DDx 2 eye complaints

what is the most common cause of central loss of vision

cataracts

what else can cause central vision loss

retinal detachment

what can cause loss of peripheral vision

glaucoma

retinitis pigmentosa

what is glaucoma

buildup of pressure in anterior chamber before canal of schlemm

what is retinitis pigmentosa common population and s/s

younger people

poor night vision

often clumsy or accident prone

what can cause acute loss of vision

vascular

traumatic

what can cause a chronic loss of vision

macular degeneration

presbyopia

what can cause the visual disturbances flashes of light

migraines

vitreoretinal traction

what can cause halos around lights

glaucoma

corneal disease

what can cause transient loss of vision

amaurosis fugax

multiple sclerosis

papilledema

what can cause the diplopia (monocular)

cataracts (unilateral)

refractive errors

what can diplopia (binocular)

vascular

tumor

myasthenia gravis

multiple sclerosis

what can cause distorted vision

migraine

macular degeneration

what are the characteristics of trigeminal neuralgia

12/10 pain

mandibular and maxillary divisions typically involved

pt may be suicidal (psychological harm)

what are the characteristics of glossopharyngeal neuralgia

rare

related to swallowing and movement of pharynx

what is sphenopalatine ganglioneuralgia

brain freeze

ice cream headache

what can cause dry/gritty eye

hyperthyroidism

sjogrens syndrome

what causes eye pain without vision loss

retro-orbital eye pain

UTI

what is retro-orbital eye pain without vision loss associated with

headache

tumor

what is a UTI that causes eye pain w/o vision loss assocaited with

reactive arthritis

what condition(s) is consistent with short, sharp recurrent pain

neuralgias

what condition(s) is associated with deep, dull pain worse with bending forward or atmospheric changes

sinusitis

what condition(s) is consistent with pain radiating from front of ear and with opening the mouth

TMJ dysfunction

what condition(s) is associated with pain with chewing or hot/cold foods

dental problems

brain freeze

what is the presentation of acute angle glaucoma

severe pain

halos around lights

blurred unilateral vision

nausea

vomiting

how will seniors with acute angle glaucoma present

eye redness

cloudy looking cornea

possibly hyperopic

what is the etiology of acute angle closure glaucoma

blockage of outflow of aqueous humor from the anterior chamber increasing pressure and pain

what is the etiology of open angle glaucoma

unknown

pt often describes peripheral field of vision has been cut

what are some characteristics of open-angle glaucoma

usually presents bilaterally

pt often predisposed after past eye surgery or trauma

what is the leading cause of blindness in the geriatric population

age related macular degeneration

what is dry age related macular degeneration

slowly developing

painless

central vision loss

what is wet age related macular degeneration

sudden painless loss of vision

caused by neovascularization

what are the fundoscopic findings associated with age related macular degeneration

drusen

hemorrhages

exudates

what is retinitis pigmentosa

hereditary condition

degneration of retinal rods

peripheral ring scotoma

what is observed on fundoscopy with retinitis pigmentosa

dark pigmentation of central retina

yellow waxy disc

what are common pt factors in amaurosis fugax

>50 yo

unilateral vision loss lasting just a few minutes

history of diabetes, hypertension or smoking

what is seen on evaluation for amaurosis fugax

ipsilateral carotid bruit

fundoscopic examination may reveal signs of hypertensive retinopathy

what are the treatments and managemetns of amaurosis fugax

anti-platelet therapy

what should we warn a pt with amarosis fugax about

stroke

what is pt complaint with optic neuritis

abrupt unilateral loss of central vision that worsens over next 2 days

what causes optic neuritis

inflammation of the optic nerve usually due to demyelinating disorders (MS) or secondary infection

what are secondary infections that can cause optic neuritis

mumps

measles

influenza

varicella virus

meningitis

what is the treatment for optic neuritis

oral prednisone (increase risk of recurrence 2x)

what is the presentation of temporal arteritis

>50 yo complaints of unilateral temproal HA

generalized trunk muscle ache (bilateral)

sudden vision loss (polymyalgia rheumatica)

generalized vasculitis affecting small and medium size arteries

how is temproal arteritis evaluated

c-reactive protein

jaw claudication

ESR

what is the treatment for temporal arteritis

referral for corticosteroids

high likelihood of blindness if untreated

what is the presentation of retinal detachment

sudden onset of central vision loss with history of trauma

pt may complain of floaters or flashing lights in vision if not central vision loss

what is retinoblastoma

genetic deletion of long arm chromosome (missing RB1 suppressor gene)

what is the presentation of retinoblastoma

deterioration of vision

red or irritated eyes

strabismus

what percent of retinoblastoma cases are diagnosed before the age of 3

80%

what is the treatment for retinoblastoma

enucleation and/or chemotherapy

how effective is chemotherapy for retinoblastoma

95-98% in developed world

what is the common population for cluster headaches

middle aged male

history of smoking or alcohol abuse

what is the common presentation for cluster headaches

facial pain over the orbit that clusters

lasts for 30 minutes on average

how do we evaluate cluster headaches

nasal lacrimation on inspection during attacks

presence of horners syndrome

beats head against wall for relief

what is the treatment for cluster headaches

lidocaine

100% O2

reassurance head pain will diminish

what are examples of selected causes of facial pain

shingles/chickenpox

multiple sclerosis

sinusitis

what are radiograph views for sinusitis

waters view

caldwell view

chamberlain-towne view

how does shingles/chickenpox cause facial pain

burning in face specific to ophthalmic division of CN V

associated skin lesions and herpes zoster viral infection