Acute Posterior Eye Presentations

Question 1

Central retinal artery occlusion signs/symptoms

Answer 1

• sudden painless monocular loss of vision
• profound RAPD
• emboli
• whitish odaematous retina
• cherry red spot
• disc pallor
• retinal vasculature narrowing

Question 2

Optom and ophthalmology CRAO management

Answer 2

• if CRAO less than 1 day old, same day referral to ophthalmology
• initiate ocular massage while px lies in supine position

Ophthalmologist treatment
- acetazolamide
- intra-arterial fibrinolytic therapy
- aspirin
- follow up to detect neovascularisation
- dietary advice, quit smoking and manage blood pressure

Question 3

BRAO signs/symptoms

Answer 3

• sudden painless monocular drop in vision
• RAPD often present
• emboli at bifurnication points
• whitish, oedematous sector of retina
• retinal vasculature narrowing in area supplied by the affected branch
• altitudinal or sectoral visual field effect

Question 4

BRAO management

Answer 4

• if less than 24 hours same day referral
• initiate ocular massage
• ophthalmologist to same as previous

Question 5

Retinal vein occlusion signs

Answer 5

• blurred
• vision metamorphopsia
• visual loss
• dilation and tortuosity of veins
• blot and flame haemorrhages
• cotton wool spots and retina oedema
• CMO
• retinal whitening
• disc oedema
• RAPD only in ischemic CRVO

Question 6

Optometric management of vein occlusion

Answer 6

• BRVO 5/6x more common than CRVO
• if CMO present secondary to occlusion, then anti VEGF will be given so urgent referral and seen in 1-2 weeks
• px should be referred to stroke clinic for review within 48hrs if they present with vision loss, no headache or associated pain. If they have a previously undiagnosed visual field loss.

Question 7

Retinal detachment differential diagnosis

Answer 7

• PVD
• choroidal mass
• Schaffer’s sign

Question 8

Management of retinal detachment

Answer 8

• emergency referral

Question 9

Different ion between AAION and NAION

Answer 9

AAION
- jaw claudation
- scalp tenderness
- anorexia

ANAION
- painless loss of vision
- most are non arteritic

Question 10

Management of AAION and NAION

Answer 10

• emergency referral

Question 11

Cause of optic neuritis

Answer 11

• inflammatory demyelination of the nerve
• can be as a result of multiple sclerosis
• typically 20-50 years

Question 12

Management of optic neuritis

Answer 12

• urgent referral to HES For confirmation of diagnosis
• high dose IV prednisolone if within 1 week of symptoms
• investigate potential MS

Question 13

Prognosis for NAION and AAION

Answer 13

Arteritic rarely improves
Non-arteritic 31% improve