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Ophthalmology > L4: Sudden Vision Loss > Flashcards

L4: Sudden Vision Loss Flashcards

1
Q

Causes of PAINFUL Vision Loss? (5)

A

Acute Angle Closure Glaucoma

Endophthalmitis: purulent inflammation of intraocular fluids usually due to infection

Keratitis: Inflammation of the cornea

Optic Neuritis: Inflammation of optic nerve often demyelinating

Uveitis: Inflammation of the uveal tract

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2
Q

Causes of PAINLESS Vision Loss? (5)

A

Retinal Vein Occlusion (RVO)

Retinal Artery Occlusion (RAO)

Retinal Detachment

Vitreal Hemorrhage

Giant Cell Arteritis (GCA)

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3
Q

Presentation/Treatment of each of the 3 causes of Keratitis?

A

Viral (HSV1) => DENDRITIC ULCERS (Recurrence may reduce Corneal Sensation!!)

  • NO STEROIDS!!
  • Treated with Topical Acyclovir

Bacterial (Staph/Strep/Pseudomonas)=> HYPOPHYON

  1. Ofloxacin
  2. Ceftazidime + Vancomycin

Protozoa (Acanthamoeba) => RING INFILTRATES

  • Treated w/ PHMB or Chlorhexidine
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3
Q

Clinical Features of Keratitis?

A

Keratitis: Inflammation of the Cornea =>

  • Reduced Visual Acuity (if involves visual axis)
  • FBS (foreign body sensation)
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4
Q

Classification of Uveitis?

Treatment (Anterior vs. Posterior)

A

Inflammation of the Uveal Tract can be classified three ways:

  • Acute Anterior Uveitis (AAU): Iritis +/- Choroid Body
  • Posterior Uveitis: Choroid
  • Pan Uveitis: Anterior Chamber, Vitreous, Choroid, retina

Treatment

  • ANTERIOR Uveitis: Topical Steroids
  • POSTERIOR Uveitis: PO Steroids
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5
Q

Signs/Symptoms of Uveitis?

A

Symptoms:

  • Reduced Visual Acuity
  • Red Eye
  • Photophobia

Signs:

  • Anterior Chamber Flare
  • Keratic Precipitates (KPs)
  • Hypopyon: Meniscus of WBCs in anterior chamber
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6
Q

Management of Acute Angle Closure Glaucoma?

A

Acute Management: Decrease pressure w/ IV Acetlezolamide + topical agents

Definitive Treatment:

  • Peripheral Iridotomy
  • Cataract Extraction
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7
Q

Risk Factors of Acute Angle Closure Glaucoma?

A

Risk Factors:

  • Hyperope (Long Sighted)
  • F>M
  • Asia
  • Family History
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8
Q

Symptoms/Signs of Acute Angle Closure Glaucoma?

A

Symptoms:

  • PAIN!!!
  • Headache- Brow Pain
  • Blurring of Vision w/ HALOS
  • Nausea/Vomiting

Signs:

  • Corneal Oedema
  • Conjunctival Hyperemia
  • Iris Bombe: Iris Bowed Forward
  • Pupil Mid-Dilated Fixed
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9
Q

Unilateral vs. Bilateral Uveitis?

A
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10
Q

Etiology/Management of Vitreal Hemorrhage?

A

Etiology:

§ Trauma (Typically Blunt)
§ Neo-Vascularization Pathologies

  • Proliferative Diabetic Retinopathy: proliferative => new vessels at back of eye (Unhealthy, prone to leaking)
  • Vascular Occlusions: Neovascularization at back of eye due to occlusions of supply to back of eye

Management:

  • Self Limiting
  • If Persistent > 3-4 months => Laser/Evacualtion
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11
Q

Types of Retinal Detachment (Risk Factors/Etiology/Treatment)

A

Rheumatagenous: fluid flow from vitreous => subretinal space via a retinal break

Exudative: Exudation/hemorrhage in subretinal space due to inflammation or vascular abnormalities (ie. Age Related Macular Degeneration)

Traction: Traction from proliferating membranes on the retinal surface

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12
Q

What type of Retinal Detachment?

A

Rheumatagenous: fluid flow from vitreous => subretinal space via a retinal break

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13
Q

What type of Retinal Detachment?

A

Exudative: Exudation/hemorrhage in subretinal space due to inflammation or vascular abnormalities (ie. Age-Related Macular Degeneration)

Traction: Traction from proliferating membranes on the retinal surface

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14
Q

Clinical Features of Retinal Detachment?

A

Retinal Detachment Clinical Features:

  • Sudden PAINLESS vision loss
  • Floaters
  • Flashers (Photopsia)
  • Relative Afferent Pupillary Defect (RAPD)
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15
Q

Prognosis for Retinal Detachment?

A

Macula ON: 90% return to pre-op Visual Acuity

Macula OFF: 70% regain 70% of pre-op Visual Acuity

16
Q

Sub-Macular Neo-Vascularization (aka. ____________________)?

  • Pathophysiology
  • Clinical Features
  • Treatment?
A

Wet Age-related Macular Degeneration:

Clinical Features:

  • Central Scotoma (Partial loss of vision)
  • Metamorphopsia (image distortion)

Treatment: Anti-VEGF Intravitreal injections

17
Q
A
18
Q

Clinical Features/Pathophysiology/Treatment of Retinal Artery Occlusion?

A

Clinical Features:

  • Acute- Narrow Arterioles
  • Subacute: “Cherry Red Spots”

Pathophysiology:

  • Thrombotic or Embolic
  • Permanent within Hours

Treatment: Secondary prevention – Chol, HTN, +/- Aspirin

19
Q

Clinical Features of Retinal Vein Occlusion?

Pathophysiology/Treatment?

A

Retinal Vein Occlusion:

□ “Blood and Thunder” Appearance

□ Venous Engorgement

□ Optic Nerve Head Edema

Pathophysiology:

  • Associated with Hypertension/Glaucoma
  • LESS Sudden than arterial

Treatment: ‘90 day glaucoma’ due to neovascularisation (=> Visual field changes similar to glaucoma)

20
Q

Which condition is associated with Polymyalgia rheumatica (PMR)?

A

Giant Cell Arteritis

21
Q

Etiology/Clinical Features of Giant Cell Arteritis?

A

Etiology:

  • Associated with Polymyalgia Rheumatica (Bilateral shoulder weakness, trouble rising from chair)
  • F > M (ie. Woman in 70’s w/ pain while brushing hair)
  • 7th - 8th decade

Clinical Features:

  • Sudden PAINLESS visual loss
  • Scalp tenderness - Palpable temporal artery
  • Jaw claudication
  • Temporal headache
22
Q

Diagnosis/Management of Giant Cell Arteritis (GCA)?

A

Diagnosis:

  • Clinically
  • INCR ESR (Erythrocyte sedimentation rate is a blood test indicative of inflammation)
  • Temporal Ultra Count (Halo Sign)
  • Temporal Artery biopsy ( Small Lumen)

Treatment: IV Steroids – DON’T DELAY (Can become bilateral => blindness)

23
Q

Use of Steroids in Treating Sudden Vision Loss?

A

DO NOT use steroids to treat Viral (HSV1) Keratitis!! => GEOGRAPHIC ULCER

Uveitisis:

  • Anterior Uveitis: Topical Steroids
  • Posterior Uveitis: PO Steroids

Giant Cell Arteritis (GCA): IV Steroids – DON’T DELAY (Can become bilateral => blindness)

Optic Neuritis: IV Steroids speed up recovery does NOT alter final visual outcome

24
Q

Etiology/Clinical Features of Optic Neuritis?

A

Etiology:

  • 90% of cases assocaited with MS
  • F>M
  • 3rd + 4th Decade

Clinical Features:

  • Sudden PAINFUL vision loss
  • Pain on eye movement
  • Decreased color vision (NEVER RETURNS!!!)
  • Uhthoff’s Phenomenon (DEC acuity w/ INCR temp)
  • Relative Afferent Pupillary Defect (RAPD)
  • Normal Optic Disk
25
Q

Diagnosis/Treatment of Optic Neuritis?

A

Diagnosis

  • MRI
  • Visual evoked potential (VEP): Delayed but preserved waveforms)

Treatment

  • IV Steroids speed up recovery does NOT alter final vision outcome (COLOR VISION NEVER RETURNS!!!)

Ophthalmology (9 decks)

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