PANCE Blueprint EENT (7%)

Vision abnormalities (PEARLS)

NCCPA™ PANCE EENT Content Blueprint eye disorders ⇒ vision abnormalities

Amaurosis fugax Transient partial or complete loss of vision in one eye - The most common cause of amaurosis fugax is a cholesterol plaque emboli from a carotid artery plaque

  • Blockage of the central retinal artery leads to sudden, painless, monocular vision loss due to retinal hypoxia
  • Vision loss is classically described as a curtain coming down over one eye
  • Amaurosis fugax (an example of a TIA) occurs if the clot passes and the vision loss is transient. If the clot cannot pass, central retinal artery occlusion occurs

A fundus exam may reveal optic disk pallor, a cherry-red macula, and retinal edema

TX: If it does not resolve spontaneously, treatment is recommended within an hour of the occlusion

  • Treatment involves surgical decompression, but, if unavailable, digital massage of the globe and CO2 rebreathing should be initiated in an attempt to pass the clot
Amblyopia Amblyopia (lazy eye) is reduced visual acuity is not correctable by refractive means

  • It may be caused by strabismus (crossed eye); uremia; or toxins, such as alcohol, tobacco, lead, and other toxic substances

TX: Includes correction of refraction error as well as forced use of the amblyopic eye by patching the better eye or blurring with glasses or drops

Glaucoma Open-angle glaucoma: most common, aqueous outflow obstruction

  • > 40 y/o,  African Americans, often asymptomatic
  • Peripheral to central gradual visual loss (versus macular degeneration which is a central loss)

Acute narrow angle-closure glaucoma: Iris against lens, dark environment, acute loss of vision, nausea, and vomiting.

  • Classic triad: injected conjunctivasteamy cornea, and fixed dilated pupil, this is an ophthalmic emergency
  • Sudden dull or severe eye pain (bilateral), worse in dark rooms

TX:

Acute narrow angle-closure glaucoma

  • Acetazolamide IV is the first-line agent - decrease IOP by decreasing aqueous humor production
  • Topical beta blocker (ex. timolol) reduces IOP without affecting visual acuity
  • Miotics/cholinergics (ex. Pilocarpine, Carbachol)
  • Peripheral iridotomy is the definitive treatment

Chronic open-angle glaucoma

  • A gradual loss of peripheral vision
  • Painless

Tx:

  • Prostaglandin analogs are the 1'st line (ex. latanoprost), β-blocker (Timolol), α-agonist, carbonic anhydrase inhibitor to decrease production
  • Laser or surgical treatment
Scleritis Inflammation of the sclera associated with systemic immunologic disease, such as rheumatoid arthritis

  • It causes significant eye pain (severe, deep pain)
  • On examination, there is ocular redness and pain on palpation of the eyeball. It can cause visual impairment

TX: Refer the patient for prompt evaluation by an ophthalmologist.

  • Treatment involves topical and sometimes systemic corticosteroids
Strabismus (ReelDx) Strabismus is defined as any form of ocular misalignment

Tx: Patch exercises, if untreated after age two, amblyopia results

Retinal vascular occlusion (Lecture) (Prev Lesson)
(Next Lesson) Amaurosis fugax
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