Acute loss of vision Flashcards
What things should be included in a APLV history?
Previous ocular history
Cardiovascular disease
Family history of eye disease, drugs and eye drops
Symptoms- monocular or binocular
Time of event, method of becoming aware of symptoms eg. covering other eye
Change in symptoms and associated symptoms eg. flashes and floaters
Duration/recovery
Visual loss- general, central & associated field, peripheral only, global effect on function
What are monocular causes of APLV?
Acute corneal disease (usually painful, can be painless HSV), cloudy cornea
Vitreous haemorrhage
Uveitis glaucoma haemorrhage (surgery, rare)
Acute cataract
Optic neuritis
Ischaemic neuropathy
What are anterior chamber haemorrhages?
Are rare and cause a hyphaema (Collection of blood, space between cornea and iris)
these usually occurred previously with more primitive intra ocular lenses
How does an acute cataract occur?
Rare but can occur overnight
Struck by lightning
Occur over weeks if the lens has become porous and takes in fluid
What causes a vitreous haemorrhage?
More common and will cause acute disturbance of vision with substantial visual loss if fairly dense
Common causes are proliferative diabetic retinopathy, retinal tears and posterior vitreous detachment
How does cranial arteritis present?
Acute visual loss, aged over 60, has a headache, pain on chewing and combing hair, raised ESR
Can present with colour vision loss (red)
What occurs in ischaemic neuropathy?
Neuropathy the visual defect never crosses the midline unless there are multiple pathologies
a loss of lower vision will show pallor in the superior aspect of the optic disc
What are the common retinal causes of APVL?
Occlusion of the vein is the most common compared to arteries
veins present with haemorrhage, while arteries don’t
Vein occlusion does not affect vision that badly (mild to moderate vision loss) - will get better with time, but may not completely back to normal
What is branch retinal vein occlusion
Variable degree of central vision on waking in the morning
Examination will show nothing except retinal signs- variable degree of haemorrhage with cotton wool spots that are limited to one sector of the retina
Caused by: high BP- test FBC, ESR, glucose
Not an emergency refer to outpatients
Depends on severity for prognosis, if extensive then risk of formation of new blood vessels
What is central retinal vein occlusion?
is present on waking but affects all of vision and not just the central part
acuity will vary from 6/6 to CF and may have RAPD if severe- there are variable retinal signs from a few haemorrhages to extensive haemorrhages
The opposite eye should be examined for the optic disc to check for raised IOP
Inv: BP, bloods, IOP
Refer to eye casualty, treatments are beneficial in early stages
What are the complications of central retinal vein occlusion?
Permanent severe visual loss and rubeotic glaucoma
rubeosis occurs, which is the development of new vessels on the iris, and block the drainage angle
Pan retinal photocoagulation is needed to stop the new blood vessels forming- an RAPD is a good sign of this risk
What is central retinal artery occlusion?
lead to an absolute loss of vision down to no perception of light
important to ask the patient if they have had previous events where the vision has temporarily gone- they may describe it as a curtain going down over the eye
acuity will be counting finger to NPL and there will be an APD or RAPD depending on visual perception
retinal oedema, cherry red spot in the macula, emboli in the retinal arterioles and carotid bruits on neck -investigations include BP
What is the treatment for central retinal artery occlusion
In primary care includes rebreathe into paper (not plastic) bag to raise CO2 and dilate vessels to move emboli- ocular massage may help remove the emboli
In secondary care an ESR (for arteritis), carotid ultrasound and cardiac echo should be done- treatment here is similar and includes using acetazolamide and paracentesis (needle to lower IOP suddenly)- refer to eye casualty as max 12 hours until retina dies.
What is branch retinal occlusion?
occurs at any time and can be sectoral or central
Acuity is from 6/5 to CF and may have RAPD, carotid bruits, field defects and an embolus on fundoscopy
signs of hypertensive retinopathy (AV nipping and flame shaped haemorrhages)
Inv: BP, carotid ultrasound, bloods and cardiac echo
Refer to eye casualty
How does retinal detachment/vitreous haemorrhage present?
History of floaters and flashes followed by field loss
Acuity is normal if macula is attached but may have a field loss of variable pattern depending on amount of retina detached
if sufficient retina is detached then there will be a RAPD
The red reflex will be abnormal Nothing should be done in primary care and referred directly to eye casualty
