Acute visual disturbances

Question 1

is macular degeneration reversible?

Answer 1

no

Question 2

what types are MD are there?

Answer 2

dry and wet

Question 3

what is characteristic of dry MD?

Answer 3

drusen (yellow lipid depositis behind retina)
atrophy of retinal pigmenet epithlium
sow progression
less dramatic

Question 4

what vision is lost in MD?

Answer 4

central vision

Question 5

what is characteristic of wet MD?

Answer 5

accumulation of fluid 
heamorrhages
scarring
macular thickening 
swelling 
develops dramatically

Question 6

who tends to get MD?

Answer 6

over 50 yrs

its 3rd most common cause of blindness worldwide

Question 7

what are the risk factors of MD?

Answer 7

age
smoking 
alcohol
sun exposure
poorly balanced diet

Question 8

How does MD present?

Answer 8

disturbed central vision - blurring, scotoma, distortion
difficult reading fine print, recognising faces and appreciating fine detail

distortion on Amsler grid testing
Fundsocopy - drusen, atrophy, scarring, pigmentation and in wet -haemorrhages

Question 9

when do you refer dry and wet MD pts to specialist?

Answer 9

dry - routine referral if pt symptomatic

wet - within 2 weeks if new signs seen

Question 10

what is the tx for MD?

Answer 10

NO CURE!
lifestyle modifications - stop smoking, reduce alcohol, better diet, minimise sun exposure
supportive management - magnifiers, light modifications
wet AMD- minimise angiogenesis, give anti-VEGF (i.e ranibizumab aka ‘lucentis’) via intra vitreous injections

Question 11

what are the risk factors for posterior vitreous detachment?

Answer 11

age
myopia (short sighted) 
uveitis 
intraocular laser or surgery treatment 
eye trauma

Question 12

what are the symptoms of PVD?

Answer 12

floaters
photopsia - percieved flashes of light
painless
no visual impairment

vitreous haemorrhage - shower of black spots (vitreous heamorrhage is associated with retinal detachment)

Question 13

what signs can be seen with PVD and what instrument do you use to see the signs?

Answer 13

weiss ring
sometimes haemorrhage
use a slit lamp

Question 14

what tx is availabe for PVD?

Answer 14

PVD usually caused by retinal tear - laser repair
vitreous hemorrhage clears spontaneously but if very large may require surgery
if flashes persist - vitrectomy

Question 15

Is retinal detachment a medical emergency?

Answer 15

YES!!!!

Question 16

What three types of retinal detachment are there?

Answer 16

rhegmatogenous - tear in retina allows fluid to accumulate under retina separating it from retinal pigment epithelium which nourishes the retina. this is most common type
tractional - scar tissue pulls retina away from RPE
exudative - caused by trauma/inflammatory disorders. fluid accumulates but no tear present.

Question 17

what are the risk factors for retinal detachment?

Answer 17

any age but more common >40 
males
white
short sighted (myopia) 
diabetic 
hypertensive
retinal detachment in other eye
fhx
cataract rugery 
uveitis 
eye injury

Question 18

what are the symptoms of retinal detachment?

Answer 18

increase in floaters
light flashes in eye
sometimes curtain over field of vision
signs are seen through fundoscope

Question 19

how do you treat retinal detachment?

Answer 19

laserm(thermal)/cryopexy (freezing) to repair tear
pneumatic retinopexy - small gas bubble injected into eye and then laser or cryopexy used to seal tear
scleral buckle -sew silicone buckle around sclera to put pressure which allows tear to heal - seal with laser or cryopexy
vitrectomy - remove vitreous and replace with saline solution if large tears present

these treatments can be used in combination

Question 20

what is amaurosis fugax?

Answer 20

transient monocular blindness (curtain over one eye)
lasts for secs-mins, painless
males with cv/stroke risk factors or hx of stroke are at risk
vision returns to normal afterwards
no tx - tx underlying cause

Question 21

what is optic neuritis?

Answer 21

inflammation of the optic nerve - it is a recurring condition

Question 22

who is at risk of optic neuritis?

Answer 22

females

20-40yrs

Question 23

what are the causes of optic neuritis?

Answer 23

often unknown
could be autoimmune - MS
infection/trauma/arteritis/diabetes/glaucoma/compressive lesions?

Question 24

what are the signs and symptoms of optic neuritis?

Answer 24

vision loss ussually in one eye that develops over hours-days. it peaks at 1-2 weeks
variation in how blind the eye becomes
reduced visual acuity
reduced colour vision
loss of contrast
change in peripheral vision
pain
vision worsened by heat/exercise and pain worsened by eye movement
usually temp but can be perm
swelling of optic nerve and enlargement of blood vessels=papillitis
RAPD SEEN IF ONLY ONE EYE AFFECTED AND OTHER EYE NORMAL

nb: inflammation can be retrobulbar in 2/3 pts meaning that no signs can be seen when using an opthalmoscope = retrobulbar neuritis

Question 25

how do you treat optic neuritis?

Answer 25

some may get better on own
tx underlying cause
steroids!