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Ophthalmology 2023 > Acute visual disturbance 1 > Flashcards

Acute visual disturbance 1 Flashcards

1
Q

elderly patients with painless loss of vision may commonly have

A

age-related macular degeneration
giant cell arteritis

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2
Q

middle aged patients with painless loss of vision may commonly have

A

retinal arterial occlusions
retinal vein occlusions
diabetic macular oedema
vitreous haemorrhages

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3
Q

which common causes of painless vision loss present at any age?

A

retinal detachment
vitreous haemorrhages

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4
Q

onset of painless loss of vision over minutes

A

retinal arterial occlusions
retinal venous occlusions
vitreous heamorrhages

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5
Q

onset of painless loss of vision over hours

A

retinal detachments

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6
Q

onset of painless loss of vision over days

A

diabetic macular oedema
age related macular degeneration

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7
Q

is acute painless loss of vision usually bilateral?

A

no this is very rare
sudden loss of vision is usually unilateral
if its bilateral there is usually a central cause and not an ocular cause

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8
Q

what does hard exudate on the fundoscopy indicate

A

lipid leaking out of damaged blood vessels in people with diabetes may cause this
fluid leaking into the macula = diabetic macula oedema

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9
Q

how the vision loss processes

A

started in the centre = probably a macula problem ie. either age related macula degeneration or diabetic macular oedema
started on the sides like a curtain = retinal detatchment
progressive red haze = vitreous haemorrhage

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10
Q

progressive peripheral loss like a curtain

A

retinal detatchment

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11
Q

usual cause of vitreous haemorrhage

A

diabetes

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12
Q

painless loss of vision with a red haze

A

vitreous haemorrhage

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13
Q

associated symptom of distortion

A

straight lines start to look wavy
usually macula cause
age related macula degeneration or diabetic macula oedema

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14
Q

associated symptom of flashes/floaters

A

retinal detachment or vitreous haemorrhage

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15
Q

associated symptoms of scalp pain or jaw claudication

A

giant cell arteritis
may have another rheumatological condition

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16
Q

inferior branche retinal artery occlusion looks like

A
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17
Q

people who are myopic

A

short sightedness
these people are at an increased risk of retinal detatchment

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18
Q

diabetes causes a higher risk of

A

diabetic macular oedema
vitreous heamorrhage

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19
Q

ischaemic heart disease, AF and cerebrovascular disease increase risk of

A

vasculopaths
increased risk of retinal artery occlusion or retinal venous occlusion

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20
Q

polymyalgia rheumatica is associated with

A

GCA = giant cell arteritis

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21
Q

things you can have a family history of

A

retinal detachment
age related macular degeneration

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22
Q

steps of examination of the eye

A
  1. gross inspection
  2. optic nerve examination
  3. slit lamp examination
  4. eyelid eversion
  5. ocular motility
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23
Q

what’s included in the optic nerve examination

A
  1. visual acuity
  2. visual fields
  3. pupil reflexes/reactions
  4. optic nerve exam (fundoscopy)
  5. colour vision
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24
Q

what does a normal fundus look like

A
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25
Q

how do you tell which fundus you’re looking at

A

the optic nerve is always closer to the nose
bearing in mind you’re looking at the fundus of a person facing you
nerve is nasal

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26
Q

how should the optic nerve look

A

yellow with a distinct border
range retinal tissue
blood vessels running throughout
darker red for veins and lighter red for arteries
veins are slightly wider than arteries

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27
Q

veins look

A

fatter and darker

28
Q

arteries look

A

thinner and lighter

29
Q

macula looks

A

more darkly pigmented than the rest of the retina
temporal to the optic nerve

30
Q

wet age related macular degeneration means

A

there is blood = wet

31
Q

advanced (neovascular)/wet age related macular degeneration

A

commonest cause of vision loss
painless acute central distortion or central scotoma - usually unilateral
outer retina degenerates
new blood vessels that are abnormal grow up into the retina where they don’t belong
abnormal blood vessels are prone to bleeding and leaking fluid causing vision loss

32
Q

what might you see on fundus than indicates ARMD

A

central macular drusen +/- haemorrhage

33
Q

management of ARMD

A

urgent referral to ophthalmology
smoking cessation
intravitreal anti-VEGF therapy initially once per month then less frequent
might need it indefinitely

34
Q

intravitreal anti-VEGF therapy

A

injected into the eye under anaesthetic - painless
initially the treatment is needed once per month and less frequently thereafter
likely to need treatment for the rest of their lives

35
Q

most modifiable risk factor for ARMD

A

smoking

36
Q

Hx of retinal vein occlusion

A

painless acute blurring/loss of vision (central and/or altitudinal)
may only be inferior/superior visual field loss
inferior retinal occlusion will cause superior field loss and vice versa
middle aged or elderly, history of HTN, diabetes, hyperlipidaemia

37
Q

aetiology of retinal vein occlusion

A

arteriosclerosis leading to vein occlusion at AV junction
sclerosis of an artery which at the junction of the artery and vein leads to obstruction of the vein
leakage of blood and other fluids into the retina
macula swells leading to loss of vision

38
Q

retinal vein occlusion on examination

A

haemorrhages and dilated/tortuous veins, macula oedema
+/- RAPD (relative afferent pupillary defect caused by CRVO central retinal vein occlusion), cotton wool spots, disc swelling

39
Q

severe central retinal vein occlusion will cause

A

relative afferent pupillary defect

40
Q

two types of retinal vein occlusion

A

CRVO = central retinal vein occlusion (whole retina)
BRVO = branch retinal vein occlusion (semi-retina)

41
Q

management of retinal vein occlusion

A

systemic vascular risk factors (especially hypertension)
urgent referral to ophthalmology
intravitreal anti-VEGF or steroid therapy +/- retinal laser

42
Q

difference between retinal vein or artery occlusion

A

retinal vein occlusion produce blood
retinal artery technically can too but not as likely
retinal artery occlusion causes retinal paleness

43
Q

what does retinal artery occlusion look like

A

retinal paleness
cherry red spot if central (macula sparing)

44
Q

cherry red spot indicates

A

cherry red spot indicates central retinal artery occlusion

45
Q

Hx of retinal artery occlusion

A

painless unilateral loss of vision, central and/pr altitudinal
Middle aged/elderly
vasculopathic/cerebrovascular/AF/hyperlipidaemia

46
Q

retinal paleness indicates

A

retinal artery occlusion

47
Q

aetiology of retinal artery occlusion

A

arteriolar embolus from carotid systemic or cardiac value

48
Q

examination of retinal artery occlusion

A

pallor of whole (CRAO) or semi retina (BRAO)
there may be a cherry red spot if it is CRAO
or hemi-field it if is BRAO
+/- RAPD (CRAO), visible emboli

49
Q

management of retinal artery occlusion

A

urgent stroke work-up
- CT angiogram head/neck, carotid doppler USS
- trans thoracic echocardiogram, ECG +/- Holter
exclude giant cell arteritis in 60+ year olds (FBC, ESR, CRP), and ask about jaw claudication
urgent ophthalmology referral -> stroke referral -> thrombolysis protocol (tPA)

50
Q

retina looks like a brain

A

retinal detatchment
retinais detatched from the choroid is bulging forward into the vitreous

51
Q

tear in the retina

A

causes the majority of retinal detachments
tear usually from the vitreous gel tugging on the retina, vitreous fluid gets behind the tear and causes the detachments

52
Q

retinal detatchment Hx

A

painless unilateral flashes and floaters
progressive curtain scotoma
middle aged, elderly, myopic, trauma, diabetes

53
Q

determining if the macula is detached in retinal detatchment

A

prognosis much worse if the macula is detached
if you operate quickly you can save sight
macula off may been youre not able to regain vision

54
Q

risk factors for retinal detatchement

A

myopia
diabetes
trauma
middle aged/elderly

55
Q

examination for retinal detachment

A

greys, corrugated looking retina - macula on or off
altitudinal or total field loss
normal fundus and fields possible vitreous detatchement only

56
Q

management for retinal detatchment

A

fast and prepare for surgery
urgent referral to opthalmology
vitrectomy (most common) or scleral buckle surgery

57
Q

vitreous haemorrhage aetiology

A
  • vitreous detachment (normal) can cause sheering of blood vessel causing vitreous haemorrhage (not normal)
  • alternatively, diabetes causes abnormal blood vessels which are prone to bleeding (frilly looking blood vessels), may indicate proliferative diabetic retinopathy
58
Q

vitreous haemorrhage looks like

A
59
Q

two main causes of vitreous haemorrhage

A
  • vitreous detatchment
  • diabetes
60
Q

Hx of vitreous haemorrhage

A

painless unilateral floaters or ‘red haze’
+/- loss of vision
diabetes, trauma, myopia

61
Q

examination of vitreous haemorrhage

A

variable change in VA and fields
visible blood on fundoscopy +/- detached retina

62
Q

treatment for vitreous haemorrhage

A

vitrectomy surgery or laser surgery
fast for theatre
systemic management for diabetes

63
Q

diabetic macular oedema Hx

A

caused by hyperglycaemia
painless central visual blurring
always bilateral but might be asymmetric
onset days to weeks
diabetes, hypertension, hyperlipidaemia

64
Q

aetiology of diabetic macular oedema

A

retinal vascular hyperpermeability from chronic hypoerglycaemia
swelling of the macula

65
Q

examination of diabetic macular oedema

A

variable change in VA, central field loss
central macular haemorrhages +/- hard exudates

66
Q

diabetic macular oedema management

A

optimal metabolic management
semi-urgent referral to ophthalmology
intravitreal therapy (anti-VEGF or steroids) +/- retinal laser

Ophthalmology 2023 (18 decks)

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