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Ophthalmology > Gradual Loss of Vision > Flashcards

Gradual Loss of Vision Flashcards

1
Q

Questions

A

Same as sudden

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2
Q

What are common causes of loss of vision gradual

A 
Macular degeneration
Diabetic retinopathy
Hypertensive retinopathy
Cataract
Open angle galucoa
Optic atrophy
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3
Q

What are less common causes

A

Coloboma
Retinal dystrophy
Drug induced
Retinitis pigments

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4
Q

What causes hypertensive retinopathy

A

Chronic hypertension

Malignant hypertension.

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5
Q

What does it lead too

A

Ischaemia

No risk of new vessel formation

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6
Q

What are 4 stages

A 
1 = arteriolar narrow
2 = AV nipping
3 = cotton wool exudate + blot haemorrhage 
4 = papilloedema
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7
Q

What is most common cause of blindness in 30-60

A

Diabetic retinopathy

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8
Q

How does DM lead to retinopathy

A 
High BG causes endothelial dysfunction 
Increased vascular permeability 
- Exudates released
- Blot haemorrhage 
Cotton wool spots due to ischaemia
Micro-aneurysm of capillary
Intra-retinal microvascular abnormality = dilated and torturous vessel
Neovascularisation due to release of VEGF in response to ischaemia
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9
Q

What is mild non-proliferative

A

1+ microaneurysm

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10
Q

What is moderate

A 
Microaneurysm 
Blot haemorrhage 
Hard exudate 
Cotton wool spot 
venous bleed
IRMA less severe
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11
Q

What is severe

A

Blot haemorrhage
Aneurysm all 4 quadrant
Venous bleed 2+
IRMA 1+

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12
Q

What is proliferative

A

Retinal neovascularisation

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13
Q

What can it lead to

A

Vitreous haemorrhage + retinal detachment

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14
Q

What is maculopathy

A

Hard exudate causing changes to macula affecting visual acuity

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15
Q

When is it more common

A

Type II

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16
Q

How do you visualise changes

A

Fundoscopy

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17
Q

How do you Rx

A

DM Control
Regular screening
Lower BP

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18
Q

How do you treat proliferative

A

Laser photocoagulation

Anti-VEGF (Raibizumab)

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19
Q

What is most common cause of blindness worldwide

A

Macular degeneration

- Degeneration of photoreceptors in macula

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20
Q

What causes

A

Dry due to atrophy (Early age related)

Wet due to blood / fluid (Late age related)

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21
Q

What causes dry

A

Non-exudative
Alterations to retinal pigment epithelium
Atrophy of macula as photoreceptors die
Linked to oxidative stress / inflammation

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22
Q

What causes wet

A

Secondary to dry
Neovascularisation causes leakage of serous fluid into eye or bleeding
If bleed = catastrophic and leads to scarring
Often stimulated by VEGF
Cause scarring of macula = central visual loss
Sub-retinal haemorrhage
Can cause sensory detachment

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23
Q

What are symptoms

A 
Progressive loss central vision
Particular near objects 
Difficulty in dark adaption 
Photopsia - flashing 
Crooked or wavy appearance to straight lines
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24
Q

What may be present

A

Area of central field visual loss with normal surrounding Patient aware = +Ve scrotoma

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25
Q

What does distortion of vision / crooked lines suggest

A

Problem with macula
Known as metamorphosia
If patient complains of this = refer urgently

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26
Q

What is it till proven otherwise

A

Wet related macular degeneration

27
Q

What are other causes

A

Macular hole if older

Myoptic degeneration / central serous retinopathy if younger

28
Q

How does macular hole present

A

Central loss of vision

Distortion

29
Q

What are RF for macular degeneration

A

Age
Smoking
CVS RF
FH - some form of genetics

30
Q

What are ocular RF

A

Hypermetropia

Light iris

31
Q

What is seen on slit lamp / fundoscopy

A 
Drusen - yellow deposition in macula 
- 1st signs 
Can scar later
Loss of retinal pigment epithelium
Areas of hypo and hyperpigmentation
32
Q

If wet what also may be seen

A

Red patches suggesting haemorrhage

33
Q

What is 1st line investigation

A

Slit lamp

34
Q

What other tests are used to confirm Dx

A

OCT = 1st line to Dx wet
- Also used to monitor
- Will see oedema separating but should reduce with Rx
Fluroscein angio used in wet to guide whether VEGF useful
- Sees if there is leaky vessels

35
Q

How do you Rx dry type

A

Vitamins slow progression
Stop smoking
Control BP

36
Q

How do you Rx wet

A

Anti-VEGF 4 weekly injection into vitreous chamber
Laser photocoagulation
Regular follow up with OCT and visual assessment

37
Q

What does anti-VEGF do

A

Limits progression and staibilies loss

38
Q

What are retinal dystrophies

A

Inherited disorders affecting photoreceptors

Causes loss of vision

39
Q

How do you Dx

A

EOG

40
Q

What is a coloboma

A

Hole in structure of the ey e

41
Q

If in iris

A

Key shaped hole in pupil

Can’t control how much eye enters eye

42
Q

If in retina

A

Strange white space where degeneration occured

Poor central vision

43
Q

If in optic disc

A

Wont develop and will be blind

44
Q

What is CHARGE

A 
Coloboma
Heart defect
Atresia choanae
Retarded growth
Genital hypoplasia
Ear abnormalities
45
Q

What is the leading cause of curable blindness

A

Cataract

46
Q

What are types of cataract

A

Immature
Mature
Secondary

47
Q

What are immature cataracts

A

Fine in the day as pupil constricted so light doesn’t touch opaque lens
In dark pupil dilates and vision = hazy

48
Q

What is mature

A

Hazy all the time

Need surgery

49
Q

What is secondary

A

Due to nuclear sclerosis

Sutual and zonular common in childhood

50
Q

What causes cataract

A

Normal part of ageing process
Lens gradually opacifies as avascular and can’t shed
Harder for light to reach retina

51
Q

How does patient present

A

Reduced vision
Faded colour vision
Glare / halo
Loss of red reflex

52
Q

What are RF

A 
Age 
Smoking
Alcohol
DM
Long term steroid
Radiation 
Myotonic dystrophy
Metabolic
53
Q

What shows cataract

A

Slit lamp

54
Q

What must be done prior to surgery

A

Ocular biometry

Opthamolscopy after pupil dilation shows normal funds and optic nerve

55
Q

How do you treat non-surgical

A

Stronger glasses

Brighter lightening

56
Q

What is surgery

A

Only effective Rx

Replace with artificial lens

57
Q

What do you need post surgery

A

Steroid + Ax eye drop 4 weeks
Eyewear
Post op optician at 6 weeks
Stop smoking

58
Q

if cataract present at birth

A

REFER urgent to exclude retinoblastoma + surgical correction

59
Q

What are complication of surgery

A 
Posterior capsule opacification / rupture
Retinal detachment 
Endophthalmitis 
Wound leak
Astigmastic may become noticeable after
60
Q

What is retinitis pigmentosa

A

Inherited condition causing inflammation of retina and rod and cone cells

61
Q

What does it cause

A

Tunnel vision
- Tends to affect predominantly rods which is more peripheral vision
- Cones preserved till late which is for central and colour
Night blindness = first sign
Can cause earlier cataract formation

62
Q

How do you Dx

A

Fundoscopy

63
Q

What are other causes of tunnel vision

A 
Papilloedema
Glaucoma 
Choroidretintiis
Optic atrophy
Hysteria

Ophthalmology (10 decks)

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