Acute Painless vision loss

Question 1

Acute corneal disease

Answer 1

• Rarely painless unless HZV (herpes zoster virus) which has anaesthetic properties
• Central corneal clouding
• Comes on over a couple of days
• Usually blurry vision unilateral

Question 2

Anterior chamber haemorrhage

Answer 2

rare
• Blurry vision unilateral
• Post eye surgery
• Haemorrhage obvious in AS

Question 3

Acute cataract

Answer 3

rare
• Blurry vision unilateral
• No Red reflex

Question 4

Vitreous haemorrhage

Answer 4

•	Caused by : proliferative diabetic retinopathy, retinal tear, posterior vitreous detachment
•	Substantial unilateral LOV
•	Unable to view fundus for blood
•	Abnormal red reflex
•	If caused by retinal detachment (can just happen w/ age)
        o	floaters and flashing lights
        o	Field loss
        o	If severe RAPD

Question 5

Arteritic Ischeamic Optic neuritis

Answer 5

• Ischaemic optic neuropathy
• Can be anywhere form blurry vision to complete loss unilateral (incl half visual field loss)
• Swollen pale optic disc, cotton wool spots
• May also have central retinal aa occlusion
• Caused by giant cell arteritis/cranial arteritis/temporal arteritis ergo sx of such
• Younger patients
• APD

Question 6

Non – Arteritic Ischeamic Optic neuritis

Answer 6

• Ischaemic optic neuropathy
• Can be anywhere form blurry vision to complete loss unilateral (incl half visual field loss)
• Swollen pale optic disc
• May also have central retinal aa occlusion
• Caused by clots, atherosclerosis
• Older patients
• APD

Question 7

Rapidly expanding pituitary tumour

Answer 7

• Bilateral acute visual loss
• No signs in eye
• APD

Question 8

Increased intracranial pp

Answer 8

leading to papilledema

• Bilateral acute vision loss
• Swollen pale disc
• Headache, confusion, nausea and vomiting

Question 9

Stroke

Answer 9

• Homonomous hemianopia
• Focal neuro sx
• Stroke RF: HTN, AF, DM, Smoking, atherosclerosis

Question 10

Branch retinal vv occlusion

Answer 10

• Variable visual loss worse on wakening
• Central blurring unilateral
• Retinal signs pale (if ischaemic), swollen and variable wedge shaped haemorrhage (area drained by vv)
• HTN (cause)
• If mild may spontaneously resolve

Question 11

Central retinal vv occlusion

Answer 11

• Variable visual loss worse on wakening
• Blurryness of whole visual field unilateral
• HTN (cause)
• Retinal signs pale (if ischaemic), swollen and variable haemorrhage (if haemorrhagic)
• May have RAPD if severe
• Can be caused by increased intraocular pp (glaucoma)

Question 12

Central retinal aa occlusion

Answer 12

• May have had shutter like coming down on vision (prodromal)
• Very poor vision
• Unilateral
• RAPD/APD
• Retinal odema, cherry red spot, emboli, carotid bruits
• Causes: HTN, giant cell arteritis

Question 13

Branch retinal aa occlusion

Answer 13

• Part of vision goes missing
• Unilateral
• May have RAPD
• Retinal emboli, carotid bruits, cotton whool spots
• Causes: HTN, giant cell arteritis

Question 14

Macular haemorrhage

Answer 14

• Only causes vision loss if central on macula and severe
• Causes: age related macular degen (AMD), diabetic retinopathy
• Acute unilateral visual loss
• Black central block +ve scotoma
• No RAPD
• Haemorrhage on fundoscopy and signs of causes
• HTN
• Associated with Viagra use

Question 15

Symptoms of giant cell arteritis/cranial arteritis/temporal arteritis (inflammation in arteries in the head and neck)

Answer 15

• temporal headache
• Pain on combing hair
• lethargy
• weight loss
• jaw claudication
• Symptoms of polymyalgia rheumatica (stiffness, especially in the morning and after resting, weakness, generally feeling poorly, mild fevers)
• Preform ESR and refer to opthalmologist