Loss of Vision Flashcards
What would you ask when taking a history of someone with vision loss?
Unilateral/bilateral
Gradual/sudden
Blurred/distorted/black
Associated symptoms e.g. pain, redness, discharge
Which examination would be carried out in loss of vision cases?
Fundal examination- direct ophthalmoscope slit lamp and volk lens
Which ancilliary tests are used to diagnose and monitor eye conditions?
Amsler Chart
Colour vision chart
Visual Filed Assessment
Fluorescein Angioplasty
Optic Cohernece Tomography
Which chart is useful in assessing function of the optic nerve?
Colour Vision Chart
Which chart is useful for detecting colour blindness?
Colour Vision Chart
->especially good for red-green colour blindness
Is optical coherence tomography invasive or non-invasive?
Non-invasive
What is the most likely vascular cause of sudden complete loss of vision?
Central Retinal Artery Occlusion
When you examine a patient with central retinal artery occlusion using fundus imaging, what would be seen?
A pale retina with a cherry red spot
In patients with central retinal artery occlusion, which specialists need to be contacted?
Stroke team
What will need to checked in patient’s with central retinol artery occlusion?
BP
Pulse
What is the treatment for central retinal artery occlusion?
Identify and treat cardiovascular risk factors
Which drug will you often start a patient with central retinol artery occlusion on?
Aspirin
What is the treatment of a branch retinal artery occlusion, in which there is an arterial occlusion to a particular branch of vessels?
Identify and treat cardiovascular risk factors
Central retinal vein occlusion is another cause of sudden complete loss of vision.
How is this managed?
Identify and treat CV risk factors.
What may patients with central retinal vein occlusion develop?
Macular oedema
If a patient develops macular oedema, which treatment is given to reduce this fluid?
Intravitreal Anti Vegf
Anterior ischaemic optic neuropathy can also cause sudden complete loss of vision.
Which two divisions of AION are there?
Arteritic (Giant Cell Arteritis)
Non-arteritic
What are some of the symptoms of Giant Cell Arteritis?
Loss of vision
Unilateral temporal headache
Loss of appetite- weight loss
Scalp tenderness
Jaw claudication
What are some of the signs of Giant Cell Arteritis?
Tenderness of superficial temporal arteries
Raised inflammatory markers
Raised platelets
Which inflammatory markers would be raised in patient’s with Giant Cell Arteritis?
ESR
CRP
What is the management for Giant Cell Arteritis?
High dose systemic steroids
How will non-arteritic anterior ischaemic optic neuropathy patient’s present?
Half their vision completely missing, no pain
What is the treatment for non-arteritic anterior ischaemic optic neuropathy ?
Identify and treat CV risk factors
If you suspect non-arteritic anterior ischaemic optic neuropathy, what must you rule out first?
Giant Cell Arteritis
This can be done by checking inflammatory markers
What happens if Giant Cell Arteritis is not diagnosed?
Loss of vision in both eyes, even if one does not appear to be affected
Describe the speed of vision loss of vitreous haemorrhage.
Rapid but not sudden
What can cause Vitreous Haemorrhage?
Trauma
Posterior vitreous detachment
Proliferative diabetic retinopathy
What are some risk factors for retinal detcahment?
Myopia
Trauma
Cataract surgery
What will most patients with retinal detachment experience?
Flashing lights and floating spots in their vision.
What is the management for retinal detachment?
Surgical repair
If a patient is caught early and has a retinal tear rather than a retinal detachment, and the fluid has not seeped to behind the retina, what can the management be?
Laser retinal plexi
What are some common causes of gradual loss of vision?
Cataract
Glaucoma
Age related macular degeneration
Diabetic retinopathy
What is the most common cause of loss of vision in the world?
Cataracts
What are the symptoms of cataracts?
Loss of vision
Dazzle/glare
When are symptoms of cataracts particularly noticeable?
At night/evening
What is the management of cataracts?
Surgery- phacoemulsification with intraocular lens implant
What is glaucoma?
Optic neuropathy with typical optic nerve damage and associated visual field changes.
What is glaucoma usually associated with?
Raised IOP
What are the classifications of glaucoma?
Open or closed angle
Chronic or acute
What are the symptoms of glaucoma?
Asymptomatic to start with
Gradual loss of peripheral field vision.
Patients at a higher risk of developing glaucoma get checked to try and catch it before it develops.
What is done to try and diagnose glaucoma?
Check IOP
Fundoscopy
Visual field test
What are to signs indicative of glaucoma?
Raised IOP
Visual field defects
Optic disc damage
What is the gold standard for measuring eye pressure?
Goldmanm Tonometer
What is the initial management for glaucoma?
Topical treatment
What is the secondary management for glaucoma?
Surgery
e.g. trabeculectomy, drainage
Which topical treatments may be given as the initial management for glaucoma?
Prostaglandins
Beta blockers
Carbonic anhydrase inhibitors
What is the most common cause of severe permanent visual loss and people over the age of 60?
Age related macular degeneration (AMD)
What are the symptoms of AMD?
Progressive loss of central vision
Distortion
What might be seen on fundoscopy in someone with AMD?
Yellow patches at the macula- called reasons.
They are calcium and protein salt deposits.
Which chart can be used to assess distortion?
Amsler chart
AMD can be classified as wet or dry. Which type is more common?
Dry AMD
What is the treatment for dry AMD?
No treatment, mainly supportive in form of low vision aids and registration for sight impairment/severe sight impairment
Which investigations can be done in those with wet AMD?
OCT- Optical CT
Fluorescein angiography
Can dry AMD progress into wet AMD or does wet AMD progress into dry AMD?
Dry AMD can turn into wet AMD.
Why type of AMD involves abnormal blood vessels?
Wet AMD
What is the management for wet AMD?
Intravitreal antivegf
Low vision aids
Registration with sight impairment/severe sight impairment
What might be seen on fundoscopy of someone with diabetic retinopathy?
Micro-aneurysms
Retinal haemorrhages
Exudate
When may those with diabetes get diabetic retinopathy?
If their diabetes is poorly managed or they have a risk factor e.g. pregnancy
What happens in proliferative diabetic retinopathy?
New vessels or neovascularization on the retina
Which investigation is particularly useful in patients with diabetic retinopathy?
Fluorescein angiography
What is the management of diabetic retinopathy?
-Control of diabetes
-Control of BP, BM and cholesterol
-Intravitreal antivegf
-Laser- PRP
-Low vision aids
-Registration for sight/severe sight impairment
What is the most common treatment for diabetic retinopathy?
Laser- panretinal photocoagulation (PRP)
What can happen if diabetic retinopathy is not managed?
Could lead to fractional retinal detachment leading to sight loss
