Posterior Eye Pathology Core Concepts

Join the Drs. Ray and Barlock from the EMGuideWire team as the discuss the initial assessment and evaluation of some ocular complaints with specific attention to pathology of the Posterior Eye.

SHOWNOTES:

Key Points
Always get visual acuity for any eye complaint
Swinging flashlight test can help with your diagnosis
Dilate the eyes for optimal fundoscopic exam
Optic neuritis -> give IV steroids
Use U/S to look for papilledema along with optic nerve sheath diameter
Find the optic nerve when evaluating retinal detachment vs vitreous hemorrhage
CRAO= “stroke of the eye”
CRVO= “DVT of the eye”

Optic Neuritis
Onset: Acute
Pain: With EOMI, can be painless
Visual Acuity: Decreased
Laterality: Usually unilateral, can be bilateral
Classic presentation: Young female (15-45) with acute vision loss
Exam: + APD
Associations: MS, infection (lyme, herpes, syphilis), autoimmune, methanol, DM
Treatment: IV steroids

Papilledema
Onset: Subacute to chronic
Pain: Headache
Visual Acuity: Normal initially
Laterality: Bilateral
Classic presentation: Headache, N/V, transient vision loss
Exam: Optic disc swelling
Treatment: treat underlying cause

Retinal Detachment
Onset: Sudden
Pain: No
Visual Acuity: Impaired
Laterality: Unilateral
Classic presentation: Sudden, painless, with flashes, or a curtain over the visual field
Exam: +/- mild APD
Management: Ophtho consult, minimize activity, treat underlying cause, surgical options available

Central Retinal Artery Occlusion
Onset: Sudden
Pain: No
Visual Acuity: Impaired
Laterality: Unilateral
Classic presentation: Sudden, painless vision loss in vasculopathy
Exam: + APD
Associations: carotid vascular disease, pediatric blood disorders (SCD, leukemia)
Management: Ophtho consult, restore blood flow

Central Retinal Vein Occlusion
Onset: Acute
Pain: No
Visual Acuity: Impaired
Laterality: Unilateral
Classic presentation: Sudden blurry or distorted vision in hypercoagulable patient
Exam: + APD
Associations: OCPs, HTN, DM, vasculitis
Management: Ophtho consult