Loss of vision and ENT Flashcards
Painless sudden loss of vision
• Vitreous haemorrhage
• Optic neuritis
• Retinal detachment
• Wet Macular degeneration
• Central retinal vein occlusion
• Central retinal artery occlusion
• Central serous retinopathy
Vitreous haemorrhage
• Sudden painless loss of vision
• Caused by CRVO, proliferative diabetic retinopathy
• Symptoms- tadpoles, swirling, floaters or total visual loss
• PRP laser when clears or vitrectomy if doesn’t
Optic neuritis
• Sudden painless loss of vision
• Young, often female
• Red-desaturation, pain on movement, uni/bilateral, recurrent, usually resolves over 2 months
• Caused by MS or post infection
• Neuro referral, IV steroids if disabling visual loss
Retinal detachment
• Sudden painless loss of vision
• Myopes, trauma
• Flashes, floaters, curtains, shadows
• Urgent if macula still on or has just come off
Wet macular degeneration
• Sudden painless loss of vision
• >50
• Sudden onset, distortion, or central vision scotoma
• Needs urgent referral for OCT/IVFA and anti-VEGF as necessarily
Central serous retinopathy
• Painless sudden loss of vision
• Young men, type A
• Fluid under retina, increased hypermetropia
• Self-limiting, recurrent, usually no treatment
Central retinal vein occlusion
• Painless sudden loss of vision
• Risk factor- cardiovascular, smokers, obese, BP, DM, MI, CVA
• Haemorrhage, oedema, cotton wool spots, swollen disc
• Ischaemic/non-ischaemic
• Treatment- Ozurdex, anti VEGF, PRP laser
Central retinal artery occlusion
• Painless sudden loss of vision
• Risk factors- cardiovascular, smokers, obese, BP, DM, MI, CVA
• If its within 24 hours- rebreathing paper bag, ocular massage, then Diamox +/- paracentesis
• Refer to a stroke clinic asap
Anterior ischaemic optic neuropathy
• Arteritic or non arteritic
• GCA- old, unwell, weight loss, jaw claudication, scalp tenderness, headache
• ESR, CRP, platelets, temporal artery biopsy
• Admit IV steroids, then oral for at least 2 years. 2nd eye is at risk if 1st not treated promptly
Swollen optic disc
• Decreased vision, loss of colour vision, enlarged blind spot, RAPD
• Papilloedema,
• Optic neuritis
• Ocular tumours
• Hypermetropia, Hypotony
• Idiopathic intracranial hypertension
• Optic nerve head drusen
• CRVO
• Malignant hypertension
• Anterior ischaemic optic neuropaphy
Papilloedema
• Swollen optic disc
• Raised ICP
• Risk factors- tumour, haemorrhage, aneurysm, reduced CSF drainage, meningitis
• Visual obscurations, enlarged blind spot, headache, nausea, vomiting, usually bilateral disc swelling, dilated vessels, haemorrhages, cotton wool spots (cws), no RAPD other neuro signs/symptoms, VI nerve palsy
• Needs urgent scan and treatment of cause
Idiopathic intracranial hypertension-eyes
• Swollen optic disc
• Commonest cause of papilloedema, obese young women,
• Normal neuro imaging and CSF, but high opening pressure
• Visual obscurations, headache, disc swelling
• Monitor fields and colour vision, Weight loss, Diamox, optic nerve sheath fenestration, shunts
Optic nerve head drusen
• Swollen optic disc
• 0.5% Caucasians, bilateral, become more apparent with age, lumpy disc appearance, absent cup, trifurcation of vessels, VA normal but can have field defects
• Can be diagnosed by ultrasound, or autofluoresnce.
Optic neuritis
• Swollen optic disc
• Variable sudden loss of vision, uni or bilateral, red desaturation, pain on movement, young females, other neuro symptoms?
• 50% MS, refer neuro, IV steroids if disabling loss
Central retinal vein occlusion (CRVO)
• Swollen optic disc
• Cardiovascularpaths
• Sudden loss of vision, RAPD, swollen disc, haemorrhages on disc and throughout retina, usually unilateral
• Ozurdex, Anti VEGF, PRP laser
Ocular tumours and Hypermetropia
Ocular tumours- causes a swollen optic disc. Tuberous sclerosis, Neurofibromatosis, Haemangioma, Melanocytoma, Giloma, metasteses
Hypermetropia- swollen optic disc, small crowded disc, no change in vision, asymptomatic. Swollen optic disc
Hypotony and malignant hypertension
Hypotony- swollen optic disc, decreased IOP, usually iatrogenic after surgery, no visual symptoms
Malignant hypertension- swollen optic disc, disc swelling, retinal haemorrhage. BP >220/120, refer medics urgently
Anterior ischaemic optic neuropathy
• Sudden loss of vision, usually unilateral
• Symptoms of GCA or cardiovascularparth
• RAPD, swollen disc, typically pale +/- peripillary haem and cotton wool spots
• Treat according to cause i.e. high dose steroids for GCA
Causes and risk factors of otitis externa
Bacterial/ fungal- Pseudomonas, Staphlococcus, Candida, Aspergillus
Risk factors- swimming, immunosuppression, diabetes
Symptoms of otitis externa
-Pain (otalgia)
- Itching
- Discharge
- Redness (erythema)
- Hearing loss (conductive)
- Eczematous dry skin
Otitis externa- investigations and management
Otoscopy, ear swab
Topical +/- oral antibiotics- Gentamicin / Ciprofloxacin drops
Topical steroids
Micro suction
Water precaution
Complications of otitis externa
Necrotising otitis externa- spread of infection to the surrounding bone, osteomyelitis of the temporal bone
Pina cellulitis- spread of infection to the surrounding soft tissue
Necrotising otitis externa (NOE)
Can cause
Intra-cerebral abscess
Cranial nerve palsy (VII-XII)
Venous sinus thrombosis
Meningitis
Encephalitis
Long term IV antibiotics- Meropenem/Tazocin
Mortality- 10%