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Ophthal > Acute Visual Loss > Flashcards

Acute Visual Loss Flashcards

1
Q

2 min approach of acute visual loss

A

Red reflex: media problem
Pupillary light reflex: conduction problem
Fundoscopy examination

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2
Q

Causes of reduce/absent red reflex
Causes of white reflex

A

Reduce/absent red reflex
- corneal scar
- cataract (lens)
- hyphaema (ant chamber)
- vitreous haemorrhage (vitreous)
- retinal detachment (retina)

White reflex
- retinoblastoma
- persistent fetal vasculature (PFV)
- retinopathy of prematurity (ROF)
- coats ds
- toxocariasis

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3
Q

Pupillary light reflex
- what is the normal pupil size
- the causes of abnormal pupil size
- normal vs abnormal RAPD

A
  • 2-4 mm
  • dilated (>4mm): third nerve palsy
  • constricted (<2mm): opiate, horner syndrome, argyll robertson pupil (neurosyphilis)
  • normal rapd: ABSENT
  • abnormal rapd: PRESENT dt optic neuropathy (2nd cranial nerve abnormality), massive haemorrhage

Ie for optic neuropathy
- glaucoma
- optic neuritis
- AION
- CRAO
- CRVO
- Massive RD
- Large macula lesion

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4
Q

2 min approach fundoscopy

A

Optic disc margin
Normal: well defined, clear margin
Abnormal: blurred margin (optic disc swelling)

Optic disc colour
Normal: pink (slightly orange and red)
Abnormal: pale/hyperemic

Cup to disc ratio
Normal: less than 0.5
Abnormal: more than 0.7 (ie: glaucoma)

Macular region: must look at the light source
Normal: no drusen, no haemorrhage, no exudates
Abnormal: hard exudate or haemorrhage (PDR, NPDR), drusen (degeneration/ARMD)

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5
Q

Acute vs subacute

A

Acute: within seconds > vascular
Subacute: hours > inflammatory

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6
Q

Causes of vitreous haemorrhage

A
  • proliferative neuropathy: PDR, CRVO, BRVO
  • posterior vitreous detachment
  • retinal detachment
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7
Q

Findings on fundoscopy;
Proliferative retinopathy

A
  • neovascularization
  • boat shaped haemorrhage
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8
Q

Findings on fundoscopy;
CRVO

A
  • flamed shaped/red dot haemorrhage in all quadrant of retina
  • tortous vessels
  • cotton wool spots at macula region
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9
Q

Classification of CRVO

A

Ischemic CRVO
- extensive blockage
- very poor vision
- positive RAPD
- neovessel formation: vitreous haemorrhage, rubeosis, tractional retinal detachment

Non ischemic CRVO
- partial blockage
- good vision
- negative RAPD
- no neovessel formation

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10
Q

Symptoms and signs of BRVO

A

Symptoms: sudden poor vision, visual field defect

Signs: RAPD negative, intraretinal haemorrhage, cotton wool spot, dilated/tortuous vessels, +/- macula edema

Most common site at superotemporal quadrant

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11
Q

Patho proliferative retinopathy: CRVO/BRVO/PDR

A

BRVO/CRVO causing increase in VEGF. Leads to neovascularisation which cause vitreous haemorrhage.

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12
Q

Ix of vitreous haemorrhage

A
  • RAPD
  • projection of light
  • B scan ultrasound: retinal detachment, posterior vitreous detachment
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13
Q

Mx of vitreous haemorrhage

A

-Non clearing VH: vitrectomy
- tx underlying cause: CRVO, BRVO, PDR, retinal tear, PVD

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14
Q

Types of retinal detachment

A
  • rhegmatogenous RD
  • tractional RD: proliferative DR
  • exudative RD: choroiditis, pre eclampsia
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15
Q

Symptoms of posterior vitreous detachment

A
  • floaters
  • flashes
  • visual field defect
  • poor vision: macular involvement
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16
Q

Risk factors of posterior vitreous haemorrhage

A
  • myopia
  • blunt trauma
  • Intraocular surgery
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17
Q

Management of post vitreous haemorrhage

A
  • scleral buckle
  • vitrectomy
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18
Q

Symptoms of CRAO

A
  • sudden reduced vision
  • painless
  • previous hx of amaurosis fugax
  • u/l medical problem: HTN, DM, hyperlipidemia, valvular heart ds
19
Q

Signs of CRAO

A
  • pallor retina
  • cherry red spot
  • attenuation of artery
  • severe visual loss
  • positive RAPD
  • embolus in retina vessel
20
Q

Mx of CRAO

A
  • hyperventilate
  • carbogen 95% oxygen and 5% oxygen
  • digital massage
  • oral acetazolamide
  • AC paracentesis to reduce IOP
21
Q

RF of CRAO

A
  • age older than 70y/o
    -atherosclrosis
  • high cholesterol
  • hypertension
  • arteritis
  • young: connective tissue ds, valvular heart ds, sickle cell ds
22
Q

Types of ARMD

A
  • wet ARMD: subretinal haemorrhage
  • dry ARMD- drusen
23
Q

Symptoms of ARMD

A
  • metamorphopsia
  • central scotoma
  • painless
24
Q

Investigation of ARMD

A
  • Amsler grid test
  • Optical Coherence Tomography (OCT) macula
  • Fundus Fluorescein Angiography
  • Indocyanine green
25
Q

RF of ARMD

A
  • smoking
  • ageing
26
Q

Mx of ARMD

A
  • stop smoking
  • anti oxidant
  • intravitreal anti vegf - ranibizumab
  • photodynamic therapy (PDT): for idiopathic polypoidal choroid vasculopathy
27
Q

Symptoms of optic neuritis

A
  • subacute reduction of vision within hours to days
  • central scotoma
  • retrobulbar optic neuritis: pain upon eye movement
28
Q

Symptoms of optic neuritis

A
  • subacute reduction of vision within hours days
  • central scotoma
  • retrobulbar optic neuritis: pain upon eye movement
29
Q

Causes of optic neuritis

A

Non infective
- demyelinating disease: idiopathic or MS related
- autoimmune

Infective
- tuberculosis
- syphilis

30
Q

Most common causes of optic neuritis

A

idiopathic/ demyelinating
- young female
- unilateral

31
Q

Investigation and Management of optic neuritis

A

infective
non infective: demyelinating
- mri of orbit, brain, spine: plaque formation
- lumbar puncture: oligoclonal bland

Treatment: high dose steroid, interferon

32
Q

Types of AION

A
33
Q

Types of AION

A
  • arteritic
  • non arteritic
34
Q

Symptoms of non arteritic AION

A
  • sudden loss of vision
  • painless
  • no red eye
  • pre existing medical problem: DM, HTN, Hyperlidemis
35
Q

Signs of non arteritic AION

A
  • poor vision
  • ON dysfuntion
  • pale swolled dics
  • typical visual field chsmnma
36
Q

Altitude visual field defect for non arteritic AION

A

Inferior or superior altitude VF defect

37
Q

RF for temporal arterities

A
  • elderly (50 y/o)
  • female
38
Q

Symptoms of temporal arterities

A
  • temporal headache
  • jaw claudication
  • proximal myopathy
  • amaurosis fugax
39
Q

Signs of temporal arteritis

A
  • temporal tenderness
  • pulseless
  • thickened superficial temporal artery
40
Q

Investigation of temporal arteritis

A
  • ESR
  • CRP
  • temporal artery biopsy
41
Q

Tx of temporal arteritis

A
  • high dose steroids
42
Q

Symptoms of retinal detachment

A
  • photopsia (sensation of flashing light)
  • floaters
  • reduce vision
  • metamorphopsia
43
Q

Signs of retinal detachment

A
  • reduced vision
  • positive RAPD
  • visual field defect
  • retinal tear
44
Q

Mx of retinal detachment

A
  • pars plana vitrectomy
  • buckle surgery

Ophthal (9 decks)

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