Gradual and Acute Visual Loss Flashcards
Refractive errors types
Myopic = short sighted (objects close to eye appear in focus) = eyeball is squashed down Hypermetropic = long sighted - eyeball is taller/narrower than it should be Presbyopia - old eyes - when convex lens is unable to move as quickly so glasses are required to read etc.
Causes of refractive errors and treatment (specific investigation for myopia)
Myopia - c - senile cataracts, DM, Eye drops, lens sublux, genetic link also t - concave lens glasses or lasik surgery I - pinhole glasses will confirm Hypermetropia - c - DM, Eye drops, lens sublux t - convex lens glasses
Macular Degeneration - ? / 2 main types / CF + pathology of each / I / T
chief cause of registerable blindness in the uk split into WET and DRY CF - elderly person complaining of deteriorating central vision, distortion PATH of DRY = slowly progressing, drusen and degenerative changes at the macula PATH of WET = aberrant vessels grow from choroid into neurosensory retina and leak –> rapid vision deterioration + distortion I - fundus fluorescein angiography for BOTH, fluid exudation in WET T - No treatment currently available for DRY, stop smoking Photodynamic therapy/ laser coag/ intravitreal VEGF inhib or steroids for WET
Dry ARMD
WET ARMD
Acute Glaucoma
Anterior Uveitis
Iritis
Viral Conjunctivitis
cataracts - ? / C / CF / o/e / RF / T / post op compl
? - any opacity in the lens, leading cause of blindness in the world , 75% of over 65’s sufferC - many causes / DM, diarr + dehydration, daylight, diseases of the eye(uveitis), DNA (genetics)CF - Uni or Bi-lat / blurred vision, visual loss, halo’s, glare (in kids=squint, decrease binocular func, white pupil, nystagmuso/e - loss visual acuity, reduced red reflex, change in lens appearanceRF - AGE! genetic, DM, Steroid use, severe myopiaT - SURGERY - when symptoms restric lifestyle or gross vision for driving.PHOTOEMULSIFICATION is most common method, pt can resume full activities following day + post op ABx’s and anti-inflam drops for 3-6 weeks + new glassesComp:2% complications + no guarentee cataract will completely improve visioncapsule thickening, irritated eyes, ant uveitisRARE= vit haem, retinal detachment, glaucoma
Retinal Detachment - ? / CF / RF / I / T / comp
? - holes or tears in retina allow fluid to seperate the 2 layers of retinaCF - 4 F’s = Floaters, Flashes, Field Loss, Fall in ACuity (painless)RF - MyopiaI - ophthalmoscopy - grey retina, ballooning forward (severe= macular detachment and central vision lost)T - urgent surgical intervention (virectomy + gas tamponade) cryotherapy/ laser coag used to secure retinaComp - post op detachment = 5-10%
chronic glaucoma - ? / RF /CF / o/e / T /
? - requires a screening program which tests IOP (norm 21mmHg), visual fields and optic disc appearance. - requires screening as it is asymptomatic until severe damage done.RF - >35, FHx, afro caribean, myopia, thyroid / DM eye diseasesCF - visual fields loss (nasal first, if peripheral = optic atrophy) o/e - optic disc cupping(cup:disc >0.4), optic nerve damage, notching at optic cup, optic disc haem + atrophyT - IOP increase will cause irreversible optic nerve damage but once controlled no more will occurAim to reduce IOP by 35%DRUGS - Prostaglandin analogues (latanoprost) increase outflow / SE:red eye - B Blockers (timolol)or alpha agonist will decrease production of aqueous SE: dry eyes - carbonic anhydrase inhib (acetazolamide) decrease aqueous prod SE: cant in PREG - mioticscombo of B block/prostogland = xalacomSURGtrabeculectomy - establishes outflow tract SE: infection/ leakage
Diabetic Retinop - ? / screening/ RF / CF / Stages / T
leading cause of blindness in the uk in pts aged 20-65screened by annual funduscopy + acuityRF - glyc control poor, long term DM, hypertension**, cholesterol up, PREGCF - increases speed of ARMDStages - Background = DOTS (micro-aneurysm) BLOTS (flame haem) + hard exudatesPre-Pro = BLOTS, cotton wool spots (oedema from infarcted area) venous bleedingPro = new vessel growth on disc etc, retinal/vitreal haemRetinal Detachment - fibrosis**Maculopathy (can occur with any stage) - macular oedema, exudates, haem, ischT - good glyc control and BP control, photo-coag to remove maculopathy
Acute Painless Visual Loss
Retinal DetachmentCentral retinal Vein or Artery occlusionischaemic optic neuropathyhaemorrhage - vit or retinal
Acute Painful Visual Loss
Acute Glaucomaoptic neuritiscorneal ulceruveitis
Gradual Painless Loss of Vision
GlaucomaCataractsDM retinopathyRefractive ErrorARMD
what might cause a bitemporal hemianopia?
pituatary
what might cause a right homonomous hemi?
left occipital lobe infarct
what might cause a right superior quadrantanopia?
left temporal lobe lesion
causes of unilateral visual loss?
stroke - Central Retinal Art/Vein occlusionretinal detachmentARMDoptic nerve disease (neuritis, ischaemia, infection)
cause of constricted pupil?
horners, pharmacological, argyll robertson
cause of dilated pupil?
glaucoma, 3rd nerve palsy, pharmacological
RAPD - c
optic nerve pathology (neuritis / glaucoma)severe retinal damage,macular lesion
3rd nerve palsy CF (6)
diplopia, ptosis, squint, fixed dilated pupil, down and out eyeball
hypertensive retinopathy - ? / grade 5 CF
graded 1-4 with grade 5 CF = papilloedema, haemorrhages, cotton wool spots (malignant HTN)
Renal Art Occlusion - c / CF / T
c - carotid atherosclerosis/emboli or vasculitisCF - sudden loss vision, pale fundus, T - refer to STROKE clinic
GCA - ? / when to suspect / I / T
temporal arteritis, suspect if hx of headache + vision lossI - ESR up + temporal artery biopsyT - pulsed IV methylpred
Central Retinal Vein Occlsuion - o/e / T
o/e - retina looks like planet mars + swollen discT - anti-VEGF +/- long acting steroid implants?
squint (strabismus)- c / consequence / T
c - refractive error, unilat vision loss, genetic
consequence - KIDS –> amblyopia, decrease depth perception
ADULTS –> diplopia + cosmetic aspect
T - glasses/surg
infant glaucoma - CF/ T
CF - big watery, cloudy eye
T - refer immediately
