PANCE Blueprint EENT (7%)

Vision abnormalities (PEARLS)

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
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

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
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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