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3.1 cards > Assessment of Visual Failure - Murtag > Flashcards

Assessment of Visual Failure - Murtag Flashcards

1
Q

Blindness by WHO

A

less than 3/60

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2
Q

Minimum vision for driving in Australia

A

6/12

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3
Q

Key points for Sudden vision failure

A

Transient occlusion of retinal artery (amaurosis) and migraine

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4
Q

Flashing lights

A

retinal detachment

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5
Q

Floaters and blobs

A 
Aging
Pigment in viterous humor
Vitreous hemorrhage
Posteroir viterous detachment 
Choroiditis
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6
Q

Acute onset of floaters

A

posterior vitreous detachment

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7
Q

Causes of central vision impairment

A

defective retinal

  • Refractive error
  • opacity in occular media
  • macular/optic nerve dysfunction
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8
Q

Causes of peripheral vision impairment

A

extramacular disease

defects in visual pathway

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9
Q

Oculotoxic drugs

A

TB
ethambutol
quinine, chloroquinine

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10
Q

Family History important in vision loss

A 
DM
Migraines
Lebers heriditary optic atrophy
Tay-Sach disease
Retinitis pigmentosa
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11
Q

Causes of coloured halos around lights

A

Glaucoma

Cataracts

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12
Q

Causes of worsening vision in night or around dim lights

A

retinitis pigmentosa
hysteria
syphilitic retinitis

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13
Q

Causes of headache with vision changes

A

Migraine
Temporal arteritis
Benign intracranial HT

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14
Q

Causes of central scotomata (blind spot)

A

Macular Disease

Optic Neuritis

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15
Q

Pain on occular movement

A

Retrobulbar neuritis

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16
Q

Distortion Micropsia (smaller), macrospsia (larger)

A

Macular degeneration

17
Q

Disorders to exclude

A
  1. DM
  2. Gaint cell (temporal) arteritis
  3. hypopiturism (pituatary adenoma)
  4. Cerebrovascular ischemia/carotid artery stenosis
  5. MS
  6. Cardiac disease (arrhythmias and SBE - emboli
  7. Anemia (severe can cause retinal hemorrhages and exudate)
  8. Marfan’s syndrome - subluxated lens
  9. Melanoma of choroid
18
Q

Examinations of vision failiure

A
  1. Visual Acuity - Snellen Chart, pinhole testing ?refractive
  2. Pupil reaction - afferent (sensory) responses to light ?temporal arteritis, ?central retinal artery occlusion, ?optic neuritis
  3. Confrontation field
  4. Colour vision
  5. Amslers grid
  6. Fundus exam with dilated pupil - note red reflex (?cataracts, malignant melanoma), retina, macula, nerves
  7. Tonometry ?glaucoma
19
Q

Investigation

A
  1. Blood test - Full blood (?Anemia, ?lead poisoning ?leukemia)
    - ESR - ?Temporal cell arteritis
    - Blood sugar ?DM
  2. Temporal artery biopsy ?temporal cell arteritis
  3. CT/MRI ?CVA, ?optic nerve lesion, ?space occuping lesions
  4. Formal perimetry and Bjerrum screen ?glaucoma
  5. Fluroscein angiography ?retinal vascular obstruction, ?DM retinopathy
  6. Visual evoked potential ?demyelinating disorders
  7. Carotid doppler US
20
Q

Types of Macular degeration

A

Dry - build up of drusen in retinal pigment epithelium leading to loss of retinal pigment epithelium
Wet - choroidal neovascularisation

21
Q

Urgent consideration for vision loss

A
  1. Acute angle closure glaucoma - severe periorbital pain, with abdo symptoms
  2. Retinal detachment - visual field loss, peripheral vision loss, flashes and floaters, surgery immediately
  3. Retinal vascular occlusion - similar to detachment
  4. Corneal ulcer - vision loss w/ painful red eye
  5. Pituitary apoplexy - acute vision loss with headache and ocular motility disorder
  6. Gaint cell artheritis - monoocular, jaw caudication and headache, scalp tenderness, weight loss
  7. Cerebrovascular accident
  8. Uveitis - conjuctivitis
  9. Post-operative endophthalmitis - painful red eye after cataract surgery
  10. Trauma
22
Q

Sudden monoocular vision loss in older patients

A

Gaint cell arteritis

23
Q

Sudden monoccular vision loss in younger adults

A

Embolic event - from coagulation disorders

24
Q

DM patient with recent hyperglycemic event and now vision loss

A

refractory error due to lens swelling

25
Q

Drugs causing colour changes to vision

A

digoxin = yellow

erectile dysfunction drug = blue

26
Q

Corneal Ulcer

A
  • Think for contact lens wearers
  • Painful red eye with watery or mucoid disarge
  • Exam = Fluorescien staining,
    First test = gram stain for bacteria, corneal culture
27
Q

Dry eye syndrome

A

-Intermittent visual blurring, may be worse in morning or evening, gritty sensation, light sensitivity without photophobia. relieved by artificial tear use.
Exam = normal, slit lamp may show occular surface irregularity
1st test = tear breakup time

28
Q

Dry age related macular degeration

A

acute or chronic painless loss of vision or distortion of the central vision.
Exam = distorted central acuity with normal peripheral vision
1st test = fluorescein angiogram
refer to retinal specialist within 72 hours

29
Q

Posterior Uveitis

A

painful onset of clouding, slowly, flashes and floaters, photophobia, pain on eye movement
Exam- tender red eye, +/- nodular lesion on sclera, cloudy/obstructed view of retina
1st test = FBC with differentials (inflammatory vs infective)

30
Q

Cataracts

A

painless, progressive loss of vision

3.1 cards (13 decks)

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