Approaches to Visual Loss and Retinal Disorders Flashcards
General approach to visual loss
-Confrontational visual field (monocular vs binocular vision)
-Visual acuity (normal/ reduced)
-Pupil reactions (RAPD)
-Fundoscopy (diagnosis)
Questions for visual loss
-Demographic details
-Onset: sudden, gradual
-Uni or binocular-Associated symptoms: pain, photopsia, floaters, field loss, red eye, epiphora
-First episode or recurrent
-If possible let patient describe in his own words
Histories to take for visual loss
-Ocular
-Medical
-Current medication
-Family
Symptoms of presenting complaint to explore
-Pain
-Change in vision
-Swelling
-Watering/ discharge
-Itchy/ gritty
-Floaters
-Redness
Features of presenting complaint history
-Duration
-Timescale
-Frequency
-Laterality
-Full or part of visual field
-Exacerbating or relieving factors
-Associated features
Features of past ophthalmic history
-Glasses and contact lenses
-Similar symptoms
-Previous ocular trauma
-Previous ocular surgery
-Previous treatments including laser
Conditions in past medical history
-Allergic eye disease & atopy
-Herpetic disease & cold sores
-Uveitis & inflammatory conditions
-Choroidal masses & malignancy
-Vascular occlusions & general risk factors
Medications in drug history
-SSRI
-TCA
-Steroids
-Oculotoxicity= hydrocholoquine, ethambutol, tamoxifen
Features of family history
-Visual impairment
=Retinal dystrophies e.g. RP
=Corneal dystrophies
-Glaucoma
-General medical FH (Diabetes, IHD, HTN)
Types of retinal disorders
-AMD
-Vitreo retinal disorders
-Vascular disorders
-Tumours
-Inherited retinal conditions
Examples of vitreo-retinal disorders
-Macular hole
-Retinal tear/ detachment/ vitreous haemorrhage
-Vitreous floaters
Eye tumours
-Retinoblastoma
-Choroidal melanoma
Inherited retinal conditions
-Retinitis pigmentosa
-Stargardts disease
Examples of media opacities
-Cataract
-Vitreous haemorrhage
Which conditions are more likely in short-sightedness?
-Eyeball too long
=light converges in front of retina
=Retinal detachment as more stretched
Which conditions are more likely in long-sightedness?
-Eyeball too short
=Light converges behind the eye
=acute angle closure as more bunched up
Describe macular hole
-Presentation: central distortion, scotoma
-Investigation: OCT
-Management: vitrectomy
Describe retinal detachment
-RF: DM, myopia, age, previous surgery for cataracts, eye trauma
-Presentation: flashes, floaters (=pigment cells in vitreous/ traction on retina), sudden painless and progressive visual field loss (curtain/ shadow, depends where if macula is spared), RAPD if optic nerve involved
-Investigation: fundoscopy (red reflex lost, retinal folds pale opaque or wrinkled), slit lamp, indirect ophthalmoscopy for pigment cells and VH
-Management: vitrectomy after urgent referral
Describe retinal tear
-Management: laser surgery
Describe retinoblastoma
AUTOSOMAL DOMINANT
-Presentation: leukocoria (white pupil), absence of red-reflex, strabismus, visual problems
-Investigation: OCT, fundoscopy, MRI head
-Management: enucleation, external beam radiation therapy, chemotherapy and photocoagulation
Describe choroidal melanoma
-Presentation: eye irritation, lumps, bulging, vision loss, dark patch, blurred vision shadows and flashes
-Investigation: ultrasound, fluorescein angiogram, fundoscopy
-Management: brachytherapy (tiny radioactive plates in tumour), radiotherapy, surgery, enucleation
Describe retinitis pigmentosa
ABNORMAL PHOTORECEPTORS, INHERITANCE (X-linked or dominant)
-Presentation: night blindness (loss of rods), tunnel vision (loss of peripheral retina) black dots, macular sparing, waxy pale optic nerve
-Investigation: fundoscopy (black bone spicule-shaped pigmentation in peripheral retina, mottling of retinal pigment epithelium
-Management: visual aids, vitamin A supplementation, fish oils, lutein
