Loss of vision Flashcards
Name causes of unilateral sudden painless loss of vision of a few seconds’ duration?
GCA : usually age > 55y, weight loss, fatigue, jaw/tongue claudication, pulseless/tender/thickened temporal artery, raised ESR/CRP
Papiloedema : bilateral disc swelling, loss of Spontaneous venous pulsation (SVP), peripapillary haemorrhage, features of raised ICP
Impending CRVO : dilated, tortuous retinal veins, haemorrhages
OIS : veins dilated and irregular but not tortuous, mid-peripheral haemorrhages; +/- NVD, raised IOP, carotid bruits
What is SVP?
Spontaneous venous pulsation (SVP)
A result of the variation in the pressure gradient along the retinal vein as it traverses the lamina cribrosa. [1]
When the intracranial pressure (ICP) rises, the intracranial pulse pressure also rises to equal the intraocular pulse pressure and the SVP ceases
Name causes of bilateral sudden painless loss of vision of a few seconds’ duration?
Papilloedema
Name causes of unilateral sudden painless loss of vision of a few minutes’ duration?
Amaurosis fugax : complete or partial monocular blindness +/- evidence of emboli, AF, carotid bruits
GCA
Name causes of bilateral sudden painless loss of vision of a few minutes’ duration?
Vertebrobasilar artery insufficiency : recurrent episodes +/- ataxia, dysphasia, dysarthria, hemiparesis, hemisensory disturbance
Name causes of painless sudden loss of vision of up to 1 hour duration?
Migraine : aura - fortification spectra, transient VF defects; followed by unilateral headache, associated nausea/vomiting, photophobia, phonophobia, exercise aggravation, and often FH
Name causes of persistent sudden painless loss of vision due to an abnormal cornea?
Hydrops : acute corneal oedema associated with underlying disease e.g., keratoconus
Name causes of persistent sudden painless loss of vision due to an abnormal vitreous?
Vitreous haemorrhage : varies from microscopic level to completely obscuring the fundus
Name causes of persistent sudden painless loss of vision due to an abnormal fundus?
CRAO : RAPD, attenuated arterioles, pale fundus, cherry-red spot
CRVO : dilated tortuous veins, haemorrhages in all 4 quadrants +/- macular oedema +/- CWS, RAPD; BRVO may give symptomatic altitudinal effects, particularly if on temporal arcade
RRD (rhegmatogenous retinal detachment) : flashes/floaters, tobacco dust, convex elevated retina with multiple breaks
ERD (exudative retinal detachment): convex elevated retina with shifting fluid, no break
TRD (tractional retinal detachment) : concave elevated retina with tractional membranes
Name causes of sudden painful loss of vision due to an abnormal cornea?
Acute primary angle closure (APAC) : usually hypermetropic, haloes, frontal headache, vomiting : injected, corneal oedema, fixed semi-dilated pupil, shallow AC with closed angle, raised IOP
Bullous keratopathy : thickened, hazy cornea, stromal/subepithelial oedema, bullae, evidence of underlying pathology e.g., ACIOL, Fuch’s endothelial dystrophy etc.
Keratitis : photophobia, watering, circumlimbal injection, corneal infiltrate +/- epithelial defect +/- AC activity
Name causes of sudden painful loss of vision due to an abnormal disc?
Optic neuritis
- usually aged 18-45 years
- retro-orbital pain, especially on eye movement
- RAPD
- reduced colour vision
- VF defects
- swollen discs +/- peripapillary flame-shaped haemorrhages
N.B. could also be painless
Name causes of sudden painful loss of vision due to an abnormal uvea?
Anterior uveitis
- anterior pain
- photophobia
- mildly reduced vision
- circumlimbal injection
- AC (anterior chamber) cells and flares
- KPs (keratic precipitate)
Name causes of sudden painful loss of vision due to a normal fundus?
Retrobulbar neuritis
- same presentation as optic neuritis but disc is normal
N.B. can also be painless
