41 Vision Loss

Question 1

Loss of vision x5-10min

Answer 1

platelet thrombin emboli from atheromatous plaques in the carotid artery on the same side (“amaurosis fugax”)

Question 2

Transient loss of vision in both eyes SIMULTANEOUSLY should lead the physician to suspect:

Answer 2

basilar artery insufficiency

Question 3

Short-lived loss of vision in one eye (a few seconds) is usually associated with:

Answer 3

papilledema

Question 4

Mild stage of hypertensive retinopathy?

Answer 4

AV nicking, copper wire

Question 5

Moderate stage of hypertensive retinopathy?

Answer 5

flame hemorrhages, cotton wool, silver wire, microaneurysms

Question 6

Severe stage of hypertensive retinopathy?

Answer 6

papilledema

Question 7

Cause of sudden loss of vision in 1 eye, older adult?

Answer 7

vascular

Question 8

Cause of sudden loss of vision in 1 eye, younger adult?

Answer 8

optic neuritis

Question 9

Most common causes of blurred vision?

Answer 9

Cataracts
macular degeneration
amblyopia
trauma

Question 10

The presence of a RAPD usually is associated with diseases of:

Answer 10

optic nerve, chiasm, or optic tract anterior to the exit of the pupillary fibers.

Question 11

A scotoma (blind area) in only one eye is usually associated with:

Answer 11

a retinal or optic nerve lesion in that eye.

Question 12

Compression of the optic chiasm typically results in:

Answer 12

bitemporal visual field defect

Question 13

Damage to the visual pathways behind the chiasm produce:

Answer 13

homonymous hemianopsia
(visual field defect affects same side of the patient’s visual field in both eyes)

Question 14

If homonymous hemianopsia is congruous, the lesion is:

If homonymous hemianopsia is incongruous, the lesion is:

Answer 14

occipital cortex

more anterior

Question 15

Signs/symptoms of optic neuritis?

Answer 15

1. fairly rapid loss of central vision in one eye
2. pain on motion of that eye
3. positive (abnormal) RAPD in that eye
4. possible decr intensity of color (*red)

Question 16

Appearance of disc optic neuritis?

Answer 16

normal optic disc (retrobulbar optic neuritis) vs swollen optic disc (papillitis)

Question 17

The visual field of a patient with papilledema will show:

The visual field of a patient with papillitis will demonstrate:

Answer 17

an enlarged physiologic blind spot bilaterally

a central scotoma

Question 18

Patients with papillitis will almost always have a positive:

Answer 18

(abnormal) RAPD on the affected side.

Question 19

Patients with optic neuritis should have a complete neurological exam to look for:

Answer 19

signs of MS (**common presenting symptom)

Question 20

Signs/symptoms of optic chiasm lesion?

Answer 20

bitemporal hemianopsia

asymm > symm

Question 21

Signs/symptoms of optic chiasm lesion with asymm?

Answer 21

RAPD in the eye with the poorer vision

optic n atrophy

Question 22

If the VF deficit = bitemporal hemianopsia, greater superiorly, what is the likely etiology?

Answer 22

pituitary adenoma (inf compression of optic chiasm)

Question 23

Signs/symptoms of lesion between the chiasm and the lateral geniculate body?

Answer 23

• homonymous hemianopsia
• optic n atrophy
• if asymmetric, positive (abnormal) RAPD on more involved side

Question 24

Signs/symptoms of lesion post to the lateral geniculate body?

Answer 24

• homonymous hemianopsia
• optic atrophy
• nml RAPD

Question 25

The more posterior in the post-chiasmal pathway the lesion is the more _____ the visual field defect generally is.

Answer 25

congruous

Question 26

Bilateral swelling of the optic nerve head is due to:

Answer 26

increased intracranial pressure | papilledema

Question 27

Typical ocular findings in patients with papilledema:

Answer 27

- nml visual acuity - nml VF - no pain - no afferent pupillary defect - HA/NV due to incr ICP - +/- CNVI Palsy

Question 28

Signs of papilledema?

Answer 28

- bil disc elevation - blurred disc margins - small vessels at margins obscured - retinal vessels tortuous/dilated - hemorrhages/exudates - No spon venous pulsations

Question 29

Clinical features of ischemic optic neuropathy?

Answer 29

- older patients - (+) afferent pupil defect - swollen/pale disc

Question 30

Visual defects associated with ischemic optic neuropathy?

Answer 30

- altitudinal hemianopsia - unilateral - acute

Question 31

On exam, central retinal artery occlusion will show:

Answer 31

- retina pale due to swelling (2' to ischemia) - optic disc pale - arteries narrowed - macula = “cherry-red spot”

Question 32

On exam, central retinal vein occlusion will show:

Answer 32

- hemorrhagic infarct of the retina - disc swollen + hyperemic - prominent venous distention - flame-shaped and other hemorrhages

Question 33

Central retinal vein occlusion can occur in what conditions?

Answer 33

hypertension, DM, chronic open angle glaucoma, blood diseases that incr blood viscosity

Question 34

MC causes of optic atrophy?

Answer 34

defects in the optic nerve, chiasm, or optic tract anterior to the lateral geniculate body

Question 35

Clinical features of chronic open angle glaucoma?

Answer 35

- incr ICP - large optic cup (asymm) - late = loss of centrsl vision - optic nerve damage

Question 36

What early visual field defects are associated with open angle glaucoma?

Answer 36

scotomata (w/ arcuate pattern due to anatomical orientation of the axons in the retina) ***hard to dx!!!