[Ophth] Sudden Loss of Vision

Question 1

what are the causes of painLESS loss of vision?

Answer 1

1. retinal artery occlusion
2. retinal vein occlusion
3. retinal detachment
4. stroke / TIA
5. vitreous haemorrhage

Question 2

what are the causes of painFUL loss of vision?

Answer 2

1. acute angle closure glaucoma
2. anterior uveitis
3. corneal ulcer
4. GCA
5. optic neuritis

Question 3

what are the risk factors for retinal vein occlusion?

Answer 3

• HTN
• hypercholesterolaemia
• smoking
• DM

Question 4

what do pts with retinal vein occlusion present with?

Answer 4

unilateral sudden painless loss of vision

Question 5

what can you see under direct fundoscopy for retinal vein occlusion?

Answer 5

• flame and blot haemorrhages

- macular oedema

Question 6

what is the rx for retinal vein occlusion?

Answer 6

• pan-retinal photocoagulation

- anti-VEGF

Question 7

what are the risk factors for retinal detachment?

Answer 7

• severe myopia*

- eye trauma

Question 8

what do pts with retinal detachment present with?

Answer 8

• unilateral painless vision loss

- flashes and floaters*

Question 9

what can you see under direct fundoscopy for retinal detachment?

Answer 9

detached portion appears “corrugated” or out of focus

Question 10

what is the rx for retinal detachment?

Answer 10

• vitrectomy
• scleral bulking
• pneumatic retinopexy

Question 11

what are the risk factors for stroke / TIA?

Answer 11

• HTN
• hypercholesterolaemia
• smoking
• DM

Question 12

what do pts with stroke / TIA present with?

Answer 12

• sudden visual field loss

- bilateral quadrantonopia

Question 13

what can you see under direct fundoscopy for stroke / TIA?

Answer 13

typically changes seen in hypertensive retinopathy

Question 14

what is the rx for stroke / TIA?

Answer 14

• +/- thrombolysis if ischaemic

- BP control

Question 15

from where does the central retinal artery arise?

Answer 15

internal carotid artery → ophthalmic artery → central retinal artery

Question 16

what is the aetiology of central retinal artery occlusion (CRAO)?

Answer 16

ischaemic or vasculitic

Question 17

what are the ischaemic causes of CRAO?

Answer 17

• carotid artery atherosclerosis or

- cardiogenic embolism

Question 18

what are the vasculitic causes of CRAO?

Answer 18

GCA / temporal arteritis

Question 19

what are the risk factors for CRAO?

Answer 19

• M>F
• older age
• smoking
• DM
• HTN
• cholesterol

Question 20

what is the presentation of CRAO?

Answer 20

acute, severe, painless monocular vision loss

+ RAPD

Question 21

why does CRAO present with RAPD?

Answer 21

because visual input is not sensed by the ischaemic retina

Question 22

what can you see on fundoscopy for CRAO?

Answer 22

ischaemic retinal whitening with the “cherry red spot” in the centre

Question 23

what is the mx for CRAO?

Answer 23

• intra-arterial thrombolysis

- reducing intra-ocular pressure (IOP) via anterior chamber paracentesis, Acetazolamide and ocular massage

Question 24

what is Amarousis Fugax?

Answer 24

painless and temporary vision loss (typically monocular) lasting seconds-minutes

“like a curtain coming down”

Question 25

what is the cause of Amarousis Fugax?

Answer 25

ischaemia or vascular insufficiency, commonly carotid artery stenosis

Question 26

what is Amarousis Fugax a strong predictor of?

Answer 26

future TIA / stroke

Question 27

what are the risk factors for Amarousis Fugax?

Answer 27

> 50 years + atherosclerotic risk factors

Question 28

what can you see on examination of Amarousis Fugax?

Answer 28

• normal visual acuity and visual field assessment following attack
• may have sectoral or complete visual loss during attack

Question 29

what is done to investigate Amarousis Fugax?

Answer 29

• ECG
• CT/MRI brain
• ECHO
• carotid doppler

Question 30

what is the mx for Amarousis Fugax?

Answer 30

aspirin + 2˚ prevention of cardiac and stroke risk factors

Question 31

pigment in the anterior vitreous on fundoscopy. dx?

Answer 31

Schaffer sign of retinal detachment

Question 32

pale retina without cherry red spot on fundoscopy. dx?

Answer 32

ophthalmic artery occlusion

Question 33

visual blurring made worse with heat. dx?

Answer 33

optic neuritis (Uhthoff’s phenomenon)

Question 34

what does an acute, painless loss of vision unilaterally is most likely of what origin?

Answer 34

vascular

Question 35

what does a bilateral acute visual field loss suggest?

Answer 35

non-ocular cause e.g. TIA/stroke/optic chiasm