Acute Painless Loss of Vision

Question 1

PS Acute corneal disease

Answer 1

Rare to be painless
Monocular
Blurry vision

Question 2

PS Anterior camber haemorrhage (rare)

Answer 2

Monocular

Blurry vision = ONLY Sx

Question 3

What causes most anterior chamber haemorrhages?

Answer 3

Older design lenses

Question 4

Cause of acute cataract?

Answer 4

Lightning

Question 5

Causes of vitreous haemorrhage

Answer 5

Proliferative diabetic retinopathy
Retinal tear
Vitreous detachment

Question 6

Hx - BVO

Answer 6

On waking, central blur, variable

Question 7

O/E - BVO

Answer 7

Nil
Some retinal signs
Check other eye of asymp BV

Question 8

Ix - BVO

Answer 8

BP
Bloods - FBC, ESR
Glucose

Question 9

Rx - BVO

Answer 9

Routine to OPD

Question 10

If BVO is mild - what can happen

Answer 10

Spontaneous resolution

Question 11

Hx - CRVO

Answer 11

On waking

Global blur

Question 12

O/E - CRVO

Answer 12

Acuity variable: 6/6 –> CF
May have RAPD if severe
Variable retinal signs

Question 13

Ix - CRVO

Answer 13

BP
Bloods
IOP

Question 14

Rx - CRVO

Answer 14

eye casualty

Question 15

Complications CRVO (2)

Answer 15

Permanent severe visual loss

Rubeotic glaucoma

Question 16

Hx - CRAO

Answer 16

Intermittent prodromal phase - shutter/curtain effect

Question 17

O/E - CRAO

Answer 17

Acuity CF to NPL
Pupils APD/RAPD
Signs - retinal oedema, cherry red spot –> emboli in retinal aa, carotid bruits

Question 18

Ix 1’ care - CRAO

Answer 18

BP

Question 19

Ix 2’ care - CRAO

Answer 19

ESR
Carotid USS
Cardiac echo

Question 20

Tx - 1’ care - CRAO

Answer 20

Rebreath into paper bag + ocular massage

Question 21

Tx 2’ care - CRAO

Answer 21

Rebreath + ocular massage
Acetazolamide
Paracentesis

Question 22

Rx - CRAO

Answer 22

Eye casualty

Question 23

Hx - BRAO

Answer 23

Any time - sectoral +/- central

Question 24

O/E - BRAO

Answer 24

Acuity - 6/5 to CF
May have RAPD
Carotid bruits 
Field defect
Fundoscopy - embolus - signs HTN retoinopathy

Question 25

Ix - BRAO

Answer 25

BP
Carotid USS
Bloods
Cardiac echo

Question 26

Rx - BRAO

Answer 26

Eye casualty

Question 27

Important risk w/ BRAO

Answer 27

Stroke risk

Question 28

Hx retinal detachment

Answer 28

Floaters +/- flashes +/- field loss

Question 29

O/E retinal detachment

Answer 29

Acuity norm if macula on
Field loss pattern
RAPD if extensive
Red reflex abnormality

Question 30

Ix - retinal detachment

Answer 30

Nil 1’ care

Question 31

Rx - Retinal detachment

Answer 31

Eye casualty

Question 32

Why does retinal detachment occur?

Answer 32

Short-sighted eyes

Vitreous becomes degenerative, then detaches from retina posteriorly

Question 33

Main causes macular haemorrhage (4)

Answer 33

AMD
Diabetic retinopathy
Macroaneurysm
Viagra

Question 34

Hx macular haemorrhage (2)

Answer 34

Distortion vision

Positive scotoma

Question 35

O/E macular haemorrhage (5)

Answer 35

Acuity variable 
No RAPD
Full peripheral field 
Central haemorrhage on fundoscopy 
Signs 1' disease

Question 36

Ix macular haemorrhage

Answer 36

BP

Question 37

Rx macular haemorrhage

Answer 37

Eye casualty

Question 38

What kind of defect does an ischaemic optic neuropathy cause?

Answer 38

Altitudinal field defect

Question 39

What must you exclude by Hx in ischaemic optic neuropathy?

Answer 39

Cranial arteritis

Question 40

Cranial arteritis Hx

Answer 40

Pain on combing hair

Pain on chewing

Question 41

What is a pituitary apoplexy

Answer 41

Rapidly expanding pituitary tumour

Question 42

Sx pituitary apoplexy

Answer 42

Bilateral afferent pupillary defect

Question 43

OPtic nn related monocular vision loss (2)

Answer 43

Optic neuritis

Ischaemic optic neuropathy

Question 44

Optic nn related bilateral vision loss (3)

Answer 44

Infiltration
Severe papilloedema
Optic neuritis

Question 45

Visual loss in migraine

Answer 45

Bilateral scintillating scotoma