Acute Painless Vision Loss Flashcards

1
Q

Describe important points to ask in any opthalmology history?

A

Vision loss: -duration -both eyes?

  • distortion, halos, floaters
  • flashing lights
  • momentary field loss
  • field defects
  • When vision loss occurred?
  • Gradual/sudden.
  • Any obvious cause.

Diploplia

Pain/discomfort

Discharge

Change in lacrimation

Change in appearance

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2
Q

What would you examine in a patient presenting with acute painless visual loss?

A

Acuity in both eyes. Visual fields. Pupils. Anterior segment. Fundoscopy.

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3
Q

What are the differentials of monocular APVL? (think anatomically when forming differentials)

A

Acute corneal disease (usually painful so less likely)

Anterior chamber haemorrhage (rare)

Acute cataract (rare)

Vitreous haemorrhage

Posterior vitreous detachment

Retinal tear, detachment

Retinal vein/artery occlusion

Macular haemorrhage

Optic neuritis (giant cell artiritis)

Ischaemic optic neuritis

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4
Q

What are the causes of binocular APVL (less common)?

A

Compression of the optic chiasm (pituitary adenoma)

Optic nerve damage: Infiltrative (infection, rare non hodgkins lymphoma)

Optic neuritis

Severe papilloedema

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5
Q

Describe the care pathway aka (history, examination, investigations/treatment) for ‘branch retinal vein occlusion’

A

H: Monocular vision loss on waking, centrally blurry (variable presentation depending on which vein is blocked)

E: variable degrees of intraretinal hemorrhage, cotton wool spots, macular oedema, collateral vessels (chronic), iris and retinal neovascularization, dilated and tortuous veins.

I: BP, Bloods (glucose, FBC, ESR)

T: Refer to outpatient department

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6
Q

Describe the care pathway aka (history, examination, investigations/treatment) for ‘central retinal vein occlusion’

A

H: On waking, global monocular visual loss

E: Acuity can vary between 6:6 and finger counting

If severe may have a relative afferent pupillary defect

Retinal signs: haemorrhage, cotton wool spots, macular oedema, collateral vessels, neovascularisation.

I: BP, Bloods (FBC, glucose, ESR), IOP

T: Refer to eye casualty.

New treatments may be useful in early stages. Can also treat with anti-VEGF drugs and pan retinal photocoagulation to prevent worsening and complications such as total vision loss.

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7
Q

Describe the care pathway aka (history, examination, investigations/treatment) for ‘central retinal aa occlusion’

A

H: Curtain coming down vision loss

E: Acuity finger counting to no perception of light

Pupils: Afferent pupillary defect or RAPD

On retinoscopy: retinal oedema, cherry red spot, emboli Other: Carotid bruits

I: Primary Care BP Secondary Care: ESR, Carotid US, Cardiac echo

T: Refer to eye casualty. Re-breathe through a paper bag, ocular massage, acetazolamide, paracentesis

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8
Q

Describe the care pathway aka (history, examination, investigations/treatment) for ‘branch retinal aa occlusion’

A

H: Can occur at any time a sectoral or central vision loss

E: Acuity Normal to finger counting.

Field defect

Pupils: may have RAPD

Fundoscopy: embolus, signs of hypertensive retinopathy, pale infarcted area

Carotid bruits

I: BP, Carotid US, Cardiac echo and routine bloods

T: Refer to eye casualty for confirmation, further investigations and treatment.

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9
Q

Describe the care pathway aka (history, examination, investigations/treatment) for retinal detachment or vitreous haemorrhage.

A

H: Retinal detachment causes a visual field loss Haemorrhage: floaters +/- flashes

E: Acuity will be normal if macula is intact.

Field loss pattern

RAPD if extensive loss

Red reflex abnormality

Can see detachment on fundoscopy

I: Nil

T: Refer to eye casualty will need an op.

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10
Q

Describe the care pathway aka (history, examination, investigations/treatment) for macular haemorrhage in (macular degeneration, diabetic retinopathy, macroaneurysm)

A

H: distortion, positive scotoma (an area of lost or depressed vision within a visual field. A positive scotoma usually appears as a dark spot)

E: Variable acuity, No RAPD, full peripheral field, central haemorrhage on fundoscopy.

I: BP

T: Refer to eye casualty.

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11
Q

Which of the following does the image show: retinal detachment, branch venousretinal aa occlusion, branch retinal vv occlusion, central retinal aa occlusion, central retinal vv occlusion, macular degeneration

A

Branch retinal vein occlusion

Haemorrhage in the peripheral vessels due to an occlusion

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12
Q

Which of the following does the image show: retinal detachment, branch venousretinal aa occlusion, branch retinal vv occlusion, central retinal aa occlusion, central retinal vv occlusion, macular degeneration

A

Central retinal vein occlusion

Sunset appearance with engorged central vessels and haemorrhages alongside them

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13
Q

Which of the following does the image show: retinal detachment, branch venousretinal aa occlusion, branch retinal vv occlusion, central retinal aa occlusion, central retinal vv occlusion, macular degeneration

A

Retinal Detachment

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14
Q

Which of the following does the image show: retinal detachment, branch venousretinal aa occlusion, branch retinal vv occlusion, central retinal aa occlusion, central retinal vv occlusion, macular degeneration

A

Branch retinal aa occlusion

Pale area is infarcted retina from the occlusion

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15
Q

Which of the following does the image show: retinal detachment, branch venousretinal aa occlusion, branch retinal vv occlusion, central retinal aa occlusion, central retinal vv occlusion, macular degeneration

A

Central retinal aa occlusion

Characteristic cherry spot and pale optic disk indicating ischaemia

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16
Q

Which of the following does the image show: retinal detachment, branch venousretinal aa occlusion, branch retinal vv occlusion, central retinal aa occlusion, central retinal vv occlusion, macular degeneration.

A

Wet macular degeneration with a macular haemorrhage