that causes (usually more gradual) vision loss, normal with aging -*retinal detachment*- retina pulls away from choroid layer--> blind spot -*retinal vein occlusion*- atherosclerosis -*central retinal artery occlusion* patterns of change in visual acuity - Answer--entire field of vision or only a portion? -specific visual defects ? like mobile (floaters) or fixed (scotomas)? floaters could be bleeding into vitreous -are they experiencing flashing lights? (photopsia)--> suggests retinal detachment reasons for gradual BILATERAL changes in visual acuity (less concerning) - Answer-- *hyperopia*-farsightedness, difficulty focusing on near -*presbyopia*- increasing farsightedness, associated with normal aging; >40 years old-- > wear glasses -*myopia*- nearsightedness, more common in general; can't see at a distance -*cataracts*- lens opacifies, light not focused as well on retina; red light reflex -- cant't see through lens -*macular degeneration*- blurred central vision, trouble reading, driving, facial recognition ---wet- blood vessels leak blood and fluid ---dry- most common central visual changes - Answer--gradual central loss -nuclear cataract -macular degeneration- central decreased vision peripheral visual changes - Answer--gradual peripheral loss -open-angle glaucoma- increased pressure in eye, can damage optic nerve--> emergency Diplopia - Answer-double vision *etiology* -CNS lesion- brainstem, cerebellum -extraocular muscle pathology- horizontal CN III or VI, vertical CN III or IV -pathology of cornea or lens- unilateral, remains with closure of other eye -harder to tx > 7 years old, can lead to vision loss -tx: cover one eye-- if not resolved, consider pathology of cornea or lens characteristics of BENIGN red eye - Answer--mild to no pain -minimal if any vision change -peripheral injection or well demarcated area of redness -normal pupils- equal and reactive -cornea clear (part that covers iris) conjunctivitis - Answer--benign -dilated blood vessels in conjunctiva -peripheral redness subconjunctival hemorrhage - Answer--benign -leakage from blood vessel -can be from coughing, sneezing, vomiting characteristics of WORRISOME red eye - Answer--moderate to severe pain -visual acuity decreased -ciliary injection- central limbus or diffuse redness -pupils may be irregular, small or dilated, fixed -cloudy, steamy cornea corneal abrasion - Answer--damage to cornea (can be visualized with fluorescent dye-- picks up dye) -often improves within 24 hours -can be from FB -contact wearers at higher risk acute iritis/uveitis - Answer--ring around limbic area -ciliary injection -CMV, systemic infectious disease acute angle closure glaucoma - Answer--cloudy, steamy cornea -ciliary injection -aqueous humor doesn't drain effectively CONTINUES...