Approach to Visual Loss Flashcards

Question

What is the management of keratoconus?

Answer 1

Hard contact lenses Cross-linking Corneal transplant

Answer 2

Few hours of painful unilateral red eye and worsening vision Cloudy oedematous cornea Mid-dilated pupil Raised intraocular pressure

Answer 3

Reduce intraocular pressure Acetazolamide oral and IV STAT Topical beta-blocker Topical steroids

Answer 4

``` Gradual worsening of vision Glare Colours not as bright anymore Usually in older people Visual acuity not improved with pin hole PEARL Normal intraocular pressure Sclerosis of lens ```

Answer 5

Cortical Nuclear Subcapsular

Answer 6

``` Age-related Drugs - Steroids - Amiodarone Trauma, including intraocular surgery Systemic diseases - Diabetes - Myotonic dystrophy - Wilson's disease - Atopic dermatitis Ocular diseases - Uveitis - Myopia ```

Answer 7

Lens removal and introcular lens insertion

Answer 8

Zonular pathology

Answer 9

Connective tissue disorders, including Marfan syndrome

Answer 10

"I lost vision in one eye today. It was like a curtain came down over my vision" Affected eye VA: 6/60 PEARL Nil RAPD

Answer 11

Retinal detachment Proliferative diabetic retinopathy Trauma

Answer 12

Often resolves slowly over weeks/months Can need vitrectomy to clear blood Risk of re-bleed

Answer 13

``` Flashes of light in one eye = traction of retina Floaters in one eye RAPD with extensive retinal detachment Retinal detachment with fundoscopy - Difficult to see in peripheries - Need to dilate pupil ```

Answer 14

Urgent ophthalmological review | Surgical repair

Answer 15

Posterior vitreous detachment

Answer 16

``` Sudden, painless, unilateral loss of vision RAPD Pale retina Arteriolar attenuation Cerry red spot ```

Answer 17

After 90 min

Answer 18

Atherosclerosis Emboli Haematological disorders Inflammatory; eg: giant cell arteritis

Answer 19

``` Urgent priority to rule out GCA - ESR - CRP Lie patient flat Ocular massage Decrease introcular pressure > acetazolamide 500 mg IV STAT ```

Answer 20

``` Sudden, painless, unilateral loss of vision RAPD Retinal haemorrhages Macular oedema Cotton wool spots ```

Answer 21

HTN Diabtes Hyperlipidaemia Smoking

Answer 22

Sarcoidosis Behcet's disease SLE Polyarteritis nodosa

Answer 23

Protein C and S deficiency Antithrombin deficiency Antiphospholipid syndrome Multiple myeloma

Answer 24

Glaucoma | Orbital mass

Answer 25

Blood vessels grow into iris

Answer 26

Lifestyle changes Intraocular pressure control Intravitreal steroids Anti-VEGF agents

Answer 27

"I can't focus on anything with one eye. When I try and look at something, it disappears" Visual fields by confontration normal

Answer 28

Vitrectomy Removal of macular traction Insertion of gas

Answer 29

``` Gradual decrease in central vision Central scotoma FHx of macular degeneration Drusen Geographic atrophy = coalesced drusen ```

Answer 30

Loss of retinal pigment epithelium/photoreceptors Associated with - Increasing age - Smoking

Answer 31

``` Predominantly supportive care Smoking cessation Vitamin supplementation > thought to reduce oxidative stress in retina - Vitamin C and E - Zinc - Copper ```

Answer 32

``` Rapid decrease in central vision - weeks-months Metamorphopsia Central scotoma Drusen Geographic atrophy Lipid exudate Intra-retinal haemorrhage ```

Answer 33

Choroidal neovascularisation = growth of abnormal leaky vessels in RPE

Answer 34

Investigate with fluorescein angiography and optical coherence tomography Anti-VEGF intra-vitreal injections

Answer 35

Duration of diabetes

Answer 36

``` Poor glycaemic control Poorly controlled HTN Hypercholesterolaemia Nephropathy Pregnancy Obesity ```

Answer 37

Diabetic macular oedema

Answer 38

``` Circinate ring Lipid (hard) exudates Intra-retinal haemorrhage Micro-aneurysms Venous beading Intra-retinal vascular abnormalities Neovascularisation of disc Neovascularisation everywhere Vitreous haemorrhage ```

Answer 39

Most common retinal dystrophy Sporadic/inherited Affects rods first Usually in young adults

Answer 40

``` "I'm concerned about my vision. I've nearly been in a few car accident. My night vision is so bad, that I've stopped driving in the dark altogether. Blindness tends to run in my family" Normal visual acuity PEARL Nil RAPD Intraocular pressure normal Annular scotoma Waxy pallor of disc Bone-spiculae retinal pigmentation Retinal arteriolar attenuation ```

Answer 41

Retinal vasculitis Retinitis Choroiditis

Answer 42

``` Systemic inflammatory disorders - Behcet's disease - Sarcoidosis Viruses Fungal Protozoa Bacterial Lymphoma ```

Answer 43

``` Investigate cause Assess risk of bilateral vision loss Antimicrobials if infective cause Topical steroids Intraocular antimicrobials and steroids Systemic therapies ```

Answer 44

Overweight, female, 20s Headaches Blurry vision Bilateral swollen optic discs = papilloedema

Answer 45

Urgent neuroimaging | Lumbar puncture if cause not clear

Answer 46

``` Weight loss Medical Rx - Acetazolamide - Other diuretics - Corticostreoids Surgical Rx - Optic nerve sheath fenestration - Lumbar-peritoneal shut ```

Answer 47

"I woke up this morning and have very poor vision in one eye" RAPD in affected eye Normal intraocular pressure Reduced colour saturation in affected eye Blurred optic disc margin Swollen, inflamed, disc = papillitis

Answer 48

MRI brain and referral to neurologist to investigate for multiple sclerosis High dose prednisolone

Answer 49

Generally papilloedema Malignant HTN Pseudopapilloedema

Answer 50

Haemorrhage Haematoma Tumours

Answer 51

Choroid plexus tumour

Answer 52

Venous sinus thrombosis Aqueduct/foramen stenosis Idiopathic intracranial hypertension

Answer 53

Arteritic anterior ischaemic optic neuropathy Non-arteritic anterior ischaemic optic neuropathy Optic neuritis Tumours Infections

Answer 54

Foster-Kennedy syndrome | Raised ICP where 1 optic disc already atrophic

Answer 55

Optic disc drusen Hypermetropia = shorter eye axial length > gives disc swollen appearaance Tilted discs

Answer 56

Headache Scalp tenderness Jaw claudication Associated polymyalgia rheumatica Acute unilateral loss of vision - Usually due to ischaemic optic neuropathy - Can be due to central retinal artery occlusion

Answer 57

ESR - classically >100 CRP Temporal artery biopsy

Answer 58

40-60 mg prednisolone (high dose)

Answer 59

Chronic degenerative condition affecting optic nerve

Answer 60

Normal fields with blind spot > Arcuate scotoma - usually not noticed by patient > Progression of centrally sparing field loss - patient can still be unaware > Snuff out - can present as acute vision loss

Answer 61

Increased optic cup-to-disc ratio | Progressive visual field loss

Answer 62

Positive FHx High myopia Diabetes Elevated intraocular pressure

Answer 63

``` Refractive error Cataracct Diabetic retinopathy Macular degeneration Ocular surface disease ```