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Cultura Documentos
Objectives
Have a clear DDx for causes of acute
vision loss
Painless
Fleeting
Prolonged
Prolonged
ACG
embolic
ION
Optic Neuritis
migrain
CRAO
GCA
Raised ICP
CRVO
Orbital cellulitis
VIT.HGE
Endopthal
Ret. Detach
History
Transient visual loss (suggestive of amaurosis fugax)
sudden onset floaters and flashing light (Retinal
detachment)
History of poorly controlled diabetes mellitus and laser
treatment to the retina (vitreous haemorrhage)
Headache +/- jaw claudication (pain in the jaw on
eating) in the elderly (giant cell arteritis)
Pain on eye movement in young patients (optic neuritis)
Examination
Visual acuity
Visual field by confrontation
pupil reaction for afferent pupillary
defect
Retinal examination.
pupillary defect)
Retinal edema (after 1st few hrs)
The retinal arteries are narrow or collapsed
Embolus may be seen at O.N. (CRAO)
or branch point (BRAO)
Cherry red spot = ischemia & edema
of posterior retina
w/in several hrs of occlusion
CRAO
BRAO
BRVO
Retinal Detachment
Fluid separates retina from underlying
Retinal Detachment: Sx
Flashing lights
Floaters
Visual field loss: curtain, shadow or
bubble
Metamorphopsia
Decreased Va
Painless
Metamorphopsia
Retinal Detachment
Retinal Detachment
Retinal Detachment:
W/U & Mgmt
Immediate Ophtho referral!!
Surgical intervention
If acute or progressive should be
referred to Ophthalmology <24h, if
chronic may be seen with 2-4 weeks
Vitreous Hemorrhage
Due to underlying vascular process
Painless, pt may complain of red
shower or spots
May be slower in onset vs RAO, RVO
or retinal detachment
Visualization of retina often
impossible
Ophthalmic u/s done by eye docs
Vitreous Hemorrhage
Normal Angle
Laser iridectomy
Corneal Ulcer
Risk factors:
Recent trauma or contact lens wear
(may develop from corneal abrasion)
Poor lid apposition
Incr risk Gm neg bacteria (esp Pmonas)
w/ soft contact lens wear
Fungal: h/o trauma w/ vegetable matter
or chronic topical steroid use
Corneal Ulcer: Sx
Pain
Redness
Decreased Va
photophobia
Corneal Ulcer: Tx
Immediate Ophtho referral
Corneal scraping for Grams stain &
Cx
Abx: gent, cefazolin
Contact lens removal
Pt will require daily f/u until healed
Uveitis
May be subacute in onset
Pain, photophobia, decreased vision
Exam:
Small, sluggish pupil
Circumlimbal flush
Cell & flare in ant chamber on SLEx
Uveitis
Uveitis
Uveitis
Uveitis
Uveitis
Etiol: most idiopathic; many systemic
causes
W/U: careful H&P, looking for
systemic disease
Uveitis
Tx:
ophtho referral w/in 24h
cycloplegia (topical homatropine 5%
bid)
topical steroid (Pred-Forte 1%) initiated
by an ophthalmologist
Optic Neuritis
15-45 y.o.
Usually subacute (several days)
Pain w/ eye movement (+/-)
May have h/o transient neurological
disturbances
Assoc w/ MS
Optic Neuritis
Signs
Optic Disc edema (unusual)
Visual field cuts, esp. central
Maracus-Gunn pupil (very common)
Optic Neuritis
MR: look for white matter plaques
IV steroids if +
Decreases further MS-related events
Hastens visual recovery
No change in final Va outcome
If neg, IV steroids of no proven benefit
Consider in single-eye patients
Never use PO steroids
Increased recurrence of O.N.
Miscellaneous
CVA
Functional