Loss Of Vision/Blurry Vision Flashcards
Sequence of events
Open question
Timeline- how did it start, sudden or gradual decline, was it like a curtain coming down, how has it progressed since then
Symptom analysis
Clarify- what do you mean, is whole vision blurry or are you missing parts of your vision, do you see double or just unclear, are the images side by side or above one another, does it go away if you occlude one eye
Site- both eyes or one, entire eye or part of it, tunnel vision, which quadrant of vision is missing
Central vision- is that affected when you look directly at something
Colour vision- changes
Remaining vision- how much remains, can you recognise faces, read small text or see any light
Triggers- did anything start this, any history of trauma
Systems review
Ophthalmology- pain in eye or on movement, headache, redness in eyes, flashes and floaters
NS- zig zag lines, weakness or pins and needles, trouble with speech
HTN (morning headaches on waking), temporal arteritis (cramping pain in jaw when chewing, painful to comb hair), PMR symptoms (think GCA)
Patients perspective
Feelings and impact on life
Ideas
Concerns
Expectations
Background information
PMH- diabetes, HTN, AF, trouble with eyes, glasses, ophthalmology screening
DH
FH
SH- do they drive
Central retinal artery occlusion
Sudden onset of persistent monocular visual loss
Exact field defect depends on whether central or branch vessel occluded
Amaurosis fugax, hypercoaguable state, atherosclerotic risk factors may be present
Central retinal vein occlusion
Acute painless monocular mild to moderate visual loss
Temporal arteritis
Recent severe headache over the scalp region
Jaw claudication, scalp tenderness, proximal muscle stiffness and aching
Transient, permanent visual loss, blurred vision, amaurosis fugax
Usually 55+
Can affect other eye
Optic neuritis
Often young female patients and first presentation of MS
Deep pain associated with eye movements and central scotoma
Symptoms exacerbated by raising body temperature (Uhtoffs phonomenon) eg. Exercise or hot baths
Neurological symptoms in past such as weakness or parasthesia
Reduced colour vision
Retinal detachment
Flashes of light, floaters, peripheral scotoma
Risks- myopia (thin retina), recent cataract surgery, diabetes
Vitreous detachment
Acute visual disturbance, in middle aged and elderly
Chronic floaters, with sudden increase in number of floaters and possibly flashing lights as the vitreous starts to pull away from retina
May result in retinal detachment or vitriol haemorrhage
Visual acuity not affected and usually self limiting
Vitreous haemorrhage
Spontaneous bleeding from retinal vessels into the vitreous
Sudden onset of altered vision, blobs and floaters
Visual acuity is variable depending on site and size of haemorrhage
Red hue to vision
CVA
Sudden onset of homonymous visual field defect
Weakness, parasthesia, dysphasia, ataxia
Glaucoma
Usually asymptomatic
Visual field loss with scotomas in nasal field
Blurring and haloes around light
Afro-Caribbean, diabetes, advanced age, myopia, FH
Cataract
Blurred vision, glare (starbursts) around lights, increasing myopia, yellowish/brown discolouration, monocular Diplopia and poor night vision
Gradual worsening of symptoms
Advancing age and diabetes
