41 Vision Loss Flashcards
Loss of vision x5-10min
platelet thrombin emboli from atheromatous plaques in the carotid artery on the same side (“amaurosis fugax”)
Transient loss of vision in both eyes SIMULTANEOUSLY should lead the physician to suspect:
basilar artery insufficiency
Short-lived loss of vision in one eye (a few seconds) is usually associated with:
papilledema
Mild stage of hypertensive retinopathy?
AV nicking, copper wire
Moderate stage of hypertensive retinopathy?
flame hemorrhages, cotton wool, silver wire, microaneurysms
Severe stage of hypertensive retinopathy?
papilledema
Cause of sudden loss of vision in 1 eye, older adult?
vascular
Cause of sudden loss of vision in 1 eye, younger adult?
optic neuritis
Most common causes of blurred vision?
Cataracts
macular degeneration
amblyopia
trauma
The presence of a RAPD usually is associated with diseases of:
optic nerve, chiasm, or optic tract anterior to the exit of the pupillary fibers.
A scotoma (blind area) in only one eye is usually associated with:
a retinal or optic nerve lesion in that eye.
Compression of the optic chiasm typically results in:
bitemporal visual field defect
Damage to the visual pathways behind the chiasm produce:
homonymous hemianopsia (visual field defect affects same side of the patient’s visual field in both eyes)
If homonymous hemianopsia is congruous, the lesion is:
If homonymous hemianopsia is incongruous, the lesion is:
occipital cortex
more anterior
Signs/symptoms of optic neuritis?
- fairly rapid loss of central vision in one eye
- pain on motion of that eye
- positive (abnormal) RAPD in that eye
- possible decr intensity of color (*red)
Appearance of disc optic neuritis?
normal optic disc (retrobulbar optic neuritis) vs swollen optic disc (papillitis)
The visual field of a patient with papilledema will show:
The visual field of a patient with papillitis will demonstrate:
an enlarged physiologic blind spot bilaterally
a central scotoma
Patients with papillitis will almost always have a positive:
(abnormal) RAPD on the affected side.
Patients with optic neuritis should have a complete neurological exam to look for:
signs of MS (**common presenting symptom)
Signs/symptoms of optic chiasm lesion?
bitemporal hemianopsia
asymm > symm
Signs/symptoms of optic chiasm lesion with asymm?
RAPD in the eye with the poorer vision
optic n atrophy
If the VF deficit = bitemporal hemianopsia, greater superiorly, what is the likely etiology?
pituitary adenoma (inf compression of optic chiasm)
Signs/symptoms of lesion between the chiasm and the lateral geniculate body?
- homonymous hemianopsia
- optic n atrophy
- if asymmetric, positive (abnormal) RAPD on more involved side
Signs/symptoms of lesion post to the lateral geniculate body?
- homonymous hemianopsia
- optic atrophy
- nml RAPD
The more posterior in the post-chiasmal pathway the lesion is the more _____ the visual field defect generally is.
congruous
Bilateral swelling of the optic nerve head is due to:
increased intracranial pressure
papilledema
Typical ocular findings in patients with papilledema:
- nml visual acuity
- nml VF
- no pain
- no afferent pupillary defect
- HA/NV due to incr ICP
- +/- CNVI Palsy
Signs of papilledema?
- bil disc elevation
- blurred disc margins
- small vessels at margins obscured
- retinal vessels tortuous/dilated
- hemorrhages/exudates
- No spon venous pulsations
Clinical features of ischemic optic neuropathy?
- older patients
- (+) afferent pupil defect
- swollen/pale disc
Visual defects associated with ischemic optic neuropathy?
- altitudinal hemianopsia
- unilateral
- acute
On exam, central retinal artery occlusion will show:
- retina pale due to swelling (2’ to ischemia)
- optic disc pale
- arteries narrowed
- macula = “cherry-red spot”
On exam, central retinal vein occlusion will show:
- hemorrhagic infarct of the retina
- disc swollen + hyperemic
- prominent venous distention
- flame-shaped and other hemorrhages
Central retinal vein occlusion can occur in what conditions?
hypertension, DM, chronic open angle glaucoma, blood diseases that incr blood viscosity
MC causes of optic atrophy?
defects in the optic nerve, chiasm, or optic tract anterior to the lateral geniculate body
Clinical features of chronic open angle glaucoma?
- incr ICP
- large optic cup (asymm)
- late = loss of centrsl vision
- optic nerve damage
What early visual field defects are associated with open angle glaucoma?
scotomata (w/ arcuate pattern due to anatomical orientation of the axons in the retina)
***hard to dx!!!
