What is Amblyopia? How is it commonly expressed?
- Vision impairment d/t interference with image processing by the brain in first 6-7 years of life.
- Commonly seen in child with strabismus who can make two overlapping images.
- w/o correction, the brain suppresses one of the images and can lead to cortical blindness in the suppress eye, regardless of how well it works. -Same problem developes if an obstacle impedes vision in one eye during those early years of life
How is strabismus verified?
By shining a light into the pts eye, if the reflexion is in the center of each pupil they don’t have strabismus. If the reflection is in the center of one pupil and deviated ( near the iris or cornea) in the other–the pt has strabismus. It should be corrected early to prevent development of amblyopia.
How can true strabismus be identified?
- When reliable patients report development of strabismus in late infancy but absent in the early years, it is likely exaggerated convergence that can be resolve with glasses.
- True strabismus never resolves spontaneously
What should be done if a white pupil is noticed in a baby?
- IT should be worked up as an emergency bc it may be caused by retinoblastoma.
- Even more benign conditions, like a congenital cataract, need to be attended quickly in order to prevent amblyopia
How does acute angle glaucoma present?
- very severe eye pain or frontal headache starting when the pupils have been dilated several hours (night time while watching TV)
- Patient reports seeing halos around lights
- pupil is mid-dilated and does not retract to light
- the cornea is cloudy with a greenish hue
- eye fields are “hard as rock”
How is acute angle glaucoma managed?
- Emergently
- Systemic carbonic anhydrase inhibitors (Diamox)
- Topical beta-blockers and alpha-2 selective agonists
- Mannitoland pilocarpine can be used
- Wait for ophthalmologist who will drill a whole in the iris with a laser beam to provide drainage
What is orbital cellulitis? How is it managed?
- Ophthalmologic emergency
- Eye lids are hot, tender, red, and swollen, patient is febrile, , pupil is dilated and fixed, and eye has a limited motion
- There is pus in the orbit
- Emergency Ct and drainage are needed
What is the first step in the treatment of chemical burns of the eye?
Irrigation with plain water should be done ASAP and cannot wait until arrival to the hospital
- Pry eye open and wash under running water for about half an hour
- In the hospital the eye is cleaned with saline until no more particles are found
- pH is tested before discharge
- Alkaline burns are worse than acid burns
How does retina detachment present?
- -The patient reports seeing flashed of light and having “floaters” in the eye
- one or two “floaters” can mean just tearing of the retine w/o detachment
- Dozens of “floaters” a “snow storm” or a “big dark cloud” at the top of the visual field means there’s a horseshoe piece of retina pulled away and at risk of ripping out
How is retina detachment treated?
Emergency laser “spot welding” will protect the remaining retina
How does embolic occlusion of the retinal artery present?
-Typically elderly patients complaining of sudden loss of vision from one eye
How is embolic occlusion of the retinal artery managed?
- PAtient should breath into a bag and have someone repeatedly press hard on the eye while on the way to the ER. This is to vasodilate and shake the thrombus into a more distal location where a smaller area become ischemic.
- Not much can be done about this. In about 30 minutes the damage will be irreversible.
What should be done for newly diagnosed diabetic patients?
- They should have their retina checked if they have type 2 bc they might have had it for years, and retinal damage might have already occurred.
- Younger DM1 patients are about 20 years away from getting eye problems
