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1 - MSRA > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

Definition of glaucoma

A

Group of disorders characterised by optic neuropathy due to (in majority) raised IOP

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2
Q

Factors predisposing to acute angle closure glaucoma

A

Hypermetropia (long sightedness)
Pupillary dilatation
Lens growth associated with age

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3
Q

Features of acute angle closure glaucoma

A
  • Severe pain
  • Decreased visual acuity
  • Symptoms worse with mydriasis, e.g. watching TV in a dark room
  • Hard, red eye
  • Haloes around lights
  • Semi-dilated non-reacting pupil
  • Corneal oedema resulting in dull or hazy cornea
  • Systemic upset, e.g. nausea and vomiting, abdominal pain
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4
Q

Initial management of acute angle closure glaucoma

A

Combination of eye drops
IV acetazalomide
Topical steroids

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5
Q

Eye drops used in acute angle closure glaucoma

A

Direct parasympathomimetic, e.g. pilocarpine
Beta blocker, e.g. timolol
Alpha-2 agonist, e.g. apraclonide

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6
Q

Mechanism of action of pilocarpine in acute angle closure glaucoma

A

Contraction of ciliary muscle → opening trabecular meshwork → increased outflow of aqueous humuor

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7
Q

Mechanism of action beta blocker in acute angle closure glaucoma

A

Decreases aqueous humour production

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8
Q

Mechanism of action apraclonidine in acute angle closure glaucoma

A
  • Decreases aqueous humour production
  • Increases uveoscleral outflow
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9
Q

Mechanism of action IV acetazolamide in acute angle closure glaucoma

A

Reduces aqueous secretions

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10
Q

Definitive management acute angle closure glaucoma

A

Laser peripheral iridotomy

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11
Q

Most common cause of blindness in UK

A

Age-related macula degeneration

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12
Q

Characteristics of dry macular degeneration

A

Drusen - yellow round spots in Bruch’s membrane

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13
Q

Characteristics of wet macular degeneration

A

Choroidal neovascularisation - leakage of serous fluid and blood can subsequently result in rapid loss of vision

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14
Q

Presentation of macular degeneration

A
  • Reduction in visual acuity, particularly near field objects
  • Difficulties in dark adapation, overall deterioration of vision at night
  • Fluctuations in visual disturbance, may vary significantly day to day
  • Photopsia and glare around objects
  • Visual hallucinations (Charles-Bonnet syndrome)
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15
Q

What is photopsia

A

Perception of flickering or flashing lights

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16
Q

Speed of onset of reduction in visual acuity in macular degeneration

A

Gradual in dry
Subacute in wet

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17
Q

Signs of macular degeneration

A
  • Distortion of line perception on Amsler grid testing
  • Drusen on fundoscopy, become confluent in later disease to form macular scar
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18
Q

Signs of wet ARMD on fundoscopy

A

Well demarcated red patches (intra-retinal or sub-retinal fluid leakage or haemorrhage)

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19
Q

What are drusen

A

Yellow areas of pigment deposition in the macular area

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20
Q

Treatment dry ARMD

A

Combo zinc with vitamins A, C and E - reduce progression

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21
Q

Treatment wet ARMD

A

Anti-VEGF
Laser photocoagulation

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22
Q

What is anterior uveitis

A

Inflammation of anterior portion of uvea - iris and ciliary body

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23
Q

Associations anterior uveitis

A

HLA-B27 and linked conditions:
- Ankylosing spondylitis
- Reactive arthritis
- UC, Crohn’s
- Behcet’s
- Sarcoidosis

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24
Q

Features anterior uveitis

A
  • Acute onset
  • Ocular discomfort and pain
  • Pupil small +/- irregular
  • Photophobia
  • Blurred vision
  • Red eye
  • Lacrimation
  • Ciliary flush
  • Hypopyon
  • Visual acuity initially normal → impaired
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25
Q

What is ciliary flush?

A

Ring of red spreading outwardsW

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26
Q

What is hypopyon

A

Pus and inflammatory cells in anterior chamber, often results in visible fluid level

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27
Q

Management anterior uveitis

A

Urgent opthal review
Cycloplegics, e.g. atropine, cyclopentolate
Steroid eye drops

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28
Q

What is Argyll-Robertson pupil

A

Small irregular pupils
No response to light, but response to accommodate

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29
Q

Causes of Argyll-Robertson pupil

A

Diabetes mellitus
Syphilis

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30
Q

Presentation of cataracts

A
  • Reduced vision
  • Faded colour vision
  • Glare
  • Halos around lights
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31
Q

Complications following cataract surgery

A
  • Posterior capsule opacification
  • Retinal detachment
  • Posterior capsule rupture
  • Endopthalmitis
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32
Q

What is endophthalmitis

A

Inflammation of aqueous and/or vitreous humour

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33
Q

Features central retinal artery occlusion

A

Sudden painless unilateral visual loss
Relative afferent pupillary defect

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34
Q

Fundoscopy central retinal artery occlusion

A

Cherry red spot on pale retina

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35
Q

Features central retinal vein occlusion

A

Sudden, painless reduction or loss of visual acuity, usually unilateral

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36
Q

Fundoscopy central retinal vein occlusion

A

Widespread hyperaemia
Severe retinal haemorrhages

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37
Q

Indications for treatment CRVO

A

Macular oedema - intravitreal anti-VEGF
Retinal neovascularisation - laser photocoagulation

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38
Q

Infectious causes chorioretinitis

A

Toxoplasmosis
CMV (particularly in immunocompromised)
Syphilis
TB

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39
Q

Autoimmune causes chorioretinitis

A

Sarcoidosis
Behcets
SLE

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40
Q

Presentation chorioretinitis

A

Unilateral vision changes, blurred vision
Scotomas (blind spots)
Floaters

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41
Q

Opthalmoscopic findings chorioretinitis

A

Focal or diffuse areas retinal whitening
‘Pizza pie’ fundus - retinal spots (superficial retinal infarction and flame shaped haemorrhage)

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42
Q

Management toxoplasmosis chorioretinitis

A

Pyrimethamine and sulfadiazine

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43
Q

Management CMV chorioretinitis

A

Ganciclovir or valganciclovir

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44
Q

Management autoimmune chorioretinitis

A

Systemic corticosteroids mainstay
Often in combination with other immunosuppressive agents e.g. methotrexate, azathioprine

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45
Q

Features corneal abrasion

A

Eye pain
Lacrimation
Photophobia
Foreign body sensation and conjunctival injection
Decreased visual acuity in affected eye

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46
Q

Management corneal abrasion

A

Topical antibiotic (to prevent secondary bacterial infection)

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47
Q

Causes of corneal ulcer

A

Bacterial keratitis
Fungal keratitis
Viral keratitis - herpes simplex, herpes zoster
Acanthamoeba keratitis

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48
Q

What is Acanthamoeba keratitis associated with?

A

Contact lens use

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49
Q

Features of acanthamoeba keratitis

A

Eye pain
Photophobia
Watering of eye

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50
Q

Classification of diabetic retinopathy

A

Non-proliferative diabetic retinopathy - mild, moderate, severe
Proliferative diabetic retinopathy
Maculopathy

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51
Q

Features mild non-proliferative diabetic retinopathy

A

1 or more microaneurysm

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52
Q

Features moderate non-proliferative diabetic retinopathy

A

Microaneurysms
Blot haemorrhages
Hard exudates

Cotton wool spots (soft exudates), venous beading/looping, and intraretinal microvascular abnormalities are less severe than in severe NPDR

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53
Q

Features severe non-proliferative diabetic retinopathy

A

Blot haemorrhage and microaneurysms in 4 quadrants
Venous beading in at least 2 quadrants
Iintraretinal microvascular abnormalities in at least 1 quadrant

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54
Q

Features proliferative diabetic retinopathy

A

Retinal neovascularisation (may lead to vitreous haemorrhage)
Fibrous tissue forming anterior to retinal disc

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55
Q

Features of diabetic maculopathy

A

Hard exudates and other ‘background’ changes on macula

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56
Q

Management diabetic maculopathy

A

If change in visual acuity, intravitreal anti-VEGF

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57
Q

Management non-proliferative diabetic retinopathy

A

Regular observation
If severe/very severe, consider panretinal laser photocoagulation

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58
Q

Management proliferative diabetic retinopathy

A

Panretinal laser photocoagulation
Intravitreal VEGF inhibitors
If severe or vitreous haemorrhage, vitreoretinal surgery

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59
Q

Complications of panretinal photocoagulation

A

Decrease in night vision
Generalised decrease in visual acuity
Macular oedema

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60
Q

Cause of episcleritis

A

Majority idiopathic
Inflammatory bowel disease
Rheumatoid arthritis

61
Q

Features episcleritis

A

Red eye
Classically not painful, but mild pain/irritation common
Watering and photophobia may be present

62
Q

Episcleritis vs scleritis

A

Scleritis painful, episcleritis not
Scleritis vessels not mobile, episcleritis mobile on gentle pressure
Scleritis vessels don’t blanch with phenylephrine, do with episcleritis

63
Q

% of episcleritis bilateral

64
Q

Management episcleritis

A

Conservative
Artificial tears sometimes used

65
Q

What is stye

A

Infection of glands of eyelids

66
Q

What is entropion

A

In turning of eyelids

67
Q

What is ectropion

A

Out turning of eyelids

68
Q

What is chalazion

A

Retention cyst of Meibomian gland

69
Q

Presentation of chalazion

A

Firm painless lump of eyelid

70
Q

Treatment chalazion

A

Majority of cases resolve spontaneously, some require surgical drainage

71
Q

Features of herpes simplex keratitis

A

Red painful eye
Photophobia
Epiphora
Visual acuity may be decreased
Flourescein staining may show epithelial ulcer

72
Q

Treatment herpes simplex keratitis

A

Immediate referral to an opthalmologist
Topical aciclovir

73
Q

Features of Holmes-Adie pupil

A

Dilated pupil
Once pupil has constricted, remains small for an abnormally long time
Slowly reactive to accommodation, but very poorly (if at all) to light

Unilateral in 80%
More common in women

74
Q

What is Holmes-Adie syndrome

A

Holmes-Adie pupil in association with absent ankle/knee reflexes

75
Q

Features of Horner’s syndrome

A

Miosis (small pupil)
Ptosis
Enophthalmos (sunken eye)
Anhidrosis (loss of sweating one side)

76
Q

Unique feature of congenital Horner’s sydnrome

A

Heterochromia

77
Q

Features of Horner’s syndrome caused by central lesions

A

Anhidrosis of face, arm, and trunk

78
Q

Central lesions causing Horner’s syndrome

A

Stroke
Syringomyelia
Multiple sclerosis
Tumour
Encephalitis

79
Q

Features of Horner’s syndrome caused by pre-ganglionic lesions

A

Anhidrosis of face

80
Q

Pre-ganglionic lesions causing Horner’s syndrome

A

Pancoast’s tumour
Thyroidectomy
Trauma
Cervical rib

81
Q

Features of Horner’s syndrome caused by post-ganglionic lesions

A

No anhidrosis

82
Q

Post-ganglionic lesions causing Horner’s syndrome

A

Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache

83
Q

Stage I hypertensive retinopathy

A

Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring

84
Q

Stage II hypertensive retinopathy

A

Arteriovenous nipping

85
Q

Stage III hypertensive retinopathy

A

Cotton wool exudates
Flame and blot haemorrhages

86
Q

Stage IV hypertensive retinopathy

A

Papilloedema

87
Q

What is keratitis

A

Inflammation of cornea

88
Q

Causes of keratitis

A
  • Bacterial
  • Viral
  • Fungal
  • Amoebic
  • Parasitic
  • Environmental
89
Q

Most common bacterial cause keratitis

A

Staphylococcus aureus

90
Q

Pathogen causing bacterial keratitis in contactg lens wearers

A

Pseudomonas aeruginosa

91
Q

Features amoebic keratitis

A

Increased incidence of eye exposed to soil or contamined water
Pain out of proportion to findings

92
Q

Environmental causes keratitis

A

Photokeratitis, e.g. welders arc eye
Exposure keratitis
Contact lens acute red eye

93
Q

Viral cause keratitis

A

Herpes simplex

94
Q

Clinical features keratitis

A

Red eye, pain and erythema
Photophobia
Foreign body, gritty sensation
Hypopyon

95
Q

Management keratitis

A

Stop using contact lens until fully resolved
Topical antibiotics, typically quinolones
Cycloplegic for analgesia, e.g. cyclopentolate

96
Q

Complications keratitis

A

Corneal scarring
Perforation
Endophalmitis
Visual loss

97
Q

Cause of lens dislocation

A

Marfans syndrome
Homocystinuria
Ehlers-Danlos syndrome
Trauma
Uveal tumours
Autosomal ressive ectopia lentis

98
Q

Direction of lens dislocation in Marfans syndrome

99
Q

Direction of lens dislocation in homocystinuria

100
Q

What is mydriasis

A

Large pupil

101
Q

Causes of mydriasis

A

Third nerve palsy
Holmes-Adie pupil
Traumatic iridoplegia
Phaeochromocytoma
Congenital
Drug

102
Q

Drug causes of mydriasis

A

Topical mydiatrics, e.g. topicamide, atropine
Sympathomimetic drugs, e.g. amphetamines, cocaine
Anticholinergic drugs, e.g. TCAs

103
Q

Management nasolacrimal duct obstruction

A

Teach parents to massage lacrimal duct
Symptoms resolve in 95% by 1yo, unresolved refer opthal for consideration of probingF

104
Q

Features of orbital compartment syndrome

A

Eye pain/swelling
Proptosis
Rock hard eyelids
RAPD

105
Q

Management orbital compartment syndrome

A

Urgent lateral canthotomy

106
Q

Causes optic neuritis

A

Multiple sclerosis
Diabetes
Syphilis

107
Q

Features optic neuritis

A

Unilateral decrease in visual acuity over hours/days
Poor discrimination of colours, red desaturation
Pain worse on movement
RAPD
Central scotoma

108
Q

Treatment optic neuritis

A

High dose steriods
Recovery takes 4-6 weeks

109
Q

Fundoscopy findings papilloedema

A

Venous engorgement
Loss of venous pulsation
Blurring of optic disc margin
Elevation of optic disc
Loss of optic cup
Paton’s lines - concentric/radial retinal lines cascading from the optic disc

110
Q

Causes of papilloedema

A

Space occupying lesion - neoplastic, vascular
Malignant hypertension
Idiopathic intracranial hypertension
Hydrocephalus
Hypercapnia

Rare:
Hypoparathyroidism and hypocalcaemia
Vitamin A toxicity

111
Q

First line treatment open angle glaucoma

A

360 selective laser trabeculoplasty

112
Q

When should laser trabeculoplasty be offered in open angle glaucoma

A

If IOP ≥24mmHg

113
Q

Limitations of 360 selective laser trabeculoplasty in open angle glaucoma

A

Can delay need for eye drops but does not remove chance they’ll be needed at all
Second procedure may be needed at later date

114
Q

Second line treatment open angle glaucoma

A

Prostaglabin analogue eyedrops

115
Q

Third line treatment open angle glaucoma

A

Beta blocker eye drops
Carbonic anhydrase inhibitor eye drops
Sympathomimetic eye drops

116
Q

Treatment refractory open angle glaucoma

A

Trabeculectomy

117
Q

Prostaglandin analogue eye drop e.g.

A

Lanatoprost

118
Q

Mechanism of action prostaglandin analogue eyedrops

A

Increases uveoscleral outflow

119
Q

Adverse effects prostaglandin analogue eye drops

A

Pigmentation of iris
Increased eyelash length

120
Q

Beta blocker eye drops e.g.

A

Timolol
Betaxolol

121
Q

Mechanism of action beta blocker eye drops

A

Reduces aqueous production

122
Q

When to avoid beta blocker eye drops

A

Asthmatics
Heart block

123
Q

Sympathomimetic eye drops e.g.

A

Brimonidine

124
Q

Mechanism of action sympathomimetic eye drops

A

Reduces aqueous production and increases outflow

125
Q

When to avoid sympathomimetic eye drops

A

If taking MAOI or TCAs

126
Q

Adverse effects sympathomimetic eye drops

A

Hyperaemia

127
Q

Carbonic anhydrase eye drops e.g.

A

Dorzolamide

128
Q

Mechanism of action carbonic anhydrase eye drops

A

Reduces aqueous production

129
Q

Adverse effects carbonic anhydrase eye drops

A

Systemic absorption may cause sulphonamide-like reactions

130
Q

Miotic eye drops e.g.

A

Pilocarpine

131
Q

Mechanism of action miotic eye drops

A

Increases uveoscleral outflow

132
Q

Adverse effects pilocarpine

A

Constricted pupil
Headache
Blurred vision

133
Q

Clinical features primary open angle glaucoma

A

May present insidiously, often detected during routine appointments

Peripheral visual field loss
Decreased visual acuity
Optic disc cupping

134
Q

Fundoscopy signs primary open angle glaucoma

A

Optic disc cupping - cup to disc ratio >0.7
Opic disc pallor
Bayonetting of vessels (vessels have breaks as they disappear into deep cup and re-appear at base)
Cup notching
Disc haemorrhages

135
Q

Retinitis pigmentosa features

A

Night blindness often initial sign
Tunnel vision

136
Q

Fundoscopy findings retinitis pigmentosa

A

Black bone spicule shaped pigmentation in peripheral retina
Mottling of retinal pigment epithelium

137
Q

Disease associated with retinitis pigmentosa

A

Refsum disease
Usher syndrome
Abetalipoproteinaemia
Lawrence-Moon-Biedl syndrome
Kearns-Sayre syndrome
Alport’s syndrome

138
Q

Features of Refsum disea

A

Cerebellar ataxia
Peripheral neuropathy
Deafness
Ichthyosis

139
Q

Ocular manifestations rheumatoid arthritis

A

Keratoconjunctivitis sicca
Episcleritis and scleritis
Corneal ulceration
Keratitis

140
Q

Conditions associated with scleritis

A

Rheumatoid arthritis
SLE
Sarcoidosis
Granulomatosis with polyangiitis

141
Q

Treatment scleritis

A

Same day opthal assessment
Oral NSAIDs first line
Oral glucocorticoids for more severe presentations
Immunosuppressive drugs for resistant cases

142
Q

Most common causes of sudden loss of vision

A

Ischaemic/vascular - thrombosis, embolism, temporal arteritis
Vitreous haemorrhage
Retinal detachment
Retinal migraine

143
Q

Ischaemic/vascular causes of sudden loss of vision

A

Large artery disease - atherothrombosis, embolus, dissection
Small artery occlusive disease - anterior ischaemic optic neuropathy, vasculitis
Venous disease
Hypoperfusion

144
Q

Features ischaemic/vascular sudden loss of vision

A

Altitudinal field defects - ‘curtain coming down’

145
Q

Features of posterior vitreous detachment

A
  • Photopsia in peripheral vision
  • Floaters, often temporal side of central vision
146
Q

Features of retinal detachment

A
  • Dense shadow that starts peripherally and progresses towards the central vision
  • Veil or curtain over field of vision
  • Straight lines appear curved
  • Central visual loss
147
Q

Features of vitreous haemorrhage

A
  • Large bleeds cause sudden visual loss
  • Moderate bleeds may be described as numerous dark spots
  • Small bleeds may cause floaters
148
Q

Causes of tunnel vision

A

Papilloedema
Glaucoma
Retinitis pigmentosa
Choroidoretinitis
Optic atrophy secondary to tabes dorsalis
Hysteria

1 - MSRA (23 decks)

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