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 PointsAlways 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 NeuritisOnset: 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 OcclusionOnset: 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 OcclusionOnset: 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