[Ophth] Sudden Loss of Vision Flashcards
what are the causes of painLESS loss of vision?
- retinal artery occlusion
- retinal vein occlusion
- retinal detachment
- stroke / TIA
- vitreous haemorrhage
what are the causes of painFUL loss of vision?
- acute angle closure glaucoma
- anterior uveitis
- corneal ulcer
- GCA
- optic neuritis
what are the risk factors for retinal vein occlusion?
- HTN
- hypercholesterolaemia
- smoking
- DM
what do pts with retinal vein occlusion present with?
unilateral sudden painless loss of vision
what can you see under direct fundoscopy for retinal vein occlusion?
- flame and blot haemorrhages
- macular oedema
what is the rx for retinal vein occlusion?
- pan-retinal photocoagulation
- anti-VEGF
what are the risk factors for retinal detachment?
- severe myopia*
- eye trauma
what do pts with retinal detachment present with?
- unilateral painless vision loss
- flashes and floaters*
what can you see under direct fundoscopy for retinal detachment?
detached portion appears “corrugated” or out of focus
what is the rx for retinal detachment?
- vitrectomy
- scleral bulking
- pneumatic retinopexy
what are the risk factors for stroke / TIA?
- HTN
- hypercholesterolaemia
- smoking
- DM
what do pts with stroke / TIA present with?
- sudden visual field loss
- bilateral quadrantonopia
what can you see under direct fundoscopy for stroke / TIA?
typically changes seen in hypertensive retinopathy
what is the rx for stroke / TIA?
- +/- thrombolysis if ischaemic
- BP control
from where does the central retinal artery arise?
internal carotid artery → ophthalmic artery → central retinal artery
what is the aetiology of central retinal artery occlusion (CRAO)?
ischaemic or vasculitic
what are the ischaemic causes of CRAO?
- carotid artery atherosclerosis or
- cardiogenic embolism
what are the vasculitic causes of CRAO?
GCA / temporal arteritis
what are the risk factors for CRAO?
- M>F
- older age
- smoking
- DM
- HTN
- cholesterol
what is the presentation of CRAO?
acute, severe, painless monocular vision loss
+ RAPD
why does CRAO present with RAPD?
because visual input is not sensed by the ischaemic retina
what can you see on fundoscopy for CRAO?
ischaemic retinal whitening with the “cherry red spot” in the centre
what is the mx for CRAO?
- intra-arterial thrombolysis
- reducing intra-ocular pressure (IOP) via anterior chamber paracentesis, Acetazolamide and ocular massage
what is Amarousis Fugax?
painless and temporary vision loss (typically monocular) lasting seconds-minutes
“like a curtain coming down”
