Term
| What is the uvea? What are the anterior and posterior parts? |
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Definition
Middle layer of the eye.
Anterior: iris and ciliary body
Posterior: choroid layer |
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Term
| Describe the epidemiology of uveitis? |
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Definition
- >280,000 cases in US/yr
- Common in ages 20-50
- Causes 30,000 new blindness/yr and up to 10% of all cases of blindness |
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Term
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Definition
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Term
| What is the etiology of uveitis? |
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Definition
- Infection, trauma or surgery, systemic immune-related disease
- 30% are idiopathic |
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Term
| What types of infection cause uveitis? |
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Definition
- Bacterial/spirochetal (TB, syphillus, lyme dz, leprosy, cat scratch fever)
- Viral (CMV, HZV, HSV)
- Fungal
- Parasitic-toxoplasmosis |
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Term
| What are immune-mediating causes of uveitis? |
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Definition
- Ankylosing spondylitis
- Crohn's dz
- Juvenile rheumatoid arthritis
- MS
- Psoriatic arthritis |
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Term
| What type of uveitis is irregular pupil typical? |
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Definition
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Term
| What are the sx of anterior uveitis? |
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Definition
| Redness (erythema or injection), pain, photophobia, variable visual disturbance |
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Term
| What are sx of posterior uveitis? |
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Definition
| More likely to be painless, floaters, visual loss |
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Term
| What tests are used to det. the 2 types of uveitis? |
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Definition
Anterior: slit lamp exam
Posterior: direct visualization of inflammation on ophthalmic exam |
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Term
| How is anterior uveitis tx? |
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Definition
- Tx directed toward infectious agent: abx or antiviral
- Non-infectious tx w/ glucocorticoids and a dilating loop (relieves pain d/t muscle spasm) |
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Term
| How is posterior uveitis tx? |
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Definition
| Periocular and rarely intraocular glucocorticoid injections, or oral steroids or immunosuppresive meds to address underlying disease process |
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Term
| What are complications of chronic uveitis? |
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Definition
| Cataract, IOP, glaucoma, retinal problems (swelling or detachment), blindness |
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Term
| What eye sx should lead to an immediate referral? |
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Definition
| Visual deficit, irregular pupil shape or dilation, pain, photophobia |
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Term
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Definition
| Opacity of the lens that causes partial or total blindness |
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Term
| Describe the epidemiology of cataracts. |
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Definition
- 50% of world's blindness (15M)
- Affects 50% of Americans >65, 70% >70yo
- 3M cataract surgeries in US/yr |
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Term
| What are risk factors of cataracts? |
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Definition
| Age, smoking, etoh, sunlight, trauma, DM, systemic corticosteroids and high doses of inhaled steroids, diuretics |
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Term
| What are the 3 types of cataracts? |
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Definition
| Nuclear, cortical, subscapular |
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Term
| Describe nuclear cataracts. |
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Definition
| Most common form, forms in the nucleus (center of lens) d/t natural aging changes |
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Term
| Describe cortical cataracts |
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Definition
| Gradually extends its spokes from outside to the center of the lens, often seen in DM |
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Term
| Describe subscapular cataracts. |
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Definition
| Begins at posterior aspect of lens. Seen in DM, extreme hyperopia, high doses of steroids, post-virectomy w/ gas bubble |
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Term
| What are sx of cataracts? |
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Definition
| Blurry vision, faded colors, light from sun appears brighter, glare from car headlights, typically bilateral but not symmetrical |
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Term
| Describe evaluation of cataracts. |
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Definition
- Suspect if c/o painless, progressive vision loss
- Nondilated fundus ophthalmascope to confirm lens opacity
- Refer to ophthalmologist
- Correcttion of myopic shift to delay surgery |
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Term
| What is the tx for cataracts? |
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Definition
- Surgery to remove lens and replace w/ intraocular lens (IOL)
- Outpatient: standard extrascapular cataract extraction or phacoemulsification (more common now) |
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Term
| Describe epidemiology of congenital cataracts. |
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Definition
- Present at birth
- 1.6-6 cases/10,000 births
- Higher in underdeveloped countries
- Unilateral or bilateral |
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Term
| What causes congenital cataracts? |
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Definition
| Isolated incidents, intrauterine infections (rubella*, syphillus, toxoplasmosis, herpes, etc.), metabolic d/o, genetic dz (Marfan's, Down's) |
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Term
| How are congenital cataracts tested and treated? |
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Definition
- All children should be tested for irregular red reflex at birth and periodically
- surgery b/f 2mths of age preferred tx |
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Term
| What is a dislocated lens? |
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Definition
| Subluxation or luxation of the lens |
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Term
| What causes dislocated lens? |
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Definition
| Blunt trauma to eye or head, systemic conditions, hypermature cataract |
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Term
| What is a possible complication of dislocated lens and what test can detect it? |
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Definition
- extreme hyperopia or myopic shift is possible, secondary angle closure glaucoma, corneal damage
- Slit lamp exam |
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Term
| What is the management for lens dislocation? |
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Definition
| Non-surgical options are 1st choice, surgery pursued if complications |
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Term
| What is the legal criteria for legal blindness in the US? |
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Definition
- Visual acuity <20/400 in better eye w/ corrective lenses
- Visual field restriction to 20 degrees diameter or less (tunnel vision) in right eye |
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Term
| What does functional limitation mean? |
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Definition
| The consequence of different levels of visual ability for the performance of common activities. |
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Term
| What is the difference between severe and non-severe visual impairment? |
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Definition
Severe: unable to see words and letters in ordinary print even w/ glasses on
Non-severe: have difficulty seeing words and letters in ordinary prints, even w/ glasses on |
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Term
| What is the visual acuity and visual field requirement for driving in Oklahoma? |
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Definition
- Acuity: 20/40 in better eye w/ or w/o corrective lenses (20/100 in better eye w/ restrictions)
- Field: 70 degrees in horizontal meridian of each eye |
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