PANCE Blueprint EENT (7%)

• 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

• > 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

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

• Prostaglandin analogs are 1st line (ex. latanoprost), Timolol

• 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

• The cover/uncover test is used to diagnose strabismus
• Exotropia: out-turning of eyes
• Esotropia: in-turning of eyes

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