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
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| 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 conjunctiva, steamy 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
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| 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
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| Strabismus (ReelDx) |
Strabismus is defined as any form of ocular misalignment
Tx: Patch exercises, if untreated after age two, amblyopia results |
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