Exam 2 - Vision Loss

Question 1

painFUL causes of vision loss

Answer 1

glaucoma (also can be painless), causes w/ red eye, optic neuritis

Question 2

painLESS causes of vision loss

Answer 2

everything else. if it’s not a painful cause, it’s painless. cataracts, glaucoma, retinal detach, macular degen, central retinal vascular occlusion, hypertensive retinopathy, refractive error, amblyopia, optic neuropathy, stroke.

Question 3

referral as part of plan

Answer 3

all visual loss, Hx of glaucoma, symptomatic cataracts, diabetes

Question 4

older patient with chronic painless loss of vision experiencing glare at night. on exam, notice yellowing of the lens. Dx, Tx, Cause?

Answer 4

Dx: cataracts
Tx: referral, glasses, surgery
Cause: deposition of lens proteins in firm lens

Question 5

upon exam of 72 year old patient, notice opacity and haziness in the lens. Dx, Tx, Cause?

Answer 5

Dx: cataracts
Tx: referral, glasses, surgery
Cause: deposition of lens proteins in firm lens

Question 6

increasing intraocular pressure resulting in nerve damage and visual field loss. Dx, Tx?

Answer 6

Dx: glaucoma
Tx: referral, topical ocular anti-hypertensives, sharks with LASERS, surgery.

Question 7

pt reports chronic, painless vision loss described as closing in (peripheral first, central later). Tonopen measurement shows increased intraocular pressure and fundoscopic exam reveals increased cup to disc ratio. Dx, Tx, Cause?

Answer 7

Dx: glaucoma (open angle only one discussed in lecture a/w vision loss)
Tx: referral, topical ocular anti-hypertensives, sharks with LASERS, surgery.
Cause: Inability to drain aqueous outflow

Question 8

pt reports painless, floaty things and flashes of light. she experiences blind spots and says her vision is closing “like a curtain.” on exam you note a whitish, raised looking retina. Dx, Tx, types?

Answer 8

Dx: retinal detachment
Tx: referral, freakin’ laaasers, surgery (scleral buckle or vitrectomy)
types: rhegmatogenous (a/w myopia), tractional (a/w DM)

Question 9

pt preports painless, decreased vision and says everything looks wavy. on exam you note Amsler grid distortion, drusen bodies and geographic atrophy. Dx (specific type), Tx?

Answer 9

Dx: dry macular degeneration
Tx: referral, vitamins (antiox/zinc), smoking cessation, phototherapy

Question 10

pt reports painless, decreased vision and waviness. on exam you note Amsler grid distortion, subretinal fluid, and neovascular membrane. Dx (specific type), Tx

Answer 10

Dx: wet macular degneration
Tx: referral, vitamins (antiox/zinc), smoking cessation, phototherapy

Question 11

pt reports black as night vision and denies any pain. on exam you note cherry red spot on the retina and an afferent pupillary defect. Dx (specific type), Tx?

Answer 11

Dx: embolic CRAO (central retinal artery occlusion)
Tx: referral, then nothing because medical science in all its miraculous efficacy hasn’t figured out how to do anything about this.

Question 12

some patients report no vision loss, some report significant vision loss. on exam you note a Hollenhorst plaque (focal whitening of retina). Dx (specific type), TX?

Answer 12

Dx: embolic BRAO (branch retinal artery occlusion)
Tx: referral, aspirin, prevention of carotid plaques and cardiac thrombi that might cause future events
Note: degree of vision loss depends on location of embolus

Question 13

pt reports sudden, painless vision decreases. on exam you note an afferent pupillary defect and blood and thunder on fundoscopic. Dx (specific type), TX?

Answer 13

Dx: thrombotic CRVO central retinal vein occlusion
Tx: referral, aspirin, observation, correct causes if possible (HTN, hypercoagulable state)

Question 14

some patients report no vision loss, some report significant vision loss. on exam you note dot/blot hemorrhages. Dx (specific type), TX?

Answer 14

Dx: thrombotic BRVO branch retinal vein occlusion
Tx: referral, aspirin, observation, correct causes if possible (HTN, hypercoagulable state)

Question 15

retinal vascular occlusion associations

Answer 15

embolic a/w arteries
thrombotic a/w veins
central always have vision loss
branch variable degrees of vision loss

Question 16

what test is used and how does an afferent pupillary defect present?

Answer 16

swinging flashlight test. Marcus Gunn pupil: focusing on the consensual response, different diameter of constriction depending on which pupil light is shined.

Question 17

pt has history of HTN (hypertension) and reports no symptoms associated with minor visual loss (some pt have no vision loss). upon fundoscopic exam you might notice any number of things including A:V ratio 1:2, retinal hemorrhages, cotton wool spots, macular stars, disc edema, silver and copper wiring, and/or A/V nicking. Dx, Tx?

Answer 17

Dx: hypertensive retinopathy
Tx: control systemic B/P. refer if there is visual loss or if condition is severe.

Question 18

diabetic pt presents with painless vision loss. upon exam you note microaneurysms, dot/blot hemorrhages, cotton wool spots, and/or venous bleeding. Dx (specific type), Tx?

Answer 18

Dx: diabetic retinopathy (non proliferative)
Tx: blood sugar control, referral for laaasssers

Question 19

diabetic pt presents with painless vision loss. you note neovascularization, vitreous hemorrhage, and/or traction retinal detachment in addition to several other abnormalities. Dx (specific type), Tx?

Answer 19

Dx: diabetic retinopathy (proliferative)
Tx: blood sugar control, referral for laaasssers

Question 20

pt presents with dot/blot hemorrhages. two conditions a/w vision loss present with this finding. how can you differentiate?

Answer 20

the Hx. pt with diabetes would likely be presenting with one of the two forms of diabetic retinopathy. Others have thrombotic BRVO.