OPTHAL 1 Flashcards
sudden vision loss
vascular retinal detachment ARMD wet closed angle glaucoma optic neuritis stroke
central retinal artery occlusion visual acuity
causes
<6 over 60
carotid artery disease
embolic: calcific heart valves, vegetations, thrombus
GCA
ix for CRAO
bilateral. age
treatment within 12-24h
RAPD. pale oedematous retina. cherry red spot (choroid). thread like vessels
1-2% bilateral. over 60s
ocular massage, paper bag breathing, IV diamond - move emboli to branch, anterior chamber paracentesis
establish source of embolism
branch RA occlusion is what
symp
management
one or multiple branch affected
only part of vision lost
assess
amaurosis - fugax is what symptoms examination cause managemetn
transient retinal artery occlusion
transient painless vision loss. unilateral - like curtain coming down. lasts around 5 mins with full recovery
nothing abnormal on examination
atherosclerosis. idiopathic. infections
immediate referral to TIA clinic. aspirin
CRVO cause what should you determine symptoms ix and on examination if no signs of ischaemia signs of iscaeqhmia and no neovasculirisation signs of neovasculisiation
virchows triad: atherosclerosis, stasis, htn
determine degree of ischaemia
sudden loss of vision. painless
retinal flame haem (stormy sunset) and blot haem. swollen disc. tortured dilated vessels. cotton wool spots. neovasculirisation if longstanding.
review 3 monthly
review in 4-5 weekly
argon laser pan retinal photocoag. anti VEGF
ischaemic optic neuropathy is what
symptoms
the two types
occlusion of optic nerve head circulation - posterior ciliary arteries become occluded leading to occlusion of optic nerve head
sudden profound vision loss and very swollen disc. altitudinal defect
arrterritic 50%
non arrteritic 50%
arteritic
symptoms
ix
treatment
GCA. in over 50s
scalp tenderness, jaw claudication, assoc with PMR
increased PV/CRP/ESR. temporal artery biopsy
IV methylpred. then high dose PO pred
non arteritic in who
assoc with what
symptoms
management
45-65yo
hypermetropes, smokers, night time hypotension
swollen optic disc. mod severe loss
no active treatment
optic/retrobulbar neuritis where and is what symptoms ix cause treatment
unilateral. progressive over das
variable loss of central vision. washed out colours. central scrotoma. pain on movement behind eye
decreased visual acuity, RAPD, enlarged blind spot, optic disc sweetness (not in retro)
demyelination. MS
gradual recovery over days- weeks. IV steroids can hasten but affect final visual acuity. B interferon may work. oral steroids - worse outcome
haemorrhage is usually what 2 types symp ix management
often vitrous haemorrhage
bleeding from normal vessels - associated with retinal tears
bleeding from abnormal vessels associated with retinal ischaemia and new vessel formation (RVO, DMR)
sudden loss. floaters
loss of red reflex
underlying cause. intervitrectomy if not responding
retinal detachment cause symptoms what is the emergency ix management
myopia, age, tear, also trauma
painless loss, persistent flashing lights in peripheral vision, bursts of new floaters, dark shadows in peripheral vision which increase in size, curtain coming down
macula still on - emergency to stop it coming off
maybe RAPD, DM, tear on opthalmascope
if retinal tear - laser to prevent detachment if detached (surgery): scleral buckle, vitrectomy/laser or cryotherapy/bubble of gas to act as internal tamponade
ARMD
symptoms of wet ARMD
ix/on examination
management
commonest cause of blindness in over 65s in western world
sudden reduction loss of central vision. distortion - metamorphosis. fluffy oedematous macular due to leaking. new blood vessels under retina
haemorrhage. exudate. ocular coherence tomography: can see fluid distorting retinal pigment epithelium
fundus fluorescent angiography: inject dye and watch it go through circulation shows hydrofluorescence leakage
Anti VEGF ranibizumab (lucentis)
anti VEGF
monoclonal ABs also used in DMR
intravitreal injection
inhibit groth factor: aborrted growth or new vessels. shrinkage of new vascular membrane. decreased fluid leakage/blood into tissues
gradual vision loss often what
CARDGIAN
bilateral cataracts ARMD dry refractive error DMR inherited disease glaucoma open access to eye clinic non urgent
cataracts is what
causes and which is the most commonest
what are the types (3)
management
clouding lens
age related - commonest
trauma, DM, congenital, steroids, intra uterine infections like rubella, CMV, toxoplasmosis
nuclear sclerotic which is the commonest. cortical. post sub capsular - DM, quick to progress
phacoemulsion with intraocular lens transplant. chloramphenicol and pred drops for 4w after
dry ARMD is what
symptom
management
wear and tear of retinal pigment epithelium: drusen, RPE hypo/hyperpigemantaion
progressive decrease in central VA
low visual aids. diet/smoking. amsler grid - metamorphosis. blind registration
refractive error myopia
hypermetropia
astigmatism
prebyopia
short sight. increased risk of tear and retinal detachment
long sighted. increased risk of closed angle glaucoma
irregular corneal curvature
loss of vision with ageing
glaucoma is what pathology symptom ix normal IOP is what visual acuity
progressive optic nerve damage due to increased IOP and visual field loss
blockage to aqueous outflow leading to increased IOP. visual acuity preserved unless v severe
peripheral vision loss
increased IOP. disc cupping - doughnut. field defects. IOP - tonometry. fields - perimetry
normal IOP 10-21
as long as macular preserved VA normal
myopics also have disc cupping
open angle glaucoma in who symp risk factors management 1 2 3 4 5 surgery and risk
75% in over 75s. picked up on screening.
asymp
age, FA, increased OAP, afrocrribean
prostaglandins - xalatan, makes iris more leaky. one drop a night. hyperpigemtn lashes and iris
add on beta blocker - timoptol, laevobutanol. decreased aq solution to avoid systemic. side effects hold tear ducts for a few mins
add on carbonic anhydrase. acetozolamide PO/IV for high IOP v effective only short term due to SE of tingling, renal calculi
dorzolamide(drops) - no systemic SE local irritation
sympathemetics - adrenaline, propine, alphagran. increased outflow. dilate pupil. local irritation. CVS side effects. awful lethargy. get allergic to in the long term. long term decreases value to surgery
parasympathememetics - pilocarpine. increased outflow. local SE - contraction, night blindness, colour vision affected, bad headaches which wear off
surgery - trabeculectomy - increased progression of cataracts
secondary open angle glaucoma
trauma, uveitis, lens protein, pseudoexfoliation
acute closed angle glaucoma
cause
symptoms including level IOP
management
hypermetropes. low light triggers
mid dilated - stuck. N/V. gradual decrease in vision after a few hours. hazy cornea - oedematous leading to halo and coloured rings. unilateral.
IOP 50-80
reduce IOP medically. peripheral irotomy - do other eye prophylactically. steroid for 1w. monster risk of open angle glaucoma
increased ICP leads to what
chronic swelling
papilloedema
atrophic and pale
