Geriatrics Final Quiz Part II

- Complete CN III palsy: down + out + complete ptosis
- Incomplete CN III palsy: developing aneurysm/mass/compression lesion
- Aberrant regeneration leads to pseudo-Von Graffe --> usually due to mass, trauma, anerysm, NOT an ischemic event

> -6.00 D
- Dec VA from atrophy @ macula
- myopic crescent from RPE atrophy (temporal or 360)
- complete PVD common
- post. staphaloma: outward bulging of ONH, ONH sinks, ON looks deeper than rest of retina

Garde 3/4 = acute

Choriocap is very sensitive to HBP --> damage to RPE

MPOD + PHP for ARMD tx

Avoid mitoics (PGs & Pilo)
Avoid CAI for potential sickle cell

Macular holes affect women > men
Due to tractional forces of the vitreous
Early stage signs = yellow spots w/ loss of foveal depression

gradual vision loss
- bilateral ONH edema

Straightened in early stages and then become tortuous over time
Some people are born with naturally tortuous vessels however

2 main causes for CRVO:
1) impingement of artery on vein (leads to endo cell damage)
2) thickening of venous blood (BC or sickle cell)

Plaques cause CRAO/BRAO

most common cause of macroanys is HTN

Def: dilation of major arterial branch (can rupture)
- indicates high mortality rate --> refer to cardiologist

iridescent spot: smalls schisis that contains hemosidern macrophages
salmon patch: heme secondary to obstruction of BV that ruptures
sunburst: collection of RPE cells from chorodial occlusions
associated with: DR, vein occlusion, iritis

Moraxella --> angular bleph

- Found in immunocompromised (think porn & AIDS...insensitive, maybe, but anything helps at this point!!!)
- Devastating, necrotizing retinitis (reduce VA quickly)

A fluorescein angiography (FA) is used to determine if a central retinal vein occlusion (CRVO) is ischemic or non-ischemic. Ischemic CRVO is associated with more severe vision loss and has a higher risk of developing complications. The level of capillary dropout observed on the FA is used to classify the CRVO as ischemic or non-ischemic. In this case, a capillary dropout of greater than 10 disc diameters (dd) is considered ischemic.

Serous: fluid from choriocap goes into sub-retinal space
Fibrovascular: secondary to CNVM (occult)

--> both can cause tear in RPE

Nongeographic Atrophy: RPE hypopigmentation, CAN'T see underlying choroid vessels, NOT distinct
Geographic Atrophy: regression of soft drusen, can see underlying choroid, distinct
Drusenoid RPE Detachments: caused by coalesced soft drusen, NOT assoc w/ CNVM & usually resolves w/o tx

- Demo: older scandanavian women
- True Ex Syn = glassblowers, lens capsule chips off
- Exfol mat'l on anterior lens capsule, pupillary ruff
- Transilumination defects around pupillary ruff
- Narrow AC w/ IRREGULAR pigmentation in TM
- Foward movement of lens due to weak zonules
- Mitotic pupil
- GLC cupping (50% get GLC in 10 years)
- Bull's Eye pattern (3 ring)

Elschnig's: yellow circular lesion that later becomes pigmented due to RPE damage
Siergrist's: linear pigmented areas that run along sclerotic choroidal vessles

Turn down sensitivity --> calcified drusen show up
Use Red-Free filter

Most common cause is idiopathic

Signs: glistening, pseudoholes, wrinkling, hemes

Other causes or iris cysts: surgery, iritis, latanoprost
Location: back of iris
SLE: best seen w/ retroillumination

Visual impairment but have vivid/clear/colorful hallucinations

Gnomes are creepy

Iris melanomas don't metastisize

Tx: Surgery, plaque radiation therapy, Transpupillary thermal radiation

aion = ocular emergency
- systemic sins
- due to GCA
- ON is infarcted & chalk white
- cupping following resoution

- Cataract sx causes vitreous to pull away from retina
- Most resolve on own w/ PVD but if VA 20/60 or worse do vitrectomy w/ ILP peel
- Present in 50% of pts over 70 yo
- can lead to CME, ERM, macular hole
- Def: partial attachment of posterior hyaloid membrane

- Bilateral
- absolute VFD
- hole in outer layer is worse than inner layer bc inner layer already detached

The given answer is correct because it states that CRAO generally causes a larger reduction in visual acuity (VA) compared to AOAO (Acute Ophthalmic Artery Obstruction). This means that in cases of CRAO, the loss of vision is typically more severe than in cases of AOAO.

IMPT to RO ocular tumor when you see these folds

- Due to aging
- Hyper/hypo pigmentation
- Seen with drusen
- Doesn't cause much of a problem visually

Vessel bifurcates before LC --> hemi-central CRVO
Vessel bifurcates after LC --> CRVO

May look like GLC, but monitor and check for progression (GLC)
- VA good
- Can cause Pseudopapilledema (elevated but not edematous) --> DDX w/ OCT
- Anomalous branching of BV
- Hemes

AION has worse VA & vision rarely improves

Aminocaproic acid prevents re-bleeding but should be avoided in pts with cardiac, hepatic, or renal disease

in OIS vessels are dilated but NOT tortuous

cause: carotid obstruction
- men > women
- no flow obstruction in carotid until 70%
- no flow obstruction in CRA until 90% (50% decrase in perfusion of CRA)

Made of same material

Pseudo-drusen indicates a higher risk of CNVM

The correct answer is 1%. This suggests that only 1% of the population has ONH drusen. Drusen are tiny yellow or white deposits that accumulate under the retina, and ONH (optic nerve head) drusen refers to the presence of these deposits at the optic nerve head. This condition is relatively rare, affecting a small percentage of the population.

Iris melanoma can also cause heterochromia and unilateral elevation in IOP (due to unilateral PDS, which is usually bilateral)

Hemi/CRVO best tx'd w/ anti-VegF injections

If asteroid hyalosis becomes really dense it will make it difficult to see inside the pts eye but it will not affect pt's VA

Non-AION RFs: small disc, HTN, DM, chl, profound blood loss, Viagra (if small disc)

Phacolytic & lens particle will have lots/large flare

multi-focal yellow-white lesions in retina --> Candidiasis (fungus) & TB
Serpiginous: atrophy & inflamm around ONH in 'snake pattern'

Def: incompetent retinal caps in foveal region or one or both eyes (thickening of retinal caps)
- Group 1 = unilateral | Group 2 = bilateral | Group 3 = bilateral + CNS vasculitis
- Temporal to fovea: localized retinal thickening, RPE hyperplasia, FA leaking

Grade 1 & 2 = chronic
Grade 3 & 4 = acute

Grade 3 = diastolic 110-115 (hypoxia, retinal heme, CWS (CWS > heme), exudates around macula
Grade 4 = diastolic 130-140 = emergency & life threatening (malignant HTN)

During the examination of the retina, the healthcare provider is specifically looking for signs of commotio retinae, macular edema, and choroidal rupture. Commotio retinae refers to retinal whitening or opacification caused by blunt trauma, while macular edema is the accumulation of fluid in the macula, the central part of the retina. Choroidal rupture refers to a tear or break in the choroid, the layer of blood vessels beneath the retina. These conditions can occur as a result of trauma to the eye, such as being hit with a football. The healthcare provider will examine the retina to assess for any signs of these specific injuries.

PITS

Reduces prgoress of wet ARMD by 25% and vision loss by 19% in mod-severe groups, not significant in pts with no/mild dry ARMD, NOT PREVENTATIVE

Junctional: @ anterior knee of Von Willian
Craniopharyngioma: Rathke's pouch (???)
Tilted disc can also cause a bi-temporal defect

Non-AION s/s: APD, unilateral always, occurs in AM, disc edema w/ hemes, sectoral edema --> altitudinal VFD, sectoral pallor, NO systemic sx

- No tx other than control underlying issues
- PION has no disc edema, all the symptoms of non-aion but NO SIGNS