L4: Sudden Vision Loss Flashcards
Causes of PAINFUL Vision Loss? (5)
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
Causes of PAINLESS Vision Loss? (5)
Retinal Vein Occlusion (RVO)
Retinal Artery Occlusion (RAO)
Retinal Detachment
Vitreal Hemorrhage
Giant Cell Arteritis (GCA)
Presentation/Treatment of each of the 3 causes of Keratitis?
Viral (HSV1) => DENDRITIC ULCERS (Recurrence may reduce Corneal Sensation!!)
- NO STEROIDS!!
- Treated with Topical Acyclovir
Bacterial (Staph/Strep/Pseudomonas)=> HYPOPHYON
- Ofloxacin
- Ceftazidime + Vancomycin
Protozoa (Acanthamoeba) => RING INFILTRATES
- Treated w/ PHMB or Chlorhexidine
Clinical Features of Keratitis?
Keratitis: Inflammation of the Cornea =>
- Reduced Visual Acuity (if involves visual axis)
- FBS (foreign body sensation)
Classification of Uveitis?
Treatment (Anterior vs. Posterior)
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
Signs/Symptoms of Uveitis?
Symptoms:
- Reduced Visual Acuity
- Red Eye
- Photophobia
Signs:
- Anterior Chamber Flare
- Keratic Precipitates (KPs)
- Hypopyon: Meniscus of WBCs in anterior chamber
Management of Acute Angle Closure Glaucoma?
Acute Management: Decrease pressure w/ IV Acetlezolamide + topical agents
Definitive Treatment:
- Peripheral Iridotomy
- Cataract Extraction
Risk Factors of Acute Angle Closure Glaucoma?
Risk Factors:
- Hyperope (Long Sighted)
- F>M
- Asia
- Family History
Symptoms/Signs of Acute Angle Closure Glaucoma?
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
Unilateral vs. Bilateral Uveitis?
Etiology/Management of Vitreal Hemorrhage?
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
Types of Retinal Detachment (Risk Factors/Etiology/Treatment)
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
What type of Retinal Detachment?
Rheumatagenous: fluid flow from vitreous => subretinal space via a retinal break
What type of Retinal Detachment?
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
Clinical Features of Retinal Detachment?
Retinal Detachment Clinical Features:
- Sudden PAINLESS vision loss
- Floaters
- Flashers (Photopsia)
- Relative Afferent Pupillary Defect (RAPD)
Prognosis for Retinal Detachment?
Macula ON: 90% return to pre-op Visual Acuity
Macula OFF: 70% regain 70% of pre-op Visual Acuity
Sub-Macular Neo-Vascularization (aka. ____________________)?
- Pathophysiology
- Clinical Features
- Treatment?
Wet Age-related Macular Degeneration:
Clinical Features:
- Central Scotoma (Partial loss of vision)
- Metamorphopsia (image distortion)
Treatment: Anti-VEGF Intravitreal injections
Clinical Features/Pathophysiology/Treatment of Retinal Artery Occlusion?
Clinical Features:
- Acute- Narrow Arterioles
- Subacute: “Cherry Red Spots”
Pathophysiology:
- Thrombotic or Embolic
- Permanent within Hours
Treatment: Secondary prevention – Chol, HTN, +/- Aspirin
Clinical Features of Retinal Vein Occlusion?
Pathophysiology/Treatment?
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)
Which condition is associated with Polymyalgia rheumatica (PMR)?
Giant Cell Arteritis
Etiology/Clinical Features of Giant Cell Arteritis?
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
Diagnosis/Management of Giant Cell Arteritis (GCA)?
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)
Use of Steroids in Treating Sudden Vision Loss?
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
Etiology/Clinical Features of Optic Neuritis?
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
Diagnosis/Treatment of Optic Neuritis?
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!!!)
