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*Nervous System - Pathology > Loss of Vision > Flashcards

Loss of Vision Flashcards

1
Q

What part of the eye is affected in loss of vision?

A

Posterior segment

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2
Q

What are the key things to remember when taking history from of a patient with loss of vision?

A
  • Unilateral/bilateral
  • Onset: sudden/gradual (over what period of time)
  • Type of visual loss: blurred/distorted/black
  • Any associated symptoms (pain, redness, discharge)
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3
Q

What examinations should be carried out for a patient with loss of vision?

A
  • Best corrected visual acuity - snellen chart

- Fundal examination - direct opthalmoscope & slit lamp and volk lens

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4
Q

What are ancilliary tests?

A

Ancillary, or point-of-care, testing is unique because it is not performed in a centralized location; for most laboratory tests, a blood or other body fluid specimen is collected from a patient and sent to the lab for testing - with point-of-care testing, healthcare professionals perform testing at the patient’s side

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5
Q

Give examples of ancilliary tests

A 
Amsler chart 
Colour vision 
Visual field assessment
Flurescein angiography
Optical coherence tomography
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6
Q

What is the Amsler chart used to assess?

A

Patients asked to look at a grid

If the lines look wavy / distorted OR some lines are missing, indicates problem with the the macula

(Macular degeneration)

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7
Q

What is fluorescein angiography?

A

The yellow fluorescein dye is injected into the bloodstream

Done to highlight the blood vessels in the back of the eye so they can be photographed

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8
Q

What is optical coherence tomography?

A

Non-invasive imaging test that uses light waves (NOT RADIATION) to take cross sectional images of the patient’s retina.

Layers within the retina and retinal thickness can be assessed

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9
Q

Name some vascular causes of sudden complete loss of vision

A

Central retinal artery occlusion

Central retinal vein occlusion

Anterior ischaemic optic neuropathy (sudden loss of vision due to an interruption of blood flow to the front (anterior) of the optic nerve (optic nerve head)

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10
Q

What is the management for central retinal artery occlusion?

A

Identify & treat risk factors e.g. embolus (eg, due to atherosclerosis or endocarditis), thrombosis, or giant cell arteritis
can also include vasodilators, fibrinolytic therapy laser photodisruption of embolus or IV steroids in the case of giant cell arteritis)

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11
Q

What is the management for central retinal vein occlusion?

A

Identify & treat risk factors e.g. caused due to a blood clot which can result from high blood pressure, high cholesterol, glaucoma, diabetes, smoking, certain rare blood disorders
OR
intravitreal antivegf

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12
Q

What are the 2 types of anterior ischaemic optic neuropathy?

A
  • Arteritic: giant cell arteritis
  • Non-arteritic
    The former is an inflammatory disease of medium/large sized blood vessels and has more serious consequences for vision.
    The latter is more common but less severe.
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13
Q

What are the symptoms of giant cell arteritis?

A
  • loss of vision
  • headache
  • loss of appetite
  • scalp tenderness
  • pain on chewing
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14
Q

What are the signs of giant cell arteritis?

A
  • tenderness of superficial temporal arteries

- raised inflammatory markers

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15
Q

What is the management for giant cell arteritis?

A

medical emergency! high dose systemic steroids

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16
Q

What is characteristic of non-arteritic AION?

A

Painless

17
Q

What is the management for non-arteritic AION?

A

Identify & treat risk factors (these again can include diabetes, hypertension and other cardiovascular diseases)

18
Q

Name some causes of a gradual loss of vision

A

Cataract

Glaucoma

Age related macular degeneration

Diabetic retinopathy

19
Q

What is a cataract?

A

Gradual opacification of the lens; proteins in lens clump together as we age and this can cloud the lens

20
Q

What are the symptoms of cataracts?

A
  • loss of vision
  • cloudy vision
  • colours more faded
  • dazzle/glare
  • multiple/double visions in one eye
21
Q

What is the investigation and management for cataracts?

A

To investigate - visual acuity test, slit lamp examination, dilated eye exam, tonometry to measure pressure
Treatment is surgery (phacoemulsification with intraocular lens implant)

22
Q

What is glaucoma?

A

Optic neuropathy with typical optic nerve damage and associated visual field changes usually associated with raised intraocular pressure

23
Q

What are the classifications of glaucoma?

A
  • open or closed angle

- chronic or acute

24
Q

What are the symptoms of glaucoma?

A
  • asymptomatic

- gradual loss of peripheral field of vision

25
Q

What are the signs of chronic glaucoma?

A
  • raised intraocular pressure
  • visual field defects
  • optic disc damage
26
Q

What is the management for chronic glaucoma?

A

topical treatment e.g. dorzolamide and brinzolamid

surgery (trabeculectomy)

27
Q

What are the symptoms of age related macular degeneration (AMD)?

A

progressive loss of central vision

distorsion

28
Q

What are the signs of AMD?

A
  • distorsion on amsler chart
  • drusen
  • pigment epithelial changes
29
Q

What are the types of AMD?

A

Dry (90%)

Wet (neovascular) (10%)

30
Q

What is found in dry AMD and what is the management for it?

A

drusen (yellow deposits under the retina)

atrophy (management = low vision aids; registration)

31
Q

What is found in wet AMD?

A

choroidal new vessels (creation of new vessels in the choroid layer of the eye)

32
Q

What are the investigations of wet AMD?

A

OCT (optical coherence tomography)

Fluorescein angiography

33
Q

What is the management for dry AMD?

A

Intravitreal anti vegf
Low vision aids
Registration

34
Q

What is the commonest cause of visual impairment in working age population?

A

Diabetic retinopathy

35
Q

What are the signs of diabetic retinopathy?

A
  • microaneursyms
  • retinal haemhorrhages and exudates
  • neovascularisation (disc/retina)
36
Q

What are the investigations for diabetic retinopathy?

A

Fluorescein angiography

OCT (showing diabetic macular oedema)

37
Q

What is the management for diabetic retinopathy?

A

Intravitreal anti vegf
Laser - panretinal photocoagulation
Low vision aids
Registration

38
Q

What are some symptoms and signs of central retinal artery occlusion?

A

Sudden, painless loss of vision occurring over seconds
Visual acuity reduced
Direct pupillary reflex absent
Fundal examination = inc milky white retina, cherry red spot, marked narrowing of retinal arteries, atrophic changes
Fluorescein angiography = delay of arterial filling, masking of choroidal vasculature due to retinal oedema

39
Q

What is intravitreal vegf?

A

Intravitreal (into the vitreous part of eye[posterior]) anti-Vascular endothelial growth factor - these treatments are given by an injection into the eye and reduce the growth of new blood vessels and the oedema (swelling) they may cause
(can also treat with steroid eye implants or laser photo-coagulation)

*Nervous System - Pathology (13 decks)

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